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04-6666 (RC)P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING PERMIT BUILDING & SAFETY DEPARTMENT (760).777-7012 FAX (760) 777-7011 INSPECTION REQUESTS (760) 777-7153 Application Number . . . . . `04-00006666 Date 11/01/04 Property Address . . . . . . L7.8-9781 HIGHWAY -111 .00 APN: . 643-020-999-6 -30903 - Application description.. REMODEL - COMMERCIAL Property Zoning . . . . . . . REGIONAL COMMERCIAL Application valuation . . . . 30000 Owner Contractor WASHINGTON 111 LTD- MOOREFIELD CONSTRUCTION, INC. C/O JOHN ANDERHOLT 3415 S. SEPULVEDA BLVD P 0 BOX 1623 LOS ANGELES CA 90034 PALM DESERT ® CA 922-I=1 (310) 390-9400 �� NOV 01 24� WCC: STATE FUND WC: 1686016 03/31/0E " CSLB:- 397892 02/28/05 CIoYO-G�(3JEv)Ti� CCC: B - - - - - - � Structu )e InfFG"Trr•�i P.O. BOX 1504 • 'u`�� 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT Application Number: Off , &j( 6 Applicant: � ' Applicant's Mailing Address: Architect or Engineer: VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Architect or Engineer's Address: Lic. No.: BUILDING PERMIT DECLARATIONS 6W1M"_q_ 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 Code, arid_my-L-icensegi,�}n full force and effect. ,7 a _ G Ucense Class f/a icense No�A O OWNERMUILDER 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 permit 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 fora permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).): U 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 sale.). U 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.). U I am exempt under Sec. , BA 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' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is -,n iccu d �Av.aenr4nrd rn.....e..�.,�:....:.............. .ozz.�.e_.�_�__,.____._____ I certify that, in the performance of the wo or 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, I shall forthwith comply with those provisions. Da�/Z �zf%�c_ Ap'\plicant WARNING: FAILURE TO SECURE WOR S' COMPENSA ION 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.). Lender's 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 180 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. 1 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. or 1 I NOV- 8-'N MON Craig Anthony Fire, Chief proudly serving the Unincrnporaied Areas ofRiveiside, County slid thw Cities of. Banning P, t Boatttnant 4- I Cabincsa i Canyon Lake Coachella Desert Hot Springs . 1. Indian Welts Indio r. Lake Elsinore La, Quints I Moreno Valley C• 11 Palin Desert . P.s � Perris 00 Rancho Mirage ., San Jacinto Tenux:nln Board of Supe I rvisors i Bob Buller. i oigbyei I I John Tavanlione, District 2 Juu Venable. 1)i�L-ic1i Roy WIISVIL Disti ict 4 4tari�n Axhlcy. Nstrict 5 I I 6:03 PM' R I V, CO, FIRE P&E I ND I 0 FAX 10. 1 760'863 7072 P. 1 RIVERSIDE COUNTY FIFE DEPARTMENT In cooperation with the California Department of Forestry and Tire Protection es an ac n o venue • Perr a t orma I • 9 ax } November 8, 2004 Building Department Re: Office Depot The Riverside County Fire Department is granting- permission for employees. only to be Able to stock at the following address -78-987 hw),10 La.Quinta. Office Depot is also required to have a fire watch until occupancy final granted from the Fire Department. Please call if you should have any questions. Ti7ljI FRANK KAWASAKI Chief Fine Department.Planner By Terry De cy -" Fire Systems Inspector EMERGENCY SERVICES DIVISION • PLAIJNING SECTION • INDIO OFFICE 82-675 Highway 111, 2n1 FL, Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072