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13-0097 (MECH)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 13-00000097 Property Address: ~�79490 HIGHWAY 111 APN: 649-820-011- - Application description: MECHANICAL Property Zoning: REGIONAL COMMERCIAL Application valuation: 14000 Tit�v 4. VOICE (760) 777-7012 FAX (760) 777-7011 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Owner: TESORO SIERRA PROPERTIES P.O. BOX 592809 SAN ANTONIO, TX 78259 Date: 1/30/13 Contractor: / e!�l C� a Applicant: Architect or Engineer: WESTERN PUMP INC / 3235 F. STREET F �dC�`� S V4-1Y&A(JIreY-N SAN DIEGO, CA 92102-3315 (619) 239-9988 1, Lic. No.: 673853 � o 00 Co v rM1-,r V CASr ' 5.F-'1 LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury that I am licensed under isions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations: Section 7000) of Division 3 of the Business and Professionals de, and my License Is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided License Class: C10 C61/D4 tense No.: 673853 for by Section 3700 of the Labor Code, for the performance of the work for which this permit is / � issued. JDate: r f � Contractor: _ I have and will maintain workers' compensation Insurance, as required by Section 3700 of the Labor VV Code, for the performance of the work for which this permit Is Issued. My workers' compensation OWNER•BUILDER DECLARATION insurance carrier and policy number are: I hereby affirm under penalty of perjur tat I am exempt from the Contractor's State License Law for the Carrier EMPLOYERS CO Policy Number WCCZ91458968012 following reason ISec. 7031..5. Business and Professions Code: Any city or county that requires a permit to _ I certify that,.in the performance of the work for hick this permit. is issued, I shall not employ any construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the person in any manner so as to become sub t to the workers' compensation laws of Colitornla, permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State and agree that, if I should become el to the workers' compensation provisions of Section License Law (Chapter 9 (commencing with Seaton 7000) of Division 3 of the Business and Professions Code) or 3700 of the Labor Code, I shall fort nh comply with those provisions. that he or she Is exempt therefrom and the basis for the alleged exemption. Any violation of Seaton 7031.5 by 9 any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (0500).: Date: / /J ADplicant: 1 _ 1 I, as owner of the property, or my employees with wages as their solo compensation, will do the work, and the structure Is not Intended or offered for sale (Sec. 7044, Business and Professions Code: The WARNING: FAILURE TO SECURE 0MINTEREST. PENSATION COVERAGE IS UNLAWFUL, AND SHALL Contractors' State License Law does not apply to an owner of property who builds or Improves thereon, SUBJECT AN EMPLOYER TO CRI AND CIVIL FINES UP TO ONE HUNDRED THOUSAND and who does the work himself or herself through his or her own employees, provided that the DOLLARS 10100,000). IN AD01� OF COMPENSATION, DAMAGES AS PROVIDED FOR IN Improvements are not Intended or offered for sale. It, however, the building or improvement is sold within SECTION 3706 OF THE LABOR%CODE,ND ATTORNEY'S FEES. 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.). - APPLICANT ACKNOWLEDGEMENT (_ 1 1,. as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. IMPORTANT Application is hereby made to the Director of Building and Safety for -a permit subject to the 7044, Business and. Professions Code: The Contractors' State License Lew does not apply to an owner of conditions and restrictions set forth on this application. property who builds or Improves thereon, and who contracts for the projects with a contractorls) licensed i s Each person upon whose behalf this application Is made, each person at whose request and for pursuant to the Contractors' State License Law.). whose benefit work is performed under or pursuant to any permit Issued as a result of this application, (_ 1 I am exemptunderSec. , B.