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09-1302 (RC)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TESORO 3450 S. SUITE 2 AUBURN, 44 WA 980 VOICE (760) 777-7012 FAX (760) 777-7011 dal INSPECTIONS (760) 777-7153 .R %E3i; / ,1 _ Applicant: Architect or Engineer: Contractor: FUELING & SVC TECHNOLOGIES INC Application Number:09_09001302 7050 VILLAGE DRIVE Property Address: 79490 HIGHWAY 111 APN: 649 -820 -011 - Application description: REMODEL - COMMERCIAL Property Zoning: REGIONAL COMMERCIAL Application valuation: 20000 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Owner: TESORO 3450 S. SUITE 2 AUBURN, 44 WA 980 VOICE (760) 777-7012 FAX (760) 777-7011 dal INSPECTIONS (760) 777-7153 .R %E3i; / ,1 _ Applicant: Architect or Engineer: Contractor: FUELING & SVC TECHNOLOGIES INC 7050 VILLAGE DRIVE BUENA PARK, CA 90621 (714)523-0194 Lic. No.: 794519 LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under pr!,/If s of Chapter 9 (commencing with Section 70001 of Division 3 of the Business and PNMI- EE0L?___ Is Comy License is in full force and effect. License Class: A C21 HAZ i s 794519 /9/O Co�tiactor:" OW B ILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 Contractor's 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).: 1 _ 1 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 theieon, and who does the work himself or herself 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.). (_) 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.). (_) I am exempt under Sec. , 8.&P.C. for this reason Date: Owner: 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: LQPERMIT Date: 2/16/10 WORKER'S 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 issued. My workers' compensation insurance carrier and policy number are: Carrier SEAFBRIGHT Policy Number BB1092653 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 provisions. Date /4d' /& Ap` pl rt: �S � &0 4&AeAn4A1_ , 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. 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 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 I ag a to comply with all city and county ordinances and state laws relating to building construc here aut roe representatives of this county to enter upon the above-mentioned property for ins io pu ose Dat �/USignature-lAPPlicant.or Agent):CV C1_1 Application Number . . 09-00001302 ------ Structure'Information REPLACEMENT OF CAR WASHING EQUIPMENT ----- Other struct info . . . CODE EDITION 2007CBC FIRE SPRINKLERS FULLY MIXED-USE OCCUPANCY B OCCUPANT LOAD .00 ------------------------------------=--------------------------------------- 1ST FLOOR SQUARE FOOTAGE .00 PermitBUILDING PERMIT Additional desc . . Permit Fee 207.00 Plan Check Fee 134.55 Issue Date . . . . Valuation . . . . 20000 Expiration Date 8/15/10 Qty Unit Charge Per. Extension BASE FEE 45.00 18.00, 9.0000 ---------------------------------------------------------------------------- THOU BLDG 2,001-25,000 162.00 Permit . . . ELECT - ADD/ALT/REM Additional desc . . Permit Fee 27.00 Plan Check Fee 6.75 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/15/10 ' Qty Unit Charge Per Extension BASE FEE 15.00 16.00 .7500 --------------------------=------------------------------------------------- PER ELEC DEVICE/FIXTURE 1ST 20 12.00 Permit . . . PLUMBING Additional desc . Permit Fee 48.00 Plan Check Fee 12.00 Issue Date . . . . Valuation . . . . 0 Expiration Date 8/15/10 Qty Unit Charge Per Extension BASE FEE 15.00 5.00 6.0000 EA PLB FIXTURE 30.00 1.00 3.0000 EA PLB WATER INST/ALT/REP 3.00 ---------------------------------------------------------------------------- Special Notes and Comments REPLACEMENT OF CAR WASHING EQUIPMENT IN EXISTING SELF SERVICE BAY [USA GAS STATION] 2007 CALIFORNIA BUILDING CODES.. February 16`, 2010 8:13:03 ------------------------------------------------------------- AM AORTEGA Other Fees . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 LQPERMIT Application Number 09-00001302 ---------------------------------------------------------------------------- Other Fees. . . ... . . . . . STRONG MOTION (SMI) = COM 4.20 Fee summary Charged Paid Credited Due ----------------- Permit Fee Total ---------- 282.00 -------------------- .00 ---------- .00 282.00 Plan Check Total 153.30 .00 .00 153.30 Other Fee Total 5.20 .00 .00 5.20 Grand Total 440.50 .00 .00 440.50 a I Bin # n� �i Qty 0f La Quin Building &r Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # --13D Project Address:D W, � J 1. Owner's Name: "r�g�� S7 Zi PT� A. P. Number: ��f �� t Address: %Llso loMj sni� Legal Description: Contractor: �% City, ST, Zip: f°v zV iZ4J(11% &:' Telephone:ZS**?--9'Ct L--eif0'a3y Address: �d Y �j� Project Description: �1r—'µ('va City, ST, Zip:1,T11zr1Y 114- N 6, C,4x-Z VIS -s14- Telephone: ' �� O1 -i` {�,..?.�4 Yiv'??i•ri �^\i': jtii'ipl:+./.`}\ti ti::}%.','. <.:�°:.�c:•rys:':�rsfzs.;n,<:s%o,;`• State Lic. #: ? City Lie. Arch., Engr., Designer- esignerAddress: Address:-210,7 ,7 L4) • &NA �-) AV, 9-L-ZoK City., ST, Zip: ��IZ'�QL �►— �L �� Tele hone:91 Z _,T q .�•1.gy':.L Construction Type: Occupancy: State Lic. Project type, (circle one): New Add'n Alter Repair Demo Name of Contact Person: A4NA-j> G D jP4 Sq. Ft.: # Stories: # Units: Telephone # of Contact Person: ' S'Sf 6-teZ -36 L L j Estimated Value of Projec'• .. ZO APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets Plan Check submitted ,2 Item Amount Structural Calcs. Reviewed, ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Title 24 Calcs. Plans picked up 1010 Construction _ Flood plain plan Plans resubmitted Mechanical Grading plan god Review, ready f orrections/ sue Electrical Subcontactor List Called Contact Person C Plumbing Grant Deed Plans picked up S.M.I. H.O.A. Approval Plans resubmitted If,1 4" Grading IN HOUSE:- ''d Review, ready for correctionsrssue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue School Fees Total Permit Fees �� 190W • USISIAM &G CW s A -.t.— -