05-0689 (RC)P.O. Box 1504
78-495 CALLS TAMPICO
�A QUINTA, CALIFORNIA 92253
BUILDING PERMIT
o
�
� c
' P ication Number . . .
Property Address
APN:
Application description . . .
Property Zoning,. . . . . . .
Application valuation . . . .
Owner
------------------------
MOUNTAIN VIEW TIRE
8577 HAVEN AVE. STE. 202
RANCHO CUCAMONGA CA 91730
BUILDING & SAFETY DEPARTMENT
(760).777-7012
FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
05-'0`0-00:0689 Ddte
79265 HIGHWAY 111
649-030-999-9 -30420 -
REMODEL - COMMERCIAL
REGIONAL COMMERCIAL
2081
Contractor
------------------------
OWNER
2/28/05
Other struct info . .
. . . CODE EDITION 2001
CBC
----`---------------------------------------------------------------------°-°---
4.01
.00
r
Permit' BUILDING PERMIT
Additional desc . .
Permit Fee
54.00
Plan Check Fee
35.10
Issue Date
Valuation . . . .
2081
Qty Unit Charge-
Per
.'
Extension
BASE FEE
45.00
1.00 9.0000
THOU BLDG 2,001-25,000
9.00
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Special Notes and Comments
TIRE STORAGE RACKS AT
GOODYEAR STORE
---------------------------
Other Fees . . .
----------------
. . . . ENERGY
----------------------
REVIEW FEE
-----------
3.51
STRONG
MOTION (SMI) - COM
.50
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Other Fee Total
Grand Total
Charged Paid
54.00
.00
35.10
.00
4.01
.00
93.11
.00
Credited Due
.00
54.00
.00
35.10
.00
4.01
.00
93.11
8
i
P.O. BOX 1504 • VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 4INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: 03�— (oB J Date:
Applicant: I Architect or Engineer:
Applicant's Mailing Address:
Architect or Engineer's Address:
pip
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
Code, and my License is in full force and effect.
License Class License No.
Date Contractor
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 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 for a permit subjects
jtp applicant to a civil penalty of not more than five hundred dollars ($500).):
/�(C1 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 fbr 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. B.& C. for his reason
ate Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury o f he ollo ing declarations:
I have and will maintain a certi scat sent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the perfornance
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
issued. My workers' compensation insurance carrier and policy number are:
Carrier Policy Number
IjK 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, I shall
forthwith comply with those provisi S.
WARNING: FAILURE TO SECURE WORKS O EN ATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUUDD S ($100,000), IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INT ST, 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 Quinta, its
officers, agents and employeesfor 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 becJS
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 per toI certify that I have read this application and state that the abovs correct. I agree to comply with all city and county ordinances and state laws relating to building
constructions, aind hereby authorize representatives of this countn the above -me tioned property for inspection purposes.
Date 1 IQ� Signature (Applicant or Agent):