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07-0918 (SOTB)P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 Application Number: 07-00000918 Property Address: 79795 HIGHWAY 111 APN: 600-020-.033- - - Application description: STRUCTURES OTHER THAN BUILDINGS Property Zoning: COMMERCIAL PARK Application valuation: 65000 Applicant: Architect or Engineer: BUILDING & SAFETY DEPARTMENT BUILDING PERMIT -------------------------------------------------- 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 C9 License No.: 436418 Date: Contractor: 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.). 1, 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: / caner: i 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: .� Owner: KOMAR INV 23 CORPORATE PLZ STE 247 NEWPORT BEACH, CA 92660 Contractor: BERGMAN COMPANIES, THE 4300 EDISON AVENUE CHINO, CA 91710 (909) 627-3651 Lic. No.: 436418 � VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Date: 9/04/07 WORKER'S CMP SATION DECLA�i%\ ;� ,<'� 1 hereby affirm under penalty of perjury one of the fo owin jg s: 007 1, _ I have and will maintain a certificate of consent to i�6 grs' comp ation las provided for by Section 3700 of the Labor C� for the p m�, ch tf s permit is issued. _ I have and will maintain workers' compensation insurance, ction 370 of the Labor Code, for the performance of the work for which this permit is issued. y compensation insurance carrier and policy number are: Carrier RICAN INTL Policy Number WC5312540 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, 3Ashould become subject to the workers' compensation provisions of Section �/r �jjj3700 of the or de, I hall forthwith comply w" those provisions. ate: ff pplicant: 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 co ty to enter upon the ove-mentioned property for i spection purposes. /' , e: Sig ure (Applicant or Agentl: LQPERMIT Application Number . . . . . 07-00000918 Permit . . . BUILDING PERMIT Additional desc . . 15 LIGHTSTANDARDS W/FOUNDTN Permit Fee . . . . 482.00 Plan Check Fee 313.30 Issue Date . . . . Valuation . . . . 65000 Expiration Date . . 3/02/08 Qty Unit Charge Per Extension BASE FEE 414.50 15.00 4.5000 THOU BLDG 50,001-100,000 67.50 ---------------------------------------------------------------------------- Permit . . Additional desc . Permit Fee . . . Issue Date . . . Expiration Date . ELEC-MISCELLANEOUS 26.25 3/02/08 Plan Check Fee . . 6.56 Valuation . . . . 0 Qty Unit Charge Per Extension BASE FEE 15.00 15.00 .7500 EA ELEC POLE LIGHT 11.25 ---------------------------------------------------------------------------- Special Notes and Comments 15 QTY X 30 FT HGT. LIGHT STANDARDS WITH FOUNDATION. 2001 CBC,CMC,CPC, 2004 CEC, 2005 ENERGY CODES. ---------------------------------------------------------------------------- Other Fees . . . . . . ENERGY REVIEW FEE 31.33 STRONG MOTION (SMI) - COM 13.65 Fee summary ------------ Permit Fee Total Plan Check Total Other Fee Total Grand Total Charged Paid 508.25 .00 319.86 .00 44.98 .00 873.09 .00 Credited Due .00 508.25 .00 319.86 .00 44.98 .00 873.09 LQPERMIT www.mtglinc.com Corporate: 2992 E. La Palma Ave. Ste. A Anaheim, CA 92806 Tel: 714.632.2999 Fax: 714.632.2974 Dispatch: 800.491.2990 MTGL Project #: 2/ /1--0 Z San Diego/Imperial County' 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 Permit # ezogi3 ?Tc�fZ - qW DAILY INSPECTION Report# ( PG DF REPORT Inland Empire: 14467 Meridian Pkwy., Bldg.2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non -compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. PROJECT NAME f_ m 7)ee e DATE f-( 7 ARCHITECT �� TIME ARRIVED TIME DEPARTED Md ENGINEER , TRAVEL TEMME�}, LUNCHTIME Y CONTRACTORSUB SJBCONT ® �� /1-��6 SE l%'r c . C..�7 INSPECTION ADDRESS c� % % �l�/ ADDRESS OF PROJECT 77 - 795 /4 1/1 L L- Cie, t TYPE OF INSPECTION ❑ BATCH PLANT ❑ MASONRY ❑ FIREPROOFING ❑ CEILING WIRE ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ HIGH STRENGTH BOLTING ❑ ANCHOR/DOWEL ❑ ❑ FOUNDATION 0 WTCRETE ❑ WELDING ❑ NDE FIELD ❑ ❑ BACK FILL gftONCRETE ❑ SHOP WELD ❑ NDE SHOP ❑ DSA/OSHPD/PROJECT: AVAILABLE: SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERIALS USED BY CONTRACTOR (INCLUDE RESEARCH REPORT NO. OR MATERIAL TEST REPORTS): e-o,fc.4 if /ill, 14 5-6a C-? Z ro 7�� p s. CONTRACTORS EQUIPMENT/MANPOWER USED: J AREA, GRID LINES, PIECES INSPECTED: 7 r�� V L 2?iL,,. - s.- G ¥--if- A-Yy--- Ci'C XX 4v-4r y 444,— .P 11 vet,- Few. f G J 4 ' (z.3' 4'du- 44- A/0 /t7'!f .o qe. .P4— 4,44G= eo':4— STRUCTURAL NOTES, DETAIL, OR RFIS USED: REMARKS, INCLUDING MEETINGS: p 07g5 �r �v /, - ?ti ? Piee ,:y1c,176`d 5.,10)47/,,4C-FN'� C Ze ei-e47'G ',,,e_e7..r' C/e- /6:z.6'er-a- 377d'9- 4 7�_ "S , REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WA3L WAS NOT Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents MATERIAL SAMPLING WA WAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED MET ❑ DID NOT MEET ❑ THE requirements d the DSA/OSHPD/PROJECT approved documents. Samples taken: I 5 7 Weather: ed`r— Temp: 78 Signature of Special Inspector Print Name Certification #: Verified by: _