&P.C. for this reason the owner, and the applicant, each agrees to, and shall defend, Indemnify and hold harmless the City Data: 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 ISec. 3097, Civ. C.). Lender's Name: _ Lender's Address: LQPERMIT of La Quints, 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 nulland void if work Is not ommenced within 180 days from date of issuance of such permit, or cessation of work for days will subject permit to cancellation. 1'certify that I have read this application and state that the above Information Is correct. ree to comply with all city and county ordinances and state laws relating to building construction, and here uthorize representatives this to enter u n the above -mentioned property for inspection purpo /Date.� Signature (Applicant or Agent): Application Number . . . . . 13-00000097 Permit MECHANICAL Additional desc . Permit Fee . . . . 54.00 Plan Check Fee 13.50 Issue Date . . . Valuation . . . . 0 Expiration Date 7/29/13 Qty Unit Charge Per Extension BASE FEE 15.00 6.00 6.5000 EA MECH OTHER MECH EQUIPMENT 39.00 ---------------------------------------------------------------------------- Special Notes and Comments REMOVE AND REPLACE FUEL DISPENSERS PER APPROVED PLANS (6 LOCATIONS) 2010 CODES. ENGINEER: NADER GHADERI C36475 ---------------------------------------------------------------------------- Other Fees . . . . . . . . BLDG STDS ADMIN (SB1473) 1.00 HOURLY PLAN CHECK 35.00 Fee summary Charged Paid Credited ---------------------------------------- Due ----------------- 'Permit Fee Total 54.00 .00 .00 54.00 Plan Check Total 13.50 .00 .00 13.50 Other Fee Total 36.00 .00 .00 36.00 Grand Total 103.50 .00 .00 103.50 Bin # City. o Q ta f- La Quin Building &r Saky Divhibn P.O. Box 1504,78-495 Calle Tampico La.Quinta, CA 92253 -:(760) 777-7012 Building Permit Application and Tracking' Shea Permit # M r 00� Project Address: 161A(�A% i l t 'owneesName: 11 6 A. P. Number: . L45A .)Xtdint Address: IC1100 T." Legal Description: liweo City, ST, Zip:SAj A-,VW07-1x Contractor. U) -T94W 0 JLQ E�O a Telephone: Address: 3236 Project Description: City, ST, Zip: SA-J-DICA0 60. C(2J0Z Telephone., 7C State Lic.#: (*-?30&1 c, 9-- Arcfi., Engr., Designer Address: 26466'-SAO) City, ST, Zip: 0x0.t-T-9-S5 Telephone: (0 State Lic. #: .3 4- Name of Contact Person: /40,x,& r�, el ph4lo I - J Construction type: Occupancy: Project type (circle one): New Add'n. A-ler Repair Demo' Sq.'Ft-: I # Stories: I N Units: Telephone# of Contact Person: 67L-La-so-3-2 00-- Estimated Value of Project:000 - APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Reqld RecId TRACKING PERMrr FEES Plan Stu Plan Check submitted it. Amount' Structural Cafes. Reviewed, ready for corrections Plan Check Depo-U. Truss C21cs. Called Contact Person- Plan Check Balarce. Tide 24 Cates. Plans picked up Construction Flood plain plan Plans resubmitted .'. Mechanical Grading plan T'! Review, ready for correttionstissue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up H.O.A. Approval Plans resubmitted Grading IN HOUSE:- Review, read I y for correcoun!6-C-) oper Impa.tt Fee Planning Approval. Called Contact Person AXP.P. Pub. Wks. Appr Date of permit Issue ti School Fees Ffts LTotal Permit fe, lyr W 16 PF-�) -4T kA44, Tmf - 4 4a" P.O. Box 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 To: Burt Hanada, Plans Examiner, Inspection Supervisor From: Les Johnson, Planning Director BUILDING cat SAFETY DEPARTMENT (760) 777-70 12 FAX (760) 777-7011 Building Plans Approval To CDD: /.2-Y 7 Due Date: 45A)o Status: %5f. The Community Development Department has reviewed the Building Plans for the following project: Description: U(54 'Sd" Address or general location: 7 q- 119Q Applicant Contact: The Community Development Department finds that: ❑ ...these Building Plans do not require Community Development Department approval. ...these Building Plans are approved by the -Community Development Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections the applicant. When the corrections are made please return them to the Comm ity De - elopment Department for review. ° 2-- Le . s Johnson, anni Director :DEC 17 2012 City of La 6ttOnta Plcnning Department Date CALIFORNIA ALL-PURPOSEACKNOWLEDGMENT.. .