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0304-103 (CSCS)LICENSED CONTRACTOR 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 # Lic. Class� f�� Exp. Date ((X/,y(; -Z r`+C.f j •'� f��' Zate Signature of Contractor s+ OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 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 & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec._ 7044, Business & Professionals Code). O I am exempt under Section B&P.C. for<if is reason. Date , 9°°--��->Signature of Owner 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 Stiction 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier EXEMPT Policy No. (This section need not be completed if the permit valuation is for'$100.00 or less). () 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 thapif I should become subject to the workers' compensation provisions of Sectibn 37.00 Ythe'Labor Code, I shall fortd._hwith,comply with those provisionsi Cif:., <G..fi'Applicant— W", r� 'r'D .Date: rte= i Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $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. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his 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 applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 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 State laws relating to the building construction, and hereby authorize representatives fo,fthis City to enter upon the above-mentioned property for linspection p ,fpdssA. `Signature (Owner/Agent)/ir!r+�i? Date BUILDING PERMIT PERMIT WZ3 DATE 41 9i VALUATION i�;,Q-Jf LOT TRACT JOB SITE ADDRESS (�il a� .-fA. i� +� a. �i APN OWNER CONTRACTOR / DESIGNER / EN &NEER DAT.- FRAWK & iiMOCU. .0 1AAA 402 c;1��F�saa. st:ir,a 1A 19W .`&Eall M -W -M ??"g, 4015 W.. q :Et;ai'SCkLI",=. ) Av+.53-To ? WN.::1K ,.42TL AW) 'i A 98046 PANORVAA C:iTY CA 91402 (1813)920-48,57 CMA Lbd USE OF PERMIT Sptu.6.n.;t Y -R' °1":�'fd • L.�e:i:..t.[,Jli, 1±i3 . 200f CODO 11 � :e','> �.C�J!:,f•l�i9 8,11RD PER (JAC X304,5 FOR WOkK Src3Lrt:111Vit5 I ill'A.T. INO PERMIT. F. nil'mrr V77 SUMMARY PUN Cl"MC.9 J`R8 IPS'E.Z*,0_431-9311 3 P1C30 CrUMSTRUCTk53.d FF' . 101.410101416_000 ;� .40 ELECTRICAL ME 101-01."'10-420-000 $12 1 15D N it -IR J` O 1110} i 10(tY FRE, • Fi i�i�it'1 A 47 i5' Vt9\t^,4rS/• D, -.000 WEST ICUA9 0111 hitt APR 09 2003 CITY OF LRA QUIIIITA FIldANCE DEPT. 1.65 RECEIPT DATE y r i• BY E, �d I DWATI A D INS E R a_ U a Job Cc¢ w CL Z z f ¢ }` w w w - C Z 0r- w _ F O -- - • ' is: a 2 cr _ • _ .] a C] ZO wa U F- O .. ."_ _. r I_�ti Cam,! •" C- f Ul ICE W _ ._ ❑- = m a ... . ti -- r ZLD W LU o co O - ° > C m 1 o 'N m RR a a. . '•,I m Z - Y w O =3 — Q c c0 a ' J UN C: - o —O y � - m O o U O r- ro Q i J O c c (D U o Z o_ c U a) a) o O O U " 0 U W c �: E m fA a) 0) -o c Z c cca (n W U U a a) c � � E o E o U U n cu '. 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P. Number: 7607777011 LA QUINTA PAGE 01 CitY of La Qulnta _ Building at Safety Division P.O. Boz 1504, 78-495 Cane Tampico La Quln[a, CA 92253 - (760) 777-7012 Bullding Permit Application and Tracking Sheet 78Y C+.A�,'/ 0uner s Name: Address: Xn% ST. Zip: Z Contractor: M� NO / %>'�q�i►.VA Ci8S FTelephone: rCa-Z)36G-,3999 x Address: 76. f�vE Project Description: Cit)'. ST. Zip: K Telephone: - 4 r�a/cA. X Statc Llc. # ; 7S',2 97, �IA Yei&Aes Cine Lic. #: AA Arch.