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05-5555 (CSCS)4 P.O. BOX 1504 78-495 CALLE TAMPICO LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT BUILDING PERMIT Application Number: 05-00005555 Owner: Property Address: 79795 HIGHWAY 111 COSTCO WHOLESALE CORP APN: 649-030-087- - - 999 LAKE DR Application description: NEW COMML - SERVICE STATIONS & GARAGES ISSAQUAH, WA 98027 Property Zoning: COMMERCIAL PARK Application valuation: 91127 Contractor: Applicant: Architect or Engineer: W L BUTLER CONSTRUCTION, 7 GOODYEAR IRVINE, CA 92618 (949)587-2206 Lic.' No.: 355353 LICENSED CONTRACTOR'S DECLARATION 1 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 L/iC' nse No.: 355353 'Date:.)/ Contractor: (��f�/ 10�M�r{i \ _ - 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).: (_ 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.). (_ 1 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.). 1 _ 1 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: LQPER114IT - VOICE (760) 777-7012 FAX (760) 777-7011 INSPECTIONS (760).777-7153 Date: 5/23/06 D Q MAY 2 5 2006 N . CITY OF LA QUINTA FINANCE DEPT. ----------------------------------------------- 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 ABD INS Policy Number 71WC12012701 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 t 700 of the Labor Code, I sha[ILLorthVicomply with t_ho-se`rovisions. Date: ✓ 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 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 a r to comply with all city and county ordinances and state laws relating to building construct , a hereby orize representatives of this county to enter upon the above-mentioned propert pur oses. Date: rSignature (Applicant or Agent): ' Application Number . . . . . 05-00005555 Permit . . . BUILDING PERMIT Additional desc . Permit Fee . . . . 603.50 Plan Check Fee 392.28 Issue Date . . . . Valuation 91127 Expiration Date 11/19/06 Qty Unit Charge Per Extension BASE FEE 414.50 42.00 ---------------------------------------------------------------------------- 4.5000 THOU BLDG 50,001-100,000 189.00 Permit . . . ELEC-NEW COMMERCIAL Additional desc . Permit Fee . . . . 91.80 Plan Check Fee 22.95 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/19/06 Qty Unit Charge Per Extension BASE FEE 15.00 3840.00 ---------------------------------------------------------------------------- .0200 ELEC GARAGE OR NON-RESIDENTIAL 76.80 Permit . . . GRADING PERMIT Additional desc . Permit Fee . . 15.00 Plan Check Fee .00 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/19/06 Qty Unit Charge Per Extension ----------------------=----------------------------------------------------- BASE FEE 15.00 Permit MECHANICAL Additional desc . Permit Fee 124.00 Plan Check Fee 31.00 Issue Date Valuation 0 Expiration Date 11/19/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 9.0000 EA MECH FURNACE <=100K 9.00 1.00 9.0000 EA MECH B/C <=3HP/100K BTU 9.00 14.00 ---------------------------------------------------------------------------- 6.5000 EA MECH OTHER MECH EQUIPMENT 91.00 Permit PLUMBING Additional desc . r LQPERMIT Application Number . . . 05-00005555 Permit . . . . . . PLUMBING Permit Fee . . . . 78.00 Plan Check Fee 19.50 Issue Date . . . . Valuation . . . . 0 Expiration Date 11/19/06 Qty Unit Charge Per Extension BASE FEE 15.00 1.00 15.0000 EA PLB BUILDING SEWER 15.00 8.00 6.0000 EA PLB ROOF DRAIN -- 48.00 ------------------------------------------------------------ Special Notes and Comments -------------- COSTCO GAS STATION CANOPY 3,840 SF (120 FT X 32 FT)TYPE II -N CONSTRUCTION, S-3 OCCUPANCY. PERMIT INCLUDES 8 PUMP DISPENSERS, CONTROLLER ENCLOSURE (75 SF). **PERMIT DOES NOT INCLUDE TEMPORARY POWER AND SITE LIGHTING.** 2001 CBC,CMC,CPC, 2004 CEC, 2005 ENERGY CODES NOTE: 2005 DIF FEES ASSESSED.BLDG AREAS (149,646 SF) ADJUSTED INDIVIDUALLY IN HTE TO REFLECT FEE INCREASE. TRANS=52.668%, CIV. CTR=64.211%, fIRE PROT.