BOTH2018-0001y � 4�i
78-495 CALLE.TAMPICO .. � D � �Ntill��il/
LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT
BUILDING PERMIT
Permit Type/Subtype:
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
'Applicant:
EDNA GALINDO
6022 BLACKTHORNE
LAKEWOOD, CA 90712
STRUCTURE OTHER THAN BUILDING/
BOTH2O18-0001_
79513 HIGHWAY 111
600020009
CHEVRON / UNDERGROUND STORAGE TANK AND DISPENSER
CHANGEOUT
$80,000.00
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 my License is in full force and effect.
License Class: B. A License No.: 831002
Date71� G
: 9 h Contract
OWNER -BUILDER DECLARATION
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.).
(� 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:
VOICE (760) 777-7125
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Owner:
G&MOIL CO
16868 A ST
HUNTINGTON
Contractor:
F R CONSTRUCTION IN
2410 RAINBOW GLEN I
FALLBROOK, CA 92028
(562)860-6593
Llc. No.: 831002
______Date 6/.4/2018
1402253
n
•r' G o
al
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
9wect_iorFW00 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: ACE AMERICAN INSURANCE COMPANY Policy Number: RWCC64400186
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.
att7 e: s Applicant
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 Building Official 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.
1 certify that 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 -mention
e
d property for inspection purposes..
Date: (�( Signature (Applicant or Agen
Date: 6/4/2018
Application Number:
BOTH2O18-0001 Owner:
Property Address:
79513 HIGHWAY 111 G & M OIL CO
APN`.
600020009 16868 A ST
Application Description:
CHEVRON / UNDERGROUND STORAGE TANK AND DISPENSER CHANGEOUT 'HUNTINGTON BEACH; CA 92253
Property Zoning:
Application Valuation:
$80,000.00
Applicant:
Contractor:
EDNA GALINDO
F R CONSTRUCTION INC
6022 BLACKTHORNE
2410 RAINBOW GLEN ROAD
LAKEWOOD, CA 90712
FALLBROOK, CA 92028
(562)860-6593
LIc. No.:831002
Detail: 10,000 GALLON DOUBLE
WALL E-85 UNDERGROUND STORAGE TANK INSTALLATION AND CHANGE OUT OF SIX (6) FUEL DISPENSERS. THIS PERMIT
DOES NOT INCLUDE MODIFICATION TO THE EXISTING RETAIL STORE OR FUELING CANOPY. 2016 CALIFORNIA BUILDING CODES.
• J
FINANCIAL• ' ' •
DESCRIPTION ACCOUNT CITY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $4.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $4.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
APPLIANCES, NON-RES
101-0000-42403
0
$156.06
DESCRIPTION
ACCOUNT
CITY
AMOUNT
APPLIANCES, NON-RES PC
101-0000-42600
0
$156.06
Total Paid for ELECTRICAL: $312.12
DESCRIPTION
ACCOUNT
QTY.
AMOUNT
FIRE STORAGE TANK - DISPENSERS
101-0000-42421
.3
$468.00
Total Paid for FIRE FEES: $468.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
PERMIT ISSUANCE
101-0000-42404
0 .
$98.83
Total Paid for PERMIT ISSUANCE: $98.83
DESCRIPTION
ACCOUNT
QTYI
AMOUNT
RECORDS MANAGEMENT FEE - MAJOR.
101-0000-42416
0
$20.00
Total Paid for RECORDS MANAGEMENT FEE - MAJOR:" $20.00
DESCRIPTION
ACCOUNT
CITY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
TOTALS:••
w �+
.._........
PERMIT # '
PLAN LOCATION: 2 9
Project Address: s 13
Project Description: Pool, Remodel, Add't, Elect, Plumb, Mech
APN #:
1
Applicant Name: 6.
S S
Address:.
City, ST, Zip:
Telephone: JWd l�
Email:fr ConS c�h i5p
Valuation of Project $ GDO
V�e�um,, r-e-t-
Contractor Name: cJ� C
New SFD Construction:_
Address: l
Conditioned Space SF
City, St; Zip
Garage SF
Telephone: r1
C7- 9 Co
Patio/Porch SF
Email:
7
Fire Sprinklers SF
State Lic: 31 061. City Bus Lic:
Arch/Eng Name:
Construction Type: Occupancy:
Address:
Grading:
City, St, Zip
Telephone:
Bedrooms:
Stories:
# Units:
Email:
State. Lic: City Bus Lic:
Property Owner's Name: .G ��
New Commercial / Tenant Improvements:
,Address: 6 $ c)
Total Building SF
City, ST, Zip
Construction Type: Occupancy:
Telephone:
Email:
78495 CALLE TAMPICO
LA QU I NTA, CA 92253
760-777=7000
-A: -APPLICATION TYPEr
JFI[tE4SPRINKLERfSYSTEM. °`;
�SUPRESSIQN SY$TEIN '" FIMMNAM
0, ;NEW COMMERCIAL/INDUSTRIAL
__________, °
0 HOOD &'DUCT '. r
. , ...
$405 ,..
"..0`0=35,000. SO FT, :.
. . ..
$639
,❑ SPRAY -BOOTH-
$795
35;001-75,OOQSQ FT
❑,CELL,SITE
❑ 75,001.1'20,000:SQ,FT :
$951
❑ `OTHER.SUPRESSION SYSTEM • ' .
$795
❑ 1201'001 AND UP
$118S
mMIS;C
❑ .TI COMMERCIAL/INDUSTRIAL.
$405
'10 .:.HAZMAT
$32T
❑,. RESIDENTIAL-1 DWELLING UNIT.
1.
�"❑ �x.>
$405, ',.
❑ ; HIGt.H PILE RACKSTORAGE
$327
RESIDENTIAL(EA)•ADDITIONAL'-'
❑.'NEW COMMERCIAL-'U/G.WATER.'
0„ MULTI-FAMILY,(3 OR MORE)
$561
0'"-FIRE FLOW REPORT .
$3Z7
�4FIRE ALARM SYSTEM
❑. TECHNICAL REPORT, RESEARCH"'
'HOURLY@$15e/HR
0, {OMMERCIAL - SPRINKLER MONITORING,.,
-$405
0N; '' SPECIAL. INSPECTION;
$161`
0.,' COMMERCIAL - FIRE�ALARM SYSTEM
$1092 �"
❑ ° FIRE•PUMPS
$639"
FIREALARM SYSTEM " '
❑. STANDPIPE SYSTEMS
❑ 'COMMERCIAL SPRINKLER MONITORING_
$405'
❑ ,WATER.TANKS :
$390,"
❑ COMMERCIAL - FIRE ALARM SYSTEM
$1092
STOR�GEA0KSIffl6,
- ❑" DISPENSERS ONLY '
HOURLY @ $15e/HR
❑: 1AB.OVE GROUND „`
..
HOURLY @ $156/HR
.. ,.
,.
Each opplication type includes a Technology Enhancement Fee$5.& Recokds Management Fee $10
,
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