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05-1292 (RC)e o�0 BUILDING & SAFETY DEPARTMENT w� O. BOX 1504 (760 777-7012 oF9 95 CALLE TAMPICO FAX (760) 777-7011 INTA, CALIFORNIA 92253 INSPECTION REQUESTS (76.0) 777-7153 �Ith BUILDING PERMIT 0 pp Number 05y00.001292.___ Daae 5/03/05 jJ Address . . . .. 79770 HIGHWAY. ill APN: 649-020-0407 - - ication description. REMODEL - COMMERCIAL Property Zoning.. REGIONAL COMMERCIAL Application,valuation'. . . . 7000-- Owner 000•Owner Contractor ---------------------------------------------------------- ------ 99C ONLY STORES INNOVATIVE STORE SYSTEMS INC C/O JEFF GOLD. 5152 MC COMBER ROAD .4000 E UNION PACIFIC AVE BUENA PARK, CA 90621 COMMERCE, CA 90023 (714)670-7776 WCC: COMBINED SPEC WC: 005-00022771 01/01/06 CSLB: 809457 06/30/06 CCC: C61 D24 Other struct info . . . . . CODE EDITION 2001'CBC FIRE SPRINKLERS YES ------------------------------------------ : ------------------------------------ P.O. BOX 1504 • /i . (N VOICE (760) 777-7012 78-495 CALLS TAMPICO FAX (760) 777-7011 LA QutNra, CALIFORNIA 92253 INSPECTIONS (760) 777-7153 BUILDING & SAFETY DEPARTMENT Application Number: Q 5-- iZ 9 Z I . Date: 3 — ©Cs Applicant: Applicant's Mailing Address: Architect or Engineer: Architect or Engineer's Address: 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 Lice s i�in f (� (QrLg n effect. ^^Z/ ry License Class lJG Lic L-7 J / i- DatebJ Contra 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 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 contractor(s) licensed pursuant to - the Contractors' Slate License Law.). U I am exempt under Sec. , BA P.C. for this reason Date Owner WORKERS' 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 �d��s, 2 My w�c�cers' compensation insurance carrier arldpo number / Carrier �0i'[xYN� 5V'�'. Policy Number (%f�j _ 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, 1 shall forthwith comply with those provisions. I / Date 6� Applicants c-/� !/ �4✓�f%�t�/` 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. 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 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 co I agree to my with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this county to enter upon t e abov -mentioned prop rty for ection purposes. Date J' �aT, Signature (Applicant or A Y--------------- - -.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - �_�;;��. �Application.Number 05-00001292 Permit BUILDING PERMIT Additional desc . Permit Fee . . . . 90.00 Plan Check Fee 58.50 Issue Date Valuation . . . . 7000 Expiration Date 10/30/05 Qty Unit Charge Per, Extension BASE FEE 45.00 5.00 9.0000 THOU BLDG 2,001-25,000 45.00 ---------------------------------------------------------------------------- Special Notes and Comments COMMERCIAL STORAGE RACKS AND SHELVING FOR SMART N FINAL STORE. 2001 CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . . . STRONG MOTION (SMI) - COM 1.47 Fee summary ------------ Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 90.00 .00 58.50 .00 1.47 .00 149.97 .00 Credited Due .00 90.00 .00 58.50 .00 1.47 .00 149.97 YO UNG ENGINEERING SERVICES *Engineering -•Architecture•Surveying• Building & Safety Services Le-tter of Transmittal r To: CITY OF LA QUINTA Date: 04-11-05 Project: SMART & FINAL 79-770 HWY 111 Attn: ED RANDALL PC#: 05-1292 Tel No.: (760) 777-7012 Tract No.: We are forwarding: X By Messenger By Mail Your Pickup No. of Copies Description: 1 PLANS 1 STRUCT Comments: STRUCTURAL CONTENTS ARE APPROVABLE. THANK YOU This Material Sent for: Your Files Per Your Request Your Review X Approval Checking At the request of: Other By: NALIN K. PACHUNURI Phone # (760) 360-5770 EXT. 108 77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770 Bronz Young