- Engr._ Designer: Address: Citi•. ST. Zip: Telephone: Stare Lic. #: X Name of Conract Person: x Telephone # of Contact Pe Submittal % Plan Sets Structural Colrs, Truss Cales. Energy Calcs. Flood plain plan Grading plan Subcontactor List Grant Deed R-O.A. Approval IN HOUSE: - Planning Approval Pub. Wks, Apar Scboal Fees Conmcdon Type: Occupancy: Proiect type (circle one) N eta Add n Alter Repair Demo Sq. Ft.: /33G Stories: k Units: rson. 60.2 -J6'- -fY99 --z' %OGS Esr,mated value of Proiect: 5000 APPLICANT. DO NOT WRITE BELOW THIS LINE 'd FReed I TRACKING Plan Cbeck submitted Reviewed. ready for corrections Called Contact Person Plans picked up Plans resubmitted 2" Review. ready for corrections/issuc Called Contact person Plans picked up Plans resubmitted 3'd Review, re==:4 Called Contact Person Date of permit issue ( [ 05 Item PERMIT FEES Amount Plan Check Deposit Pian Check Balance Construction Mechanical Electrical Plumbing 5.1.1.1. Grading Developer Impact Fee A.1_P.P. Total 2 1 k 1 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • 9 • Fax 0 March 12, 2003 Tom Tisdale Sipovac Construction Fire Chief 72-651 Theodore Ln Palm Desert, CA 92260 Proudly serving the unincorporated Re: Non -Structural Building TA Plan Review areas of Riverside LAQ-03-TI-014 / 78-595 Hwy 111, Ste. 150 & 200 County and the Cities of: Fire Department personnel have reviewed and approved the plans you submitted for the above Banning referenced project. Please be advised the following conditions apply as a part of the conditions for the issuance of a building permit. Beaumont o. 1) These conditions are for a shell building and will receive a shell final only. No fire and life safety Calimesa clearance will be issued for a tenant space until the specific occupancy classification has been ❖ established and tenant improvement plans have been reviewed and conditioned by the Riverside Canyon Lake County Fire Department. 2) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire Coachella Department for review, along with a plan/inspection fee. The approved plans, with Fire Department Dessert Hot Springs Job card must be at the job site for all inspections. 3) The building sprinkler monitoring system must be extended to provide an interior notification device Indian Wells within the tenant space. .;. 4) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per Indio recommended standard of the Knox Company or provide key(s) for inclusion in the general building ❖ Knox Box. If the building/facility is protected with a fire alarm or burglar alarm system, the lock box Lake Elsinore will require "tamper" monitoring. Special forms are available from this office for the ordering of the Knox Box. This form must be authorized and signed by this office for the correctly coded system to La Quinta be purchased. Moreno Valley 5). All egress doors shall comply with 2001 CBC Sec. 1003.3.1.8 for proper door hardware. •y 6) Install portable fire extinguishers in accordance with Title 19. Contact certified extinguisher Palm Desert company for proper placement of equipment. ., 7) Approved building address shall be placed in such a position as to be plainly visible and legible from Perris the street and rear access if applicable. In strip centers, businesses shall post the business name ❖ and suite number on back doors as well as the front. All addressing must be legible and of a Rancho Mirage contrasting color with the background. 