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04-3549 (CNHK)P.O. Box 1504 78-495 CALLS TAMPICO LA QUINTA, CALIFORNIA 92253 r BUILDING PERMIT Application Number . . . Property Address APN: Tenant nbr, name . . . . Application description . Property Zoning . . . . . Application valuation . . Owner r •'_ -------------------- STAMKO DEV CO C/.0 PROVIDENT FINANCIAL MGMT 10345 W OLYMPIC BLVD 2 FL LOS.ANGELES CA 90064 FAX (760) 77-7-Zo I j INSPECTION REQUESTS (760) 777-7153 . , �0 00003549 Date 5/07/04 79395- HIGHWAY '111 649-030-999-5 -30420 - DISPLAY / STORAGE RACKS NEW COMML - OTHER NON -HOUSEKEEPING REGIONAL COMMERCIAL 19000 Contractor--------------------- MURRAY WOODCRAFT, INC. 21821. CONSTANCIA MISSION VIEJO CA 92692 (949) 586-8090 s 16WCC : STATE FUND eo WC: 129302004 01/01/05 • i CSLB: 545823 11/30/04 o CCC: B -CS ------------------------- Structure Information ------------------------- Construction.Type . . . . . TYPE V - NON RATED Occupancy Type . . . . MERCANTILE Other struct info . . . . . CODE EDITION 2001 ------------------------------------------------------ FIRE SPRINKLERS Y Permit . . . . . ----------------------- BUILDING PERMIT- {' Additional desc .Permit Fee . . . . 198.00 Plan Check Fee 128.70 Issue Date Valuation . . . . 19000 Expiration Date 11/07/04. Qty Unit Charge Per Extension BASE FEE 45.00 17.00 9.0000 --------------------------------------------7------------------------------- THOU BLDG 2,001-25,000 153.00 Special Notes and Comments COMMERCIAL - DISPLAY AND STORAGE RACKS FOR MARSHALL'S. RETAIL M OCC, TYPE VN CONSTR. 2001 CODES. -------------------------- Other Fees . . . . ---------------------------------------- . . . STRONG MOTION (SMI) - COM ---------- 3.99 Fee.summary Charged --------------------------- Paid Credited Due ------------------------------ 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: Applicant: Appllcant's Mailing Address: Date: '--�!,— Architect or Engineer: 3Mn1 &F-) Wil_ b�.� i Architect or Engineer's Address: � �, �, 1 �� � iC vT •� EE^C P©c��ov� Lic. No.: �� 2 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 Liceo is in full force and effect. License Class License No. ' .Date Contractor OWNER -BUILDER DECLARATION 1 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 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 contractors) licensed pursuant to the Contractors' State License Law.). U I am exempt under Sec. , B.& P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION 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 issMArkers' coper insurance carrier and police number are: Cartier ``/ G �.e✓/, Policy Number YYiC Z S 3 O U?- _ I certify that, in the performance of the work for which this permit is issued, I shall not employ any rs forthwith comply with those provisions. on 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 Date Applicant 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" performance of the work for which this permit is Issued (Sec. 3097, CW. C.). Lender's Name _ K, A Lender's Address [ 1 . A 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, indemnity 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 bontioned property for inspection purposes. Date Signature (Applicant or Agent): 71 Application Number . . . . . 04-00003549 Permit Fee Total 198.00 .00 Plan Check Total 128.70 .00 `Other Fee Total 3.99 .00 Grand Total 330.69 .00 Page 2 Date 5/07/04 .00 198.00 .00 128.70 .00 1 3.99 .00 330.69 =AM if X X M X to w FCprom's 1:,:; e eA— City of La Quinta Building U Safety Division Permit # / r P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address:22-3 9��, Owner's Name: A. P. Number. Leeal Description: Contractor.v Address: -;L/ • �-� % .t/ .: �G,� Address: ?g- pbD G" LST J ICity, ST, Zip: v��%4 Z1iJ L FTelephone:=�7;`'' Y Project Description: City, ST, Zip: Mi,5,5� J i `a C4 - Telephone: Telephone: State Lic. # : ek 3 City Lic. #: Arch., Engr., Desiggner. v Address: �� ��it) f�6a."j--S G City, ST, Zip: 9� llw�a O / / Z, Telephone: -ti.. :�:` .rfi,_ •:. State Lic. #: _ - - := Construct ion Type: PeTd a- Occupancy: Project type (circle one) Add'n Alter Repair Demo Name of Contact Person: �v S9: Ft,: &7/ v D 0 1 # Stories: # Units: Telephone # of Contact Person: /4- Z)4 -3.5 stimatcd Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Cal 3 L C Reviewed, ready for corrections Plan Check Deposit Truss Cales. Energy Calcs. Flood plain plan Called Contact Person Plans picked up Plans resubmitted Plan Check Balance Construction Mechanical 12&.70 Grading plan Y' Review, ready for correctio slssue JY Electrical Subcontactor List Called Contact Person Plumbing Gnat Deed Plans picked up SAU. 3 , H.O.A. Approval Plans resubmitted Grading IN HOUSE:- '"' Review, ready for correctionsfissue Developer Impact Fee A.I.P.P. Planning Approval Called Contact Person Pub. Wks. Appr Date of permit issue School Fees 1 Total Permit Fees 'Vs- 5+-1- u &*- bets -K -4P1Oi",ovaJO4e-- YOUNG ENGINEERING SERVICES • Engineering •Architecture•Surveying• Building & Safety Services Letter of Transmittal T To: City of La Quinta Date: 4/2/04 Project. 79-395 Hwy 111 Attn: Ed Randall PC#: Marshalls Tel No.: (760) 777-7012 Tract No.: We are forwarding: X By Messenger By Mail Your Pickup No. of Copies Description: 1 Set of plans 1 Set of struct. calcs Comments: Plans are approvable. Thanks This Material Sent for: Your Files Per Your Request Your Review z Approval Checking At the request of: Other By: Eric Frenzel Phone # 760-360-5770 77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770 Bronz Young