05-3428 (ELEC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number: 05---00-0034:28
Property Address: 79840 HIGHWAY 111
APN: 649 -020 -040 -
Application description: ELECTRICAL
Property Zoning: REGIONAL COMMERCIAL
Application valuation: 20000
Applicant:
T d -4t 4 4 4"
Architect or Engineer:
ala
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
D a a
AUG 2 3 2905
CITY OF LA QUINTA
FINANCE DEPT.
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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.
Licens Claasss:B L' a No.: 397892
�e.E V � ontr r, 70/
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of p jury 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.).
(_) 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.). - .
( ) 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 th' ermit i ed 1 c. .1.
Lender's Name:
Lender's Addres
LQPERMTT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 8/23/05
Owner:
99C ONLY STORES
C/O JEFF GOLD
4000 E UNION PACIFIC AVE
COMMERCE, CA 90023
Contractor:
MOOREFIELD CONSTRUCTION, INC.
3415 S. SEPULVEDA BLVD STE 550
LOS ANGELES, CA 90034
(310)390-9400
Lic. No.: 397892
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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 1686016-2005
I certify that, in the performance of the work for which this permit is issued, 1 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 thwit o with those provisions.
cant:
WARNING: FAIL RE TO SECURE RKERS' COMPENSATI N 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 toenterupon the above-mentioned pr ty for ' ec ' n pu oses.
D;v —as,
e (Applicant or Agent .
Application Number .
. . . . 05-00003428
Permit . . .
BUILDING PERMIT
Additional desc .
Permit Fee . . . .
207.00
Plan Check
Fee
134..55
Issue Date . . . .
Valuation
. . .
. 20000
Expiration Date
2/19/06
Qty Unit Charge
Per
Extension
BASE
FEE
45.00
18.00 9.0000
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THOU BLDG
2,001-25,000
162.00
Permit . . .
ELEC-MISCELLANEOUS
Additional desc .
Permit Fee . . . .
36.75
Plan Check
Fee
9.19
Issue Date . . . .
Valuation
. . .
. 0
Expiration Date
2/19/06
f
Qty Unit Charge
Per
Extension
BASE
FEE
15.00
29.00 .7500
EA ELEC
POLE
LIGHT
21.75
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Special Notes and Comments
parking lot lighting
on concrete
base
29 ea.August 23, 2005
6:37:51 AM
jjohnson
Fee summary Charged
----------
----------
Paid
Credited
--------------------
Due
-----------------
Permit Fee Total
243.75
.00
.00
243.75
Plan Check Total
143.74
•.00
.00
143.74
Grand Total
387.49
-
.00
.00
387.49
LQPE% IIT
YO SING ENGINEERING SER VICES
•Engineering •Architecture -Surveying• Building & Safety Services
Letter of Transmittal
To: City of La Quinta
Date:
Project:
Attn: Ed Randall PC#:
Tel No.: (760) 777-7012 Tract No.:
08/10/05
79-840 Hwy 111
05-3428
We are forwarding: X By Messenger, By Mail Your Pickup
No. of Copies Description: '
1 Plans
1 Struct Calcs
Comments: Structural contents are approvable.
Thank You.
This Material Sent for:
Your Files
Your Review
Checking
Other
By: N91in Pgchunuri
Phone # - (760) 360-5770 EXT. 108
Per Your Request
X Approval
At the request of:
77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770
Bronz Young