4. 8) Electrical room door shall be posted "ELECTRICAL ROOM" on the outside of door. San Jacinto Temecula Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy. All questions regarding the meaning of these conditions should be referred to the Fire Department Board of Supervisors Planning & Engineering staff at (760) 863-8886. Bob Buster, Sincerely, District 1 John Tavaglione, FRANK KAWASAKI District 2 Chief Fire Department Planner Jim Venable, District 3 Roy Wilson, By District 4 Walter Grandes Marion Ashley - Fire Safety Specialist District 5 Cc: La Quinta City — Building Dept. HAPEMP OataHA ommalPROaecrsmuao-03.n-014.a•e EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 ' "� r g�n TUI; 3,42 PM RIP. CO, FIRE PtuE IHDIO FAX NO. 1 760 863 7072 P, 2 Ypni 1WIl• Fire Chief Yrauely the arras of Rivt-eidti Cities at BQRtriinE 4. Deavmoat 41 CaUM= 4 CanyW Dake 4 Coachella b Dcser HM SPOP Indus Web India o• Leics Elsiu= La Quints a �- Moreno valley e• Palm DUM O IWis 0 . R&Sft M�raBa o . 9anJacilito a. . 'Camecvle ..BOW of8uporvison Hob Swear, DkKd l Ja1�Tw4plloe►. Diotrior Z rga vaubW � DlaMia 3 ver witooh • nborra a Aradoe Ashley tlRtaia � ZO 'd RIMER:'1IDE COUNTY FIRE DEPARTMENT In cooperation with the Calj;� ja Department afFores" and Rre Protechon San ac n venue • • % a om ai • ax gprll 8, 2003 Jason Tlemen 3925 East Broadway Rd., 8100 Phoeft, AZ 86040 Re: No"trutdutal Building TA Plan Review LAO -03 -TI -025 / Leslle's Pool Supply' Le Quinta Fire Department personnel have reviewed and approved the plans you submMed for the above referenced protect; Please be advised the (oliowing conditions apply as a part of the conditions for the Isauenoe of a bullding.permk. 1) Provide a Knox Hs2 Met Data end Key Storage Cabinet, Model 9220 or 1300. Storage box must hew buiiding key(@), a G)py of HMIS report and appropriate MSDS copies. (Aoplicshan aftwhed? 2) Provide appropriate NFFA 701 placarding adjacent to front and rear ogress access doors. 3) All egress doors shall comply with 2001CBC Sea, 1003.3 .1,5 for proper door hardware 4) Iristell portable Ore extin(lulshers In socordance with Title 19. Contact certified extlngulehor company for proper placement of equipment. 5) Apptovad building address shall be placed In such @ position as to be plainly visible and legible from the street and rear access if applicable. In multi -tenant buildings, businesses shall post the ' business name and 601 number on back doors as well as the front. All addressing must be legible and of's contrestlnp colrlr with the background. Please contact the. Fire Depsrtment Planning A Engineering staff for final Inspection prior to occupancy. All questions regarding the rneening of these conditions should be referred to the Fire Department Planning S Engineering staff at (760) eams88. Sincerely, FRANK KAWASAKI Chief Fire Department Planner By AA Waiter Brandea Fare as" Specialht Ca Le Ownta City—Sulading VepL K,wery+o.