14-0272 (RC)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Td4t 4 4 0"
Application Number:
14-00000272
Property Address:
79795 HIGHWAY 111
APN:
600-020-033- - -
Application description:
REMODEL - COMMERCIAL
Property Zoning:
COMMERCIAL PARK
Application valuation:
50000
A
Appj' and Architect or Engineer:
01 �-- X)AL
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
COSTCO WHOLESALE CORP
999 LAKE DRIVE
ISSAQUAH, WA 98027
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/17/14
II
APR. 2011, {�
L.}
CITY OF LA QUANTA
-- - - - - - - - - - ----------------------------------- _----------------- ----- - - - - -j _ --_..---
LICENSED CONTRACTOR'S DECLARATION WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perju that I am licensed under provisions of Chapter 9 (commencing with I hereby affirm under penalty of perjury one of the following declarations:
Section 7000) of Division 3 of the Busin and Professionals Code, and my License is in full force and effect. _ I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided
License Class- B Li, 66177 for by Sec7pe.on',
he Labor Code, for the performance of the work for which this permit is
` is
sued.
f7aie: contractor: _ I have and III miker8' compensation insurance, as required by Section 3700 of the Labor
_ �� a -5 Code, f hece of the work for which this permit is issued. My workers' compensation
"YOWN ILDER DECLARATION insurance icy number are:
1 hereby affir under penalty of perjury that I am a pt m the Contractor's State License Law for the Carrier EVEREST INSPolicy Number 760006791
following reason (Sec. 7031.5, Business and Pr ns C e; Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any stru 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).:
1 �) 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:
Contractor:
HARVEY INC
8973 COMPLEX DRV,
SAN DIEGO, CA 92
(858)769-4000 1
Lic. No.: 8661771
I cartity that, in the ormancs of the work for which this permit is issued, I shall not employ any
person in any mertner as to become subject to the workers' compensation laws of California,
and agree that, if I shouk ma subject to the workers' compensation provisions of Section
371 of the Labor Code, Is
I forthwith comply with
ovisions.
4
Date: Applicant:
WARNING: VIE TO SECURE WORKERS' COMPENSAT COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND IVI PINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDITION TO THE COST OF OMA SATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND TTO EY'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 appl�ca tc, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, ents and emplc es for any act or omission related to the work being
performed under or foiiowi issuance of this permit.
2. Any permit issued as a result is application becomes null and void if work is not commenced
within 180 days from date of )ss 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 t hove information is correct. I agree to comply with all
city and county ordinances and state laws relating to buildin nsiruction. and hereby authorize representatives
of this. my to anF{{er upon the abrne-mentioned property for i ection purposes.
,Dare: { 151gnature (Applicant or Agerrri:'-
V
LQPERMIT
Application Number . . . . . 14-00000272
Permit .
. . . . . ELECTRICAL 2013
Additional
desc . .
Permit Fee
. . . . 71.49 Plan Check Fee
.00
Issue Date
. . . . Valuation
0
Expiration
Date . . 10/14/14
Qty Unit Charge Per
Extension
3.00
23.8300 EA ELEC APPLIANCES, NON-RES
71.49
Permit _
. . . _ . MECHANICAL 2013
Additional
desc . .
Permit Fee
. . _ _ 23.84 Plan Check Fee
.00
Issue Date
. . . Valuation
0
Expiration
Date . . 10/14/14
Qty
Unit Charge Per
Extension
1.00
11.9200 EA MECH APPL REP/ALT
11.92
1.00
-----------------------------------------------------------------------------
11.9200 EA MECH EXHAUST HOOD
11.92
Permit
_ . . PLUMBING 2013
Additional
desc . .
Permit Fee
. . . . 35.76 Plan Check Fee
.00
Issue Date
Valuation . . .
. 0
Expiration
Date _ 10/14/14
Qty
Unit Charge Per
Extension
3.00
----------------------------------------------------------------------------
11.9200 LS PLEG GAS SYS, 1-4 OUTLETS
35.76
Permit
. . . REMODEL 2013
Additional
desc . .
Permit Fee
. . _ . 70.07 Plan Check Fee _
.00
Issue Date
. . . . Valuation
0
Expiration
Date . . 10/14/14
Qty
Unit Charge Per
Extension
1.00
48.6200 LS MISC REMODEL, 1ST 100 SF
48.62
1.00
21.4500 EA MISC REMODEL, ADDL 500 SF
21.45
----------------------------------------------------------------------------
Special Notes
and Comments
REMOVE AND
REPLACE PIZZA OVEN AND HOOD
March 28,
2014 12:45:53 PM JJOHNSON.
-----------------------------------------------------------------------------
Other Fees
. _ _ PLAN CHECK, ELECTRICAL
71.49
PLAN CHECK, REMODEL
150.15
LQPERMIT
Application Number . . . . . 14-00000272
Other Fees PLAN CHECK, MECHANICAL 9.54
PLAN CHECK, PLUMBING 23.83
STRONG MOTION (SMI) - COM 10.50
Fee summary Charged Paid Credited Due
Permit Fee Total 201.16 .00 .00 201.16
Plan Check Total .00 .00 .00 .00
Other Fee Total 265.51 .00 .00 265.51
Grand Total 466.67 .00 .00 466.67
LQPERMIT