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BOTH2017-001478-495. CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Permit Type/Subtype: Application Number: Property Address: APN: Application Description Property Zoning: Application Valuation: DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT STRUCTURE OTHER THAN BUILDING/ BOTH2O17-0014 78364 HIGHWAY 111 604050046 CIRCLE K / REPLACE FUEL DISPENSERS $18,000.00 Applicant: V & R CONSTRUCTION SERVICE INC 9525 SLAUSON AVE PICO RIVERA, CA 90660 NOV 14 2017 C041MUNIT ITYOFL QUIkTADEPARTMENT ' 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 Professions Code, and myLicense is in full force and effect. License Class: B. C10, D40 License No.: 776 �D e: 1 1 Co�t�rKa OWNER -BUILDER DECLARATION J. -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 applicantfor 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 s 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).: LJ 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.). . LJ 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 puFsuant 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 Na Lender's Address: VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 'Date: 11/14/2017 Owner: CIRCLE K STORES INC P 0 BOX 52085: PHOENIX, AZ 92253 Contractor: - . . ISLAND PETROLEUM BUILDERS INC 7470 SVL BOX VICTORVILLE, C4 92392 (909)923-9373 Llc. No.: 776846 WORKER'S COMPENSATION DECLARATION _ - I hereby affirm under penalty of perjury one cf the following declarations: . ' - I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 37M of the Labor Code, for the performance of ttle worpor which this permit is issued. _ I have and will maintain workers' c::)mpensation insurance, as required by Section 3700 of the Labor Code, for the performance of the workfor which this permit is issued. My workers' compensation insurance.carrier and policy number are: Carrier: INSURANCE COMPANY OF THE WEST' Polity Number: WSD5020021 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner sc 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, l shall forthwith comply with those provisions. Date: It 1 14 1 T pl ca WARNING: FAILURE TO SECURE WORKERS' CC-MPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMI'dAL 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 t8:e Building Official for a permit subject to the conditions and restrictions set forth on th6 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,af La Quinta, its officers, agents, and employees for any act or omission related to tie 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 city to enter upon the above- mentioned property for inspection purposes. --------- pate: I L 1 1 Signature (Applicant or Age Date: 11/14/2017 Application Number: BOTH2O17-0014 Owner: Property Address: 78364 HIGHWAY 111 CIRCLE K STORES INC APN: 604050046 P 0 BOX 52085 Application Description: CIRCLE'K / REPLACE FUEL DISPENSERS PHOENIX, AZ 92253 Property Zoning:. Application Valuation: $18,000.00 Applicant: Contractor: V & R CONSTRUCTION SERVICE INC. ISLAND PETROLEUM BUILDERS INC 9525 SLAUSON AVE 7470 SVL BOX PICO RIVERA, CA 90660. VICTORVILLE, C4 92392 (909)923-9373 LIc. No.: 776846 Detail: REMOVAL & REPLACEMENT OF EIGHT FUEL DISPENSERS PER 2016 CEC FINANCIAL • • • DESCRIPTION ACCOUNT QTY AMOUNT BSAS SB1473 FEE 101=0000-20306 0 $1.00 Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $1.00 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCES, NON -RES' 101-0000-42403 0 $208.08 DESCRIPTION ACCOUNT QTY AMOUNT APPLIANCES, NON -RES PC 101-0000-42600 0 $208.08 Total Paid for ELECTRICAL: $416.16 DESCRIPTION ACCOUNT QTY AMOUNT FIRE SPECIAL INSPECTION 101-0000-42421 0 $156.00. DESCRIPTION ACCOUNT QTY AMOUNT FIRE STORAGE TANK - DISPENSERS'PC 101-0000-42420 1 $156.00 Total Paid for FIRE FEES: $312.00 DESCRIPTION ACCOUNT QTY 'AMOUNT RECORDS MANAGEMENT FEE - MAJOR 101-0000-42416 0 $20.00 Total Paid for RECORDS MANAGEMENT FEE - MAJOR: $20.00 DESCRIPTION ACCOUNT QTY AMOUNT TECHNOLOGY ENHANCEMENT FEE 502-0000-43611 0 $5.00 Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00 TOTALS: $754.1 r Bin# Yn Permit# 7 ,{� City of La Quinta n i o Building &Safety Division - I 