�u� o„,„r„ae�t'auooana tial.M. EMIEF'ZONCY SOVIGN DIVISION - PL WNM SECTION . W010 OPl IC11 "_&Fx r ir�hwv 1. a+ Irl.. Indlo. CA $=I F•R (7W W-34077 OI:9I 200Z 8 jdy ZZ62992ZO9:x2J 1SN00/3d S,3IIS3� �o �zT��1NIN OF TK�'9w7w o To: Greg Butler, Building &Safety Manager From:Oscar Orci, Planning To CDD: 3/23/2003 EX -- Due date: 3/31/2003 Status: 1ST REVIEW Building Plans Approval (this is an approval to issue a Building Permit) The Community Development Department has reviewed the Building Plans for the following project: . Description: TENANT IMPROVEMENT -LESLIE'S POOLMART Address or general location: 78-595 HIGHWAY 111 SUITE 150 APN and/or legal description: LA QUINTA COURT The Community Development Department finds that: ❑ ...these Building Plans do not require Community Development D - artment approval. these Buil i g Plan��f pproved by the Community Development Department. Planning c Date WLESLIES swIMMING POOL SUPPLIES 00000001 I , 1, CITY OF LA 01.11NTA Page 1 of 1 APR 3 RECD µ BUILDING AIDC:' SAVETY April 02, 2003 To: City of La Quinta, CA Building & Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 Attn: Kirk Kirkland RE: Leslie's Pool Supplies, Inc. # 468 / Plan submittal information 78595 Highway 111, Suite 150 La Quinta, CA 92253 Mr. Kirkland: The interior finish and fixture improvement plan set submitted for review, pertaining to the above referenced site location, was created internally by Leslie's Poolmart, Inc. Please accept this as clarification that the referenced plan 'set was created by me specifically for the purpose of the project review and acquisition of the authorizing permit for the above referenced project. Should you find it necessary to discuss this matter in greater detail, please contact me directly. I would be happy to discuss any issues in regard to this situation. (602) 366-3999 ext.: 4060 (602) 366-3927 / Fax Respectfully, Jason Tiernan Director of Construction & Facilities Management LESLIE'S POOLMART, INC. -CORPORATE HEADQUARTERS- 3925 E. BROADWAY ROAD, SUITE 100 • PHOENIX, AZ 85040 602.366.3999 • FAX 602.366.3944 • WWW.LESLIESPOOL.COM TO �'1' �-'.i. �;35`�J-�=" ---. ="�'^ �:. ms`s; l __.s�v r'`—`c_~u• :�''' ::..�_'�..' C: - �`�i',.:.__ -• -- - �5.'e' _ ..iij=Yra7-:7:��r •a'-•S�.�i'=.c.�q'SWIMMING POOL SUPPLIES # 468 / LA QUINTA, CA 78595 HIGHWAY 111, SUITE 150 LA QUINTA,CA 92253 . l General Notes ' z�mxa".iii..m "s••'•••• � •• •-•• m.a .ec•.r <o rJ .w w : u.n . .e� .u:a u...r •.en •a a.. r�Qa,ara n. s•a •Yt-.+.`o • . f i_a.o �a.a waw .oaa -e r.acn .� r ' � ..a r.m ".. ... ". . c. r �- vas .. •ra aaca n x w'raa r n.o-a • i'...m'�'�i -" _ _ _ _ u�"..'aw"si .c':'oa u woi.'cry ..a .. ' - OYf4rM...� Qr>.Y"O.•f.� `RJ rut .yr"i .9.O .. r-. W.. - n�.+�.e r..a o,. ... •m rar". ^ . Dare+ oma a a..o K �aoa n o .e wa..iu. w ■ �...o awn ue.a.o rcoe r .m w tYMY r ar:•'n n x.W4.n.t�ra r w .. �� Pn.-ewo �w M'�o•K Yu ■ Iola •r . ae.saaa :a{•.o A•Sm wrrn'm''a xrwi e.~� a ..�wat� PROJECT NOTES: I. ALL ELEMENTS OF THE SPACE HAVE BEEN PROVIDED BY LANDLORD AND ARE TO BE ACCEPTED AS EXISTING ELEMENTS. IUDING BUT NOT NCL LIMITED TO THE FOLLOWING ITEMS: STRUCTURAL WORK DEMISING WALLS DOORS FOR ENTRY AND EGRESS ELECTRICAL AND LIGHTING SYSTEMS MECHANICAL SYSTEMS PLUMBING SYSTEMS RESTROOM SITE ACCESS AND PARKING REQUIREMENTS UTILITY SERVICES (LANDLORD TO HAVE SEPAR.kTED SERVICE AND ACQUIRED NECESSARY APPROVALS) LANDLORD TO HAVE PERFOR.NED ALL SUCH WORK NECESSARY TO READY SPACE FOR LESLIE'S USE PRIOR TO LESLIE'S POSSESSION ' . 