08-0739 (BLCK)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Ti -ht 4 4a Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
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: B LicenseNo.: 524136
ate: IV3-Xonl,.ctor:� Cit►a�✓
OWNER -BUILDER LARATION
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).:
(_) 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 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.).
(_ 1 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. , B.&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: P x
LQPERMIT
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 STATE FUND Policy Number 0028828-2007
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.
>00f,'can,
f
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 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.
Ya"•2 0� ature (Applicant or Agent):
Date:
5/02/08
Application Number:
08-00000739
Owner:
Property Address:
79765 HIGHWAY "111
KOMAR INV
APN:
600-020-034- - -
23 CORPORATE PLZ STE 247
Application description:
WALL/FENCE
NEWPORT BEACH, CA 92660
Property Zoning:
Application valuation:
COMMERCIAL PARK
675
Contractor:1'fHY
WICKS CONSTRUCTION INC
M 1 2
OApplicant:
P:IF':1NANCdEf
20011614
Architect or Engineer:
STERLING AVENUE
RIVERSIDE, CP 92503
IYOFLAQU�NTA(951)351-8303
ri
Lic. No.: 524136
DEPT
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: B LicenseNo.: 524136
ate: IV3-Xonl,.ctor:� Cit►a�✓
OWNER -BUILDER LARATION
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).:
(_) 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 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.).
(_ 1 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. , B.&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: P x
LQPERMIT
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 STATE FUND Policy Number 0028828-2007
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.
>00f,'can,
f
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 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.
Ya"•2 0� ature (Applicant or Agent):
Application Number . . . . . 08-00000739
Permit . . . WALL/FENCE
PERMIT
Additional desc .
Permit Fee 19.00
Plan Check
Fee
.00
Issue Date . . . .
Valuation
675
Expiration Date 10/29/08
Qty Unit Charge Per
Extension
BASE
FEE
15.00
2.00 2.0000 HND BLDG
501-2,000
4.00
----------------------------------------------------------------------------
Special Notes and Comments
27 L.F. 12 HIGH SCREEN WALL, PER
APPROVED ENGINEERED PLANS.
.Fee summary Charged
----------------------------
Paid Credited
Due
----------
Permit Fee Total 19.00
----------
.00
----------
.00
19.00
Plan Check Total .00
.00
.00
.00
Grand Total 19.00
.00
.00
19.00
LQPERMIT
05/02/2008 11:49 FAX 909 351 9410 WICKS CONSTRUCTION
ICKS _
WICKS CONSTRUCTION 1NCORP[7RA7FJD
May 2, 2008
City of La Quinta
Building Department
SUBJECT: Mimi's Cafe Restaurant
79-7.65 R ighway 111
La Quinta, CA
To Whom It: May Concern:
la 001
Wicks Construction, Inc. hereby authorizes Mark Fernandez to act
on its behalf in obtaining necessary permits from the City of La
Quinta and to sign permit documents. Wicks Construction, Inc:. is
properly licensed as required by the State of California.
Wicks Construction, Inc assumes full responsibility under the
law for any permits taken by persons authorized to act on our
behalf.
This authorization shall continue until the City of La Quinta is
notified in writing that such authorization is cancelled by this
contractor.
Sincerely,
H
WICKS CONSTRUCTION, INC..
Sharon Hayden
Office Manager
California State Contractor's License #524136
11614 STERLING AVENUE, RIVERSIDE, CALIFORNIA 93503 • (951) 351-8303 • FAX: (951) 331-9410
Lic, # 524136
Td Wdb0:T0 8002 ZO 'FpW T017Z8SZbTZ: 'ON XUJ SaoTelu% '�uawdolanaa aayou2d: WOdd
Bin #
City of La. Quinta
Address: .E�6tk2_ VoN
r ,2�,•e�/ 14,2 �q�
'Building a Safety Division
Permit # (�
P.O. Box 1504, 78-495 Calle Tampico
Occupancy:
StateLit. #: � [r —Q.) 5r6•
La Quints, CA 92253 - (760) 777-7012
Name
Nae of Contact Person: o p5 ! i-i..'.._#Stories:..:
Building Permit Application and Tracking Sheet
Project Address:' ?9_76S'i-ew:q-Y
Owner's Name:
A. P. Number.
# Units: _... ..:
Address:
Legal Description: -
City, ST, Zip:
Contractor
Telephone: .
Address: I G y
• Project Description:
City, ST, Zip: I�'LtJLf .
�Zsp 3
Strnctnn[ talcs.
Reviewed; ready for corrections
Plan Check Deposit
. % C c
Telephone: CIS-( _3,1S -843
Plan Check Balance
612 CNrGf'2 .
State Lic. # :
Construction '
Flood plain plan,.
Arch., Engr., Designer:
Address: .E�6tk2_ VoN
r ,2�,•e�/ 14,2 �q�
City, ST, Zip: -7�u—ce_ji5 . CA c72(o0(a
Telephone:. k q. -2b (. '-= j 6 00.
Construction Type.
Occupancy:
StateLit. #: � [r —Q.) 5r6•
Project type (circle one): New . Add'n 'Alter Repair Demo
Name
Nae of Contact Person: o p5 ! i-i..'.._#Stories:..:
# Units: _... ..:
Telephone # of Contact-Persoa:
%(�(— ZS$ - I iSO� x (.( Estimated Value.ofProjecx
APPUCANT: DO NOT WRITE BELOW THIS UNE .
V Submittal Req'd •
Rec.'d TRACMNG .
PERMIT FEES
Plan Sets
Plan Check submitted
Item.. Amount
Strnctnn[ talcs.
Reviewed; ready for corrections
Plan Check Deposit
Truss Calm.
Called Contact Person
Plan Check Balance
Energy Coles.
Plans picked np
Construction '
Flood plain plan,.
Plans resubmitted
Mechanical
Grading plan
.2" Review, ready for corrections/issue
Electrical
Subcontactor.List '
Called*Contact Person
Plumbing
Grant'Deed
Plans, picked up
S.MI.
R.O.A. Approval
Plans resubmitted
Grading
• IN ROUSE:-
Review, ready for corrections/issue
Developer Impact Fee
PI nnipg Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
s