1 J 78-495 Calle Tampico b -I La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Project Address: 1 Owner's Name: A.P. Number Address:ZG4 to G S Legal Description: � � City, ST, Zip: CO2-0 C�(� �,n fj zglq C•+' _1_ Contractor: ,l V 4 Z COtUS t UG i (-0A) SJS Telephone: aS 1- 6-- 1'40 Address:Project GI� ZS S�-P� 56tJ �i5 Description: City, ST, Zip: G Z� W 1. Q.i> co (oD j Z,_k0QAL �' r — i z'' Telephone: Z ' Z) 5O _ State Lic. #:(a/ Q �o City Lic #: D Arch, Engr., Designer:lltP Address: 2J6 0 5 Nc)`4 City, ST, Zip Telephone:, 1 �06 Construction Type: Occupan:y: State Lic. #:^"7^— ,GS Proj. Type New Add'n Alter Repair Demo Name of Contact:SgFt: . � 0 0,1,�) ,aAr)ea #Stories # Units: Telephone of Contact: q00qZ00 Estimated Val e of Pr t:, 2 625 APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT•FEES Plan Sets Plan Check Submitted 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 Construction: Flood Plain Plan Plans Resubmitted Mechanical: Grading Plan 2nd Rev, Ready for corrections / Electrical- lectricalSubcontractor SubcontractorList Called Contact Person Plumbing: Grant Deed Plans Picked Up S.M.I. HOA Approval Plans Resubmitted Grading IN-HOUSE 3rd Rev, Ready for corrections / Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Apps Date of permit issue School Fees Total Pernit Fees La�TQ Gi yof,La_Quinta. .� o� Design and Development Department 78-495 Calle Tampico �- L`a Quinta, CA 92253 Q U S� Tele hone; (760)777 7125 Fax: (760)777-1233 ' .�.� p �FMOFTN�° www.la-quinta.org; , NOV 1 4 2017 Riverside County Fire.Department ��¢� 10 r. Riverside Office GDM I 0 EVELOPMENT DEPARTMENT 2300 Market Street, Ste. 150 Riverside, CA 92501 (951)955-4777 FIRE REVIEW APPLICATION ❑ NEW ❑ ` TENANT IMPROVEMENT PERMIT NO: Project Name �f �� `L �P ( Sign: t��F�� Site Address] (='y) Print?. � 1 c • city .& Zip': •; , ; �Pursua.nt to a Cooperative Agreement to Provide Fire Services, the'Riverside County Fire Depdrtment serves'as the City's fire department, and -the County designee serves as the City's fire chief. Applicant recognizes this .-contracted arrangement and shall comply with'County Fire Department directions. 'u?-+a7i •.„.s:,rays,trrnrsa.-„u.2��rna : ., ..,. ,e ,c:.�.a.,.m. ..v._t...,,;erry.xr..*,,>.. ,�s'2'�$ r.a... : �:` •. '+,"j. _ �APPLICtA„�NT�%C�O�NT�A►CT IN�,�fORMATI,ON O�,NTR�►CTOR�IN�f�O$RM4ATION: �.S,��e�s Appi�ca�fi�anf® . Applicant Name: (Q Q��Crp� �� j U L � Contractor: Contact Person','� t s C,o Lf-, Contact Person: -Mailing Address a� �'ay S !� (�P Mailing Address: City & Zip E Jv� u ,r`�D �1,� . cl l -7 fl City & Zip:' Phone Number: ��393 Fax:' 2-3 3i Z Phone Number: Fax” Email: Email:' A. APPLICATION TYPE ' IRESI'RINKLERISYSTEMAM- '.,SUPRESSIONfrSYSTEM. ,s r. ❑ ;NEW COMMERCIAUINDUSTRIAL ____________ ❑ HOOD,&DUCT ❑ 0-35;000 SQ FT $639 ❑ SPRAY BOOTH $795 .;. ❑ 35;001-75,000 SQ FT $756 ❑ :CELL SITE $795 ❑ 75,001-120,000 SQ FT. $9S1 "0 OTHER.SUPRESSION SYSTEM $7g5 :. ❑ 120,001 AND UP: $1185 , ❑ TI'COMMERCIAL/INDUSTRIAL$405 ❑ HAZMAT $327, -' ❑- RESIDENTIAL 17 DWELLING UNIT . $405 ❑ HIGH PILE RACK STORAGE` $327 ❑ RESIDENTIAL - (EA) ADDITIONAL x $390 ❑ NEW COMMERCIAL - U/G WATER $483-,-, 483 - 0 0 MULTI-FAMILYQ OR MORE) $561 ❑ FIRE FLOW REPORT, $327 FIRE gLARM SYSTEM; = , , ❑ TECHNICAL REPORT.RESEARCF HOURLY @ $156/HR ❑ .COMMERCIAL -SPRINKLER MONITORING $405. ❑ _SPECIAL INSPECTION $161 ❑ COMMERCIAL -FIRE ALARM SYSTEM $3092 ❑ . FIRE PUMPS . $639 ' ;- IREALARM SYSTEM ❑ 5TANDPIPE SYSTEMS-' $561 , ❑ COMMERCIAL -SPRINKLER MONITORING $405 ?... ❑ WATER TANKS .` $390 ❑ COMMERCIAL- FIRE ALARM SYSTEM $1092. STQR�AGET�ANKS• �`"" DISPENSERS ONLY HouRLY.@ $156/HR ❑ ABOVE GROUND . HouRLr @ $156/HR Fnrh nnnlirntinn tuna inrluAac n Tarhnnlnnv Fnh'n'nramPnt Faa55 f Rairidc Mnnnnamanh Fva 51(1 �, - rr.'--a.e 3- Permit Permit Number: BOTH2O17-0014 -Applied:l0/3/2017 Approved: Issued Finaled Status:'UNDER REVIEW Parent Permit: Parent Project .Details:,. i REMOVAL'`&REPLACEMENT•OF FUEL•DISPENSERS �v RETURNED ` " 4�� 144 E�„N�T MUM `a Review Group: ALL 10/3/2017 10/5/2017 10/17/2017 1S Note READ Y FOR T.FIRE (1 WK) , RONALD GRIESINGER Collect Fees APPROVAL 1ST BLDG NS (2 WK) LANNING.(2 WK) BUILDING BUCKET - CHERI FLORES