2. , LESLIE'S WORK WILL CONSIST OF FINISH WORK ONLY AS DESCRIBED IN"LESLIE'S REQUIRED WORK SCOPESECTION ON THESE PLANS 1}. v Project Information A7.1 Index to Drxvdngs D1.1 D-ulla V 7lL!x AZA Ou- FIan •� C -:q. E1.1 A3.1 Dim-nalon Floor Pte. M.1 Fixture Floor Plan Tr W levwr I • r. Feat... A41.1 It-oactad C.111-9 Fbn J33G �. /y c Ae.1 Root Plan Occa w4 -r/ : M CITY OF L, QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION / 7 DATE BY-gy-- T.1 A7.1 [sudor Ela..U— D1.1 D-ulla V 7lL!x 1161111.1 YKaanlcal ►tan -...-+.rr......- E1.1 clectrlxal Plan CITY OF L, QUINTA BUILDING & SAFETY DEPT. APPROVED FOR CONSTRUCTION / 7 DATE BY-gy-- T.1 ®. # 468 / LA QUINTA, CA I78595 HIGHWAY 111, SUITE 150 .. EXISTING •• t LA QUINTA, CA 92253 m s m n `i # 468 / LA QUINTA, CA 78595 HIGHWAY 111, SUITE I50 •• EXISTING •' '.� Dlmenslon Floor Plan t LA QUINTA, CA 92253 pPt kk7 °m= X)\ §B§ §2 /B # 468 / LA QUINTA, CA c I78595 HIGHWAY 111, SUITE 150 •' EXISTING" Reflected Celling Plan i LA QUINTA, CA 92253 to r m P i II O ' (1 # 468 / LA QUINTA, CA D I 78595 HIGHWAY 111, SUITE 150 j 1 Roof Plan - - i LA QUINTA, CA 92253 . ; ---------ju 4F rTZ11 �r/�•�rn EN�OOK� E�rA0Q1G SIDE WALL ADA TOILET 6 ADA SINK 1 BEARING WALL AT CEILING r PNT COUNTER / WATER TEST x x n 12 REAR WALL ADA TOILET 7 A/C SCREEN WALL 2 LIGHT FIXTURE BRACING O' C-7 I.Q., w•ue•nrnwaewww c.. moa con. v..n m •.oi rcoumwwc w•uo edr. ro wrram et oc F� •cua. yr . r•r " =1(18)SECT. - MADIX FIXTURE . I �\ /�,� �."� - `= ; — _--'�'`Y J ,� I, - IL•w _ 01 c'0 Q 'OF MOUNTED A/C CURB .._. ..f:e"�"' - ..... ...._ 8 COMPRESSION STRUT :,� 9 NON BEARING WALL x 14 ADA BATHROOM SIGN 9 PARTITION STIFFENER 4 CHANGE OF MATERIAL \t-7 co x x y 10 STUD ATTCHMT . 0 TRUSS 5 NON BEARING WALL J. l O k' 9 g R g r c e It4•S77 t0➢e"iv letRt.yt:�e5 i:3••1t•�E[I [41 6- �fi O ;X C z• S Z Mechanlcal Plan I # 468 / LA QUINTA. CA 78595 HIGHWAY 111, SUITE 150 •• EXISTING •• ii LA QUINTA, CA 92253 N m �.a...b� ;0.:4:.0000a...::_.. 11[ t1 ll i1►tii�iiss�r[i� t`[�i��i��j[i(lEftEltttEE�iE[ Iii ��j11 ; t��i �I�D[11'0�lI k �! E Electrical -Plan I # 468 I LA QUINTA. CA 78595 HIGHWAY 111, SUITE 150 LA QUINTA, CA 92253 •• EXISTING •' i 'ki li• D ' 61 g [ I a 41 g III C .• m ,, m. 1. il•+ I � A `" r' � r � � J J J J J N / a `•.. N � L D at l • + � �.a...b� ;0.:4:.0000a...::_.. 11[ t1 ll i1►tii�iiss�r[i� t`[�i��i��j[i(lEftEltttEE�iE[ Iii ��j11 ; t��i �I�D[11'0�lI k �! E Electrical -Plan I # 468 I LA QUINTA. CA 78595 HIGHWAY 111, SUITE 150 LA QUINTA, CA 92253 •• EXISTING •' Retail Display and Storage Leslie's Swimming Pool Supplies LA OUINTA, CA 6onfidertial Hazardous Materials Inventory Statement (HMIS) # 468 1 LPY D&wA Ion Lbs. Hazardous In 1 1 12044 12055_ 12061 12064 _ ChbrBMe Potxh 1 D. 1 B _ 25 1,3,5-Tdazine-2,4, 11-1.31-1,51-1trione-1 _ _ sodium salt, dihydrate (98-1(X _ Chlor Brite B b _ - Chbr Brite 25 lb - Sodium Chlorlde 0.1-1.00,{r Chlor erne 40 b. chlor erne spa shock__ 4o (Dichloroisocyanuric acid, dihydrate) 2 Sodium dichloroisocyanurate dihydrate TO 3 12/0_0 1_2103 _ _ISO Chlor FloW4lb. _ _- ISO EZ Chlor Can. 41b.1- 4_ 1,3,5-Triazin_e-2,4: 1H,3H,5H trione,l 4 ACL -90 TllCh/on�SOCyanf/riC aCid, d/yL - - --- -_-_ 12156 Chlor Tabs 8 6 6 (aka'Symdosene' C3CL3N3O3) 12162 Chlor Tabs _20lb. _- _ -_ Chlor Tabs 25 lb _ -- 20 '-25 Trichlorol-yai unq add -- - - ---- - 12164 - - 40 Ib Chlor P -_40 35 -50_ _---_- ----_-- 12165- - _Tabs Chlor Tabs 351b.