=40.625%, STREET MAINT=460.87% ---------------------------------------------------------------------------- Other Fees . . . . . . . ACCESSIBILITY PLAN REVIEW 39.23 ART IN PUBLIC PLACES -COM 435.63 .DIF CIVIC CENTER - COMM 599.03 ENERGY REVIEW FEE 39.23 DIF FIRE PROTECTION -COMM 172.80 STRONG MOTION (SMI) -.COM 19.13 DIF STREET MAINT FAC -COMM 407.03 DIF TRANSPORTATION - COMM 10106.88 Fee summary Charged Paid Credited --------------------------- Due ------------------------------ Permit Fee Total 912.30 .00 .00 912.30 Plan Check Total 465.73 .00 .00 465.73 Other Fee Total 11818.96 .00 .00 11818.96 Grand Total 13196.99 .00 .00 13196.99 LQPERMIT Proudly serving the unincorporated areas of Riverside County and the Cities of: Banning Beaumont Calimesa Canyon Lake Coachella Desert Hot Springs Indian Wells Indio Lake Elsinore La Quinta Moreno Valley Palm Desert . Perris Rancho Mirage 4. San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Jeff Stone, District 3 Roy Wilson, District 4 Marion Ashley, District 5 60 RIVERSIDE COUNTY FIRE DEPARTMENT 210 West San Jacinto Avenue • Perris, California 92570 • (951) 940-6900 • Fax (951) 940-6910 7q 745 H 16WWAY. I I Date�—o(.(�—b Gomco GAS bLAT109 City of La Quinta Building Department RE The Riverside County F're epartment i granting the Fire clearance for the following location 7 Q -,7 V GAS .S770776A! Please call i you should have questions 760-863-8886 Respectfully By Terry DeSoucy Fire Systems Inspe ■ . Nov. 14. 2006 3:41PM y i ET ENVIRONMENTAL CORP ■ OV -1`i LUUU tut; ai - IU ttu WL uuitrn vvutvv uv 27608631LNi`� X780 P. 1P. 001/001 IJNIFTFD PROGRAM CY)NSC)T.MATrLD FORM TANKS UNDERGROUND STORAGE TANKS - FACILITY (one page per flim) Page - of, TYPE OF ACUON .12W STPE PERMIT 3. RENEWAL P0Mr . ❑ 3,a WGE OF INFORMATION ❑ 7.)?SLMAr'E1-TTf-Y CLOSED SrrE (Check one item a* ❑ 4. AMBNDBD PBR)&T opacity thenge local use only ❑. B. TANK REMOVED (] 6.TEMPORARY SITE CLOSURE r a00 L FACILITY / SITE INFORMATION BUSINESSNAML(swoasrAcLrrywAm0rDJ1A-Dolatlw+bsdAt) IFACfTtTYID# :E ' Co�7C C i NEAREST CRO /S rte` ,, p 401 � FACQ.iTY OWNER TYPE 4. LOCAL AGEIdCY/DLSTRICT" Gi3 T /i r�y7YJU1(�6 pi 1. CORPORATION ❑ S. COWN AGENCY" ❑ 2. INDIVIDUAL ❑ S. STATE AGENCY - BUSN'ES5 ). GAS STATION 0 3. FARM 0 5. COMMERCIAL TYPE tj 2. DISTRIBUTOR [34. PROCESSOR ❑ 6. OTHER 403 ❑ 3. PARTNERSHIP ❑ 7. FEDERAL AGENCY* 402 TOTAL NUMBER OF TANKS U foci lity on Indian Reaeration or "1f owner o UST a public agency, none o rup:rvisor w division, acroon or o5icc which RHMAIHING AT SITE Wwdattds7 opamte4 :ha UST CIhis is the coma person for the tack records,) ❑ Yes No Oat 4M II. PROPERTY OWNER INFORMATION PROPERTYOWNHRNAME 407 PHONE 408 2R NOI N 409 CITY ISSAQU,�If 410 1 STATE / 'n alt I ylpQ3D27 412 PROPERTY OWNER TYPE 1. CORPORATION 2. INDIVIDUAL 4. LOCAL AGENCY / DISTRICT 6. STATE AGENCY [13. PARTNERSW ❑ 5. COUNTY AGENCY ❑ 7. FEDERAL AGENCY 431 M. TANK OWNER INFORMATION . T OX/ fA fl/i rVCJI.C. 614 OX ( y� � PSONT7 415 MAB.jTaj(jJ,�R'MA' It,ES6k 416 CITY"MJ 4u GI STATE n ae ZIP CODE g?2 419 TANK -OWNER TYPE 1. CORPORATION Lj 2. INDIVrr L3 4. LOCAL AGENCY I DISTRICT U 6. STATE AGENCY 420 3. PARTNERSHIP 0 3, COUNTY AGENCY ❑ 7, FEDERAL AGENCY IV. BOARD OF EQUALIZATION UST STORAGE FEE ACCOUNT NUMBER TY HQ 44- 1 1 1 1 1 1 Call 916 322-9669 if questions arise 421 V. PETROLEUM UST FINANCIAL RESPONSIBILITY INDICATE METHOD(6)9, SELF-INSURED ❑ 4. SURETY BOND ❑ 7. STATE FUND [310, LOCAL GOVT MECHANISM 2. GUARANTEE ❑ S. LETTER of CREDIT ❑ B. STATE FUND & CFO LETTER [199. =Em - [13. INSURANCE ❑ 6. EXEMPTION ❑ 9. STATE FUND & CD .422 VI. LEGAL NOTIFICATION AND MAILING ADDRESS Chalk one box to irAcate Which address should be used for lapel andflcwdona and tceWor. Leal aodIIadens aad matlogt wt71 be sent to the tank owner unless box 1 or 2 h chseksd. ❑ 1. FACR.ITY ❑ 2. PROPERTY OWNER . TANK OWNER 423 VII. APPLICANT SIGNATURE C&td! -J gift' u the iatbrroadon ptovtdcd heron Is crus and accurate to the best of my lmowlcdgc. SI LICANT DATE 42A TTEP"NE 425 ll Ili •3l V NAXIE OF t . (print) qF APPIWANT 427 6W ! M 1. ATE UST FACILITY NUI W& (par 1am1 ass only) 4n 1998 UPGRADII CERTIFICATE NUMB Ek (par l -a me pnly) 4 =' UPCF (1/99 ravis ) Formerly 8WRC13 Form A