—.�c ;. cc=nr=r�ccr—:—.—. State of California _. _. . Countyof._ D .n ��� �.before me,O.. G Here Insert Name: and Title of the Officer personally appeared I j a.. _ _ .. _.... Name(s) of Signer(s) who -proved to me on the basis of. satisfactoryevidence.to " be the personkgwhose nameksr-js/atesubscribed to: the within instrument :and acknowledged: to me that het4he/tW executed: the same in his/ber/ttit=fYauthorized capacitj4(i; and that by his�f*R4h�eir signaiure(q on the instrument: the -person(s�or th-e entity upon behalf:of ..... . :which the peesfonj )-agtpo, executed the instrument. STEPHANIE SUSANNE:CORREIA Commission # 1919313 c :m Notacy:Public California : i:::: I certify under: PENALTY OF PERJURY under the laws z ` San.oiego County . of the State: of California that the: foregoing paragraph: is ...... My Comm. Expires.Jan 26; 2015 true. and correct. WITNES:S.my:hand and official seal'. itiv 0 Signature I //Y1h (,lQhiZ1�.�CC- Place NotarySeal Above': : Signa ure of Notary Public ...:::..OPTIONAL Though the information below is not required by law it may prove valuable. to persons relying on the, document and could prevent fraudulent removal and reattachment of this form to another document. Description.of Attached Document . ...... Title or Type of Document: 1 % Document bate:.._1JP/i✓ 15, 26I2_ Number of'Pages: 1 Signer(s) Other Than :Named Above: j� Ca acit : .Claimed b : Si 'ner p Yf�ies ) Y s 9 (.) Signer's Name: Signer's Name: " ❑ Individual " ` Corporate Officer — Title(s):: ❑ Individual.....: ❑ Corporate Officer - Title(s): Partner = ❑Limited ❑ Generaf - ' ' " ❑Partner. — ❑Limited ❑General ❑ Attorney in Fact : ❑Attorney in Fact ❑ Trustee:... Top of thumb here "" t] Trustee . Top of thumb here' ❑ Guardian or Conservator ❑ Guardian or Conservator _❑.:.Other: . _❑_O.ther. SI er Is. qa .r' P esen , '.::'::.Signer Is Representing:. @2007 National Notary Association • 9350 De Solo Ave., P.O. Box 2402 • Chatsworth, CA, 91313-2402 • www.Nabona[Notary.org: Item N5907 Reorder: Call Toll -Free 1-800-876-6827 WESTERN PUMP, INC.. petroleum & lubrication equipment specialists A & S ENGINEERING 28405 Sand Canyon Road, Ste. B Canyon County, CA 91387 RE: LETTER OF AUTHORIZATION To whom it may concern; M E M B E R LPEip November 15, 2012 I, Ryan Rethmeier, licensed contractor, authorize the following employee's from A&S Engineering: Ahmad Ghaderi Robert Velasco Adolfo Gomez Kevin Hurley, Dan Mazoil Jason Olson, Hoss Farzad to act on my behalf. o For this property only. XFor all properties and pen -nit applications; no limitations. This authorization includes signing the permit and all supporting documentation on my behalf. I am named on the contractor's license listed below and have the authority to authorize the person named above to act as agent. Signed under penalty of perjury, �L cc, Q� ��, Cont Ufor Signature Ryan Rethmeier — Western Pump Inc Contractor Name 3235 F Street San Diego CA 92102 Contractor Address 673853 Contractor License No. 61M39-9988 Contractor Phone No. STEPHANIE SUSANNE CORREIA (� Commission 11919313 Notary Public - California San Diego County Comm. Ex lres Jan 26, 20151� 1 3235 T" Street • San Diego, CA 92102-3315 • (619) 239-9988 • Fax (619) 239-9925 www.westernpump.com ti . CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of D On / V11Q/� before me, Date Here Insert Name and Title of the Officer personally appeared IZ /? t) STEPNANIE SUSANNE CORREIA Commission # 1919313 Notary Public - California z z San Diego County D My Comm. Expires Jan 26. 