--- 12234 ISO Chlor Sticks 50 b. _ — Super Shock _-- ISO 7 oz. Bagged TeD--_-^--- 6 --- 12423_ Jumbo Tabs 7 b 7 -p ' .-----_..--_---_--. _-- 12427 _12429 Jumbo Tabs 20 b.__�-._- -------- — -- -- ---I---Totals --- - Jumbo Tabs 25 lb. - 25 -_ -_—_--__------ -___ 12437 - Jumbo 35 b. --ISO-Jumbo 35 25 12431 _Tabs 40 b.__-----__—_- _ _12609 Mighty Tabs 3.5 lb 3.5_ 12612 Mighty Tabs 35 lb 35 4 14238 chlorine No Deposit 2 pak (1 gal as) 18 Sodium hypochlorite (10-15%) _ 14240 Chlorine 1 Gal. No Deposit 10 --- 14245 chlorine 2_112 Gal. Deposit _23-_ _ - __ 14248 Chlorine 5 Gal. Carboy _ _ 45 14249 Chlorine 15 Gal. Carboy- 135 5 14181 50 6. Power powder Pro ---_ so Calcium hypochlorite (65-90%) 100 b. Power Powder Pro 100_ — _14182 14183_ _-25 lb. Power Powder Plus - - - 25 Inert Ingredients 10-35%).---. 14830 _ _Power Powder 1 lb _7_- 14670 CH Power Powder Plus 1 Ib. 1 7 14989_ _ Yellow Out 8 oz. -_ 0.5 _ Inorganic Salt 14980 Yellow Out 2 Ib _ 2 _ 14991 _Yellow Out 4 Ib _ 4- 14883 Yellow Out 20 Ib 20 8. 14022 Algae control 1 pt 1 Poly(oxyeth enensdimethyliminio athIden _ 14025 agae contra i yI 2.z5 ethylene dichloride] -(60°/6) 14028 Algae Control 12 gal - 4.5 - -- 14030 Algae Control / gal 9 - 9 14016 Algaecide - Copper 1 N 2.25_ Copper Carbonate Monoethanolamine Triethanolamine Citric Add 11 14140 _-_ Brom 25 lb. Tabs —_ 25 1-bromo-3chloro-_5,5 dimethylh -antoin 14155 _ Brom 45 b. Tabs ---Brom 45 --- 48102 1.5 b. Spa Tabs _ 1.5_ _ 48104 Brom 3.5 6. Spa Tabs 3.5 13 48300 Leslie's s a shine 1 pt 1 IlExthoxylated secondary alcohol ro riel 3/18/03 1 TradelProduct Name CAS # Leslie's Chlor Brite 5158 Leslie's Chlor Brite Spa Shock _ Leslie's Chlorinator Sticks _ Leslie's Floating Chlonnato Leslie's Refillable Chlorinator Ca 1 Max Oty Max Oty TOTAL TOTAL 1 6 1 46 1 18 36 Totals 475 1,721 Oxidizer 1 Sani-Clor Liquid Sanitizer 16 __ _ _ _ _4 —0 0 1 6 1 46 1 Leslie's Copper Algaecide I 12069-69-1 I liq I Irritant I Irritant m -- --- Totals -------- --- 17 Sani-Clor Liquid Sanitizer 7681-52-9 liq Corrosive Corrosive 0 TO - —^—�-- ---- — ------ Totals 50 Leslie's Power Powder 7778-54-3 sol Oxidizer 3 Oxidizer 3 Unstable reactive 1 _--_ 2 — Super Shock -- 6 — --- -- --- 38 ------- -------- — -- -- ---I---Totals 581 Yellow Out I none sol I Irritant I Irritant 25 Leslie's Copper Algaecide I 12069-69-1 I liq I Irritant I Irritant m Retail Display and Storage Leslie's Swimming Pool Supplies LA OUINTA, CA Confidential Hazardous Materials Inventory Statement (HMIS) # 468 3/18/03 LPM Descri lon Lbs. Hazardous Ingredients Trade/Product Name CAS # Ingred. W Hazard Class Hazard Class Max Qty TOTAL (Units) Max Oty TOTAL (Lbs) Quaternary Ammonium Salts (pro etaryj_ Irritant Aminoalkyl - functional polydimethisiloxane (proprietary) Other Health Hazard Totals 5 S 16 14797 super scale Preventative 1 q -- -____Super 1 Non -hazardous anionic polyacrylamide mixture Leslie's Super Stain 8 Scale Prev. none liq Irritant Irritant 22 22 -- 14799 Scale Preventative 1_ql -- 2.25_22 — 50 148 02 12 gal Super Seale Preventative— -- - -1 4.5 --- _— 12 54 14804 gal Stain Prevent Super .