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04-7243 (CSCS)T N a T4hf 4 4 a" BUILDING & SAFETY DEPARTMENT P.O. Box 1504 (760),777-7012 78-495 CALLE TAM PICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153 BUILDING PERMIT Application Number . . . 04-00007243 Date 12/10/04 Property Address . . . . . 4—'78950. HIGHWAY 111 APN: 643-080-004-6 .-000000- Application.description . . . NEW COMML - STORES & CUSTOMER SERVICE Property Zoning . . . . . . . REGIONAL COMMERCIAL Application valuation 200000 Owner Contractor r. ------------------------ -----------<------------- Kohl's NEAR CAL CORPORATION 78-950 Hwy 111 512 CHANEY STREET La Quinta, CA LAKE ELSINORE CA 92530 LA QUINTA CA 92253 (909) 245-5400 h WCC: STATE FUND WC: 1669490 01/01/05 CSLB: 230077 01/31/05 CCC: A -B ------ Structure Information STOCK SHELVING SYSTEM ----- Other struct info . . . . . ---------------------------------------------------------------------------- CODE EDITION 2001 Permit . . . . . . BUILDING PERMIT Additional desc . Permit Fee . . . 989.50 Plan Check Fee 643.18 Issue Date . . . . Valuation . . . . 200000 Qty Unit Charge Per ` Extension* BASE FEE. 639.50 100.00 3.5000 -THOU BLDG ---------------------------------------------- 100,001-500,000 350.00 Special Notes and Comments ----------------- -------------- Stock Shelving Systems ----------------7----------------------------------------------------------- Other Fees . . . . . . . . . STRONG MOTION (SMI) - COM 42.00 Fee summary, Charged ----------------- Paid- Credited Due ---------- Permit Fee Total 989.50 ------------------------------ .00 .00 989.50 Plan Check Total 643.18 .00 .00 643.18 Other Fee Total 42.00' .00 .00 42.00 Grand Total 1674.68 .00 .00 1674.68 or=L 2004 CITY OF LA®iaiki P.O. BOX 1504 • VOICE (760) 777-7012 78-495 CALLE TAMPICO FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: © 73 Applicant: Applicant's Mailing Address: Date: t, 2 - t Architect or Engineer: Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals god -e- and my Licens , is i full fo ce and effect. � y I/license Class iK cense No. /2 3 od % / ate (��� O`/C� ontractor ✓'� r 1 0 r co''�% t OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant'for the permtt to file a signed statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): L) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of safe.). L) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). L) I am exempt under Sec. , B.& P.C. for this reason Date WORKERS' COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. I have and will maintain workers' comp ensat ion'rance, as required by Section 3700 of the Labor Code, for the -performance of the work for which this permit is issued. My rrkers mpens�tionrier andyolicy nulg4e� arrier 5 CL i'G UV G'' lLe / a _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that, if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, 1 shall forthwith comply with those provisions. s WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lenders Name Lender's Address APPLICANT ACKNOWLEDGEMENT IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Ouinta, its officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 160 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon the above-mentioned property for inspection purposes. ate �� a y�g final' lure (Applicant or Agent):/�� CITY OF LA QUINTA PLAN CHECK CORRECTION LIST Andrew L. Kirby 5562 Rock Tree Dr. Agoura Hills CA 91301 PLAN CHECK NO., 04-7243 ADDRESS 78-950 Hwy 111 Kohl's SCOPE OF WORK Storage Racks & Conveyor System November 29, 2004 SECOND/FINAL CHECK OCCUPANCY M TYPE -OF -CONST. III -N spkd. The submitted plans and specifications have been reviewed by the VCA .CODE GROUP. In our professional opinion the plans are in substantial conformance with the building codes and regulations adopted by the CITY OF LA QUINTAand the State of California Amendment. APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND ASSOCIATIONS. Plans checked by: Hue C. Luu, PE VCA CODE GROUP 2200 W Orangewood Ave, Ste 155 Orange, CA 92868 (714) 363-4700 ext.#752 VCA File No. LQ -17025 r