2015 who proved to m on the basis of satisfactory evidence to be the persoZhose nameKis/a+esubscribed to the within instrument and acknowledged to me that he/&heAMy' executed the same in his/4eftW authorized capacityt(ies), and that by hisibe#their signature(4 on the instrument the person(s)—,or the entity upon behalf of which the person,(ssa-acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature t 1pei- Place Notary Seal Above 1L (.lQiSigna ure of Notary Public OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document _ Title or Type of Document: ffff NI Y/Z 7M tt q y Abjq, Document Date:0AAJWLbM_ 15, ZbNumber of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed b(y�Signer(s) fC Signer's Name: A A in I \� ❑ Individual Li XCorporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ General ❑ Attorney in Fact ❑ Trustee Top of thumb here ❑ Guardian or Conservator ❑ Other: I erls epresen q Signer's Name: ❑ Individual ❑ Corporate Officer — Title(s): ❑ Partner — ❑ Limited ❑ 'General ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: RIGHTTHUMBPRINT OF SIGNER of thumb here 02007 National Notary Association - 9350 De Soto Ave., P.O. Box 2402 -Chatsworth, CA 91313-2402- v~.NationalNotaryorg Item H5907 Reorder: Call Toll -Free 1.800-876.6827 January 5"', 2012 To: Various City/Cowily Municipalities wilhin Calilbeitia Stalc Dear Sir/ Madam, This letter serves as iiocumentation that n & S finginceringi and its represciitatives (Ahniad Ghaderi, Kevin Hurley, Doss far ad, Robert Velasco, Jason Olson and Orin ma iol) l ave.been authorized to represent'[' soro Refining; and Markelinf;,'i'csorci West Co�istComparly; LIC, Tesoro South Coast Company, LL.0 and Tesoro Sierra Properties, UC, for the sole purpost of filing and signing required applications to obtain the required licensesand/cnr permits for -our facilities as needed. Please do not hesitate to contact me .with any questions. Sincerely,. TESORO Lance 6uhlinan Manager-Engineering&Construction;; USA Brand Tesoro Refining and Marketing Company 1361 La Vista Ave: Concord, Calilomia 94521-2626 Cell.' 925.381.4979 OfCce: `925.687.2783 eFax: 925.807.0297 Lance.a.8ulilmanha lsocorp.cbm Planning Engineering Project Management 28405 Sand Canyon Road, Suite "B", Canyon Country, CA 91387 Ph: 661.250.9300 Fax: 661.250.9333 e February 1, 2013 City of La Quinta Building & Safety Department 78495 Calle Tampico La Quinta, CA 92253 Phone #760-777-7012 Fax #760-777-7011 Attn. Mr. Burt T. Hanada Re: Tesoro #68144 79490 Highway 111 La Quinta, CA 92253 Permit for Fuel Dispenser Replacement Dear Mr. Hanada, Per e-mail received & conversation with my supervisor, we would like to respectfully submit to your office the following documents in order to obtain Permit/Approval for proposed upgrades/ modifications to be performed at subject site; 1. Check #8538 for $103.50 2. Completed Building Permit Application 3. Letters of Authorization from Tesoro & Western Pump for A & S Engineering 4. Fedex Return Label in order for Permit/Approved plans to be shipped to us once they become available Please feel free to contact me should you have any questions. Thank you & look forward to receive the Permit/Approved Plans. Sincerely, Robert Velasco 111. � 7-mliv'"r - Sx� ' xore;'�w:� Oflt►S.' Ilk t of f CITY OF LA QUINTA BUILDING A SAFETY DEFT.` APPROVED FOR CONSTRUCTION By L .&AL f -7 GIL13ARCO VEEDER-ROOT Encoree 700 5 Dispensers Secure your competitive advantage and increase profits "ilb' WM-Gi akoVeeder-: 1n!qre , fdb� Roots Encorq700S —your iestspersqrOvinvestment il� d tomorrow > The ind , fay Mmaytout irchards ng solutions, featuring ' lid fleAlibind iriiiiiAiirerfrak` Highly secure, powedul (RIND'Deledrdrics:W a, management to -dine,, in,sto platform for your changing forecourt marketing anid.payment needs. 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