--- - 9 - --.^ — — -- 7 63 - 48725 Spa Super Seale Preventative 1 p —_ 1 - --- --------- - - 1 1 -- 48721 -- 1 qt Spa Super Scale Preventative - 2.25 — �- - -- ----- - ---- — -- — 20 45 -- -- — - Totals 84 235 18 14915 Ultra Brigid Clarifier pt. 1 Cationic Homopolymer Formulation Leslie's Ultra Bright Clarifier none liq Irritant (slight) Irritant 15 15 14916 Ultra 8dght Cladfier qt. _ 1.25 Cationic Polymide In water - — Leslie's Ultra Bright Spa Clarifier56 - -- — 126 -- 14917 Ultra Brigid Clarifier 1rz gal. 4.5 - _9 -- _— 18 81 --- 14918 Ultra Bright Clarifier gal. --_ - _-- ----- - - 12 108 -- 48165 _Ultra Bright Spa Clarifier pt _ 1 - -- - -_---_ -- - — --- — 1 -48169 -- Ultra Bright Spa Clarifier qt. --- ------ 2.25 --- - - -- ---- - — — -- _1 15 ------ - ---- --- -- - _ - Totals _ 117 _34 364 19 14130 _- Pool Sodium Bromide 4 Ib pall .-.4-- Bromide salt of sodium (natrium bromide) _ Bromide Starter 7647-15.6 Sol Irritant Irritant 8 32 -- 08100 -- m Bro2 oz Spa Bromide --------- 0.125 164 _ 21 -- —_ -- --- Totals 172 53 23 262so Epoxy Putty A b 8 - White (Pan Ax0.5lb) o.5 Mixed Glyddyl Ethers o1 Bisphenol A (23 35%0 -Epolite 9904 E22xy_ tty art A) 25068-38-6 sol Irritant Irritant 6 3 Inert non -hazardous fillers (65-80%) Sensitizer Sensitizer 26280 Epoxy Putty A 8 B - White (Part 8) (0.5 Ib)_ - o.5 Bisphenol A (1-7%) Epolite 9904 Epoxy Putty Hardener 80-5.7 Sol Irritant Irritant 6 3 _ — - _ _ Ltraethylene pentamine/Tall Oil Fa Aad Polymer (10-30%) _ _ 68513-05-3 Sensitizer Sensitizer — --_ _--- Inert non -hazardous fillers (65-80%) - _ _ -- — Totals 12 6 25 2e22o _ Deck o Seal 314 get kit Gray _ 6_ Butyl benzyl phthalate (15-20%) Deck -O -Seal Gun Gray Base 85-68-7 liq_ Combustible 111-B_ Combustible 111-B 2 12 — 26225 Deck O Seal 3/4 gal kit Ten _ 6 _ Titanium dioxide (1-5°�) _- _ _ _ 13463-07-7_ Irritant Irritant 2 12 — 26230 Deck 0 Seal 314 gal kit White-- 6- Limestone (20-25%) - _ 1317-65-3 Other Health Hazard _ Other Health Hazard _ _ 0 0 - _ Silicon dioxide, amorphous (1-5%) -_ _ _ —_-- _ _ _ 67_762-90-7 _ Second part o1 two part kit above _ Limestone (45-50%) Deck -O -Seal PG Setting Agent 1317-65-3_ liq Combustible III -A Combustible III -A — - _ — Butyl benz rLphthalate (20-25%) _ _ - - _ 85-68-7_ Sensitizer s( lightL Sensitizer (slight - -- Titanium dioxide (5-10%) _ _ 13463.67-7 Other Health Hazard Other Health Hazard - Dimethylbenzyl h r) droperoxtde (5-109,6) 80-15.9 _- _ Totals 4 24 30 26752 Pool Patch 10 m. 10 Tricalcium Silicates (40-00%) _ Patch It 12168.85-3 sol Irritant Irritant 5 50 _ 26760 _ Dicalslam Silicates (40-60%) 10034-77-2 1 0 Tricalcium Aluminate 40-60% _ 12042-78-3 _ _ Tetracalcium Aluminoferrite (4(3-60%) 12068-35-3 _ _ - Calcium Sulphate hydrous) (40-60%) 13397-24-5 Silica Sand 140-60%) 14808-60-7 _ _ Totals 6 So 32 28508 Ramuc Water Based Acrylic Paint s Ethylene Glyn<2°6) DS Paint Blk 1 gal 107-21-1 ig Combustible III -A Combustible III -A 0 0 _ 26507 Ramuc Water Based Acrylic Paint a Titanium dioxide (<15°,6) DS Paint Aqua 1 gal 13463-67-7 Irritant 0 0 26509 Ramuc Water Based Acrylic Paint s _Butyl Cellosolve (<5%) _ DS Paint Blue 1 gal 111-76-2 2 22 26512 Ramuc Water Based Acrylic Paint _ 9 Diacetone Alcohol (<5°/.) DS Paint Royal 1 gal 123-42-2 0 0 28514 —Ramuc water eased Acrylic Palm - 9 Barium Sulfate (<15%) — DS Paint White 1ag 1 7727-43-7 5 49 Silica <10% 14808-60-7 Totals 5 49 33 26720 Pool Coaling Thinner 1 ql 2.25 Xylene (<100%) - - Ramuc Type A Thinner 1330-20.7 liq Flammable I -C Flammable I -C 0 0 _ 26725 Pool Coating Thinner 1 gal 9 _ Irritant 9 _ Totals _1 1 _ 9 38 14063 Atka Up! m ' _-- - 5 Sodium bicarbonate (100°6) - Leslie's Alkalinity Up 144-55 80 sol Irritant Irritant 24 120' 14083 Aika U 10 to 10 -- — -- -- -- -- - 26 260 3/18/03 Retail Display and Storage Leslie's Swimming Pod Supplies to OUINTA, CA Gronfidential Hazardous Materials Inventory Statement (HMIS) 0 468 3/18/03 3 LPM Desert bn Lbs. Hazardous Ingredients Trade/Product Name CAS A Ingred. is Hazard Class Hazard Class Max City Max Oty TOTAL TOTAL (Units) (Lbs) 14068 Alka Up 30 D 30 7 210 - 48050 -- Spa Alk Up 1 D.- - -----.-- -_ 1 --- _-. _ 60 — - - _1 38 38 .----- ----- --- - -- - Totals _ 96 888 39 - 1.4349_ -_—_ _ Dry Add 2 D. - --- _ 2 _ _Sodium bisulfate _(93.2%)----, -- -- __ -_ - Leslie's Dry Add -- 768138-1 sol Corrosive _ Corrosive _ 8_ 16 - - _ 14353 Dry Add 10 D - -- ------ - -- 10 - Sodium sulfate 6.5% --5- - - 7757-82-6 - -- 10 100 --- 14_356 -14359 _Dry Add 20 lb --' ------Dry 20 —' -- - 7 140 - -- Add 50 D --- -- 50 --- -- — - - - — — 15 750 -- ---------- ---- -- ------ - -- Totals 40 1,006 40 — 14730 14733 soda Ash 5 D _--_ Soda Ash 10 lb -_ 5 _10 Sodium carbonate, anhydrous (98%) Leslie's Soda Ash 497-19-8 sol Irritant Imtant 36 180 _ _—..-- 19 -14736 Soda mh 30 D --,-_ ----- - -30 ' -'- -" --- - -- ---__'-- - ------------ -- — - -_ _ _190_ 5 162 -� 14738 -soda Ash 50 Ib pan — - 50 - - - ----- --- ---- - -'— — — - _ - 4 180 ---- -------- -- - - Totals _ _ 64 712 41- 14011_ - Add 1Gal. No Deposit _ _ 9- .20 Hydrochloric add (31.4%Z - _ Leslie's Muriatic Add7647-01-0 - Corrosive Corrosive 0 - 14015 - - Muriatic, Acid rm depoeN 21pack (1 gal ea) - - -- --__ - - -liq - - _0_ 106 2,120 - - - --- _----- - -- _ Totals 106 2,120 45 -- 14695 -- Do Stele It qts -- -- 2.25 Hydroxyacetic ad d -- - -- Pool & Spa Descale-It-__ - - -- - 79-14-1 ------ I1 - -Corrosive Corrosive - -Totals 19 43 79 43 51 14070 Alum 5 l _ 5 Aluminum sulfate Aluminum sulfate 10043-01-3_ sot Irritant Irritant 11 55 - 14072 - Alum 10 D 10 _ _ _ _ 01UT) _ - 3 30 Totals 14 85 52 14225 1 qt Cartridge Cleaner 2.25 Pol oxy-1,2-athanediyl, alpha nonylphenyl)- _ Leslie's Cartrid_ a Cleaner 9016459 _ _ Irritant 20 45 14227 1R gal Cartridge Cleaner - --_— 4.5 omega hydroxy, (2.5%) liq Irritant _ 5 23 — Sodium silicates15%) - -- ------ 683492-0 _ Totals 25 68 53 14099 Ascorbic Add 3 oz 0.186 Ascorbic add Ascorbic Add - itamin.1 °6) -- 50-81-7 sol Irritant Irritant 7 1 — -- Inert sails (0.9°.6) - L- - - -- - _ Totals 7 1 54 14253 3 D Chlorine Neutralizer 3 Sodium sulfite, anhydrous - Leslie's Chlorine Neutralizer 7757-83-7 sol Irritant Irritant 20 60 _ 14256 25 lb Chlorine Neutralizer- 25 ---- - -- _ t-24 -- _ Totals 160 55 12302 4 D Conditioner 4 1,3,5-Triazine-2-4-6(lH,3H,5H}trione Cyanuric Add, Dry 108-80-5 sol Irritant 12305 8 D Conditioner 8 _ - _ (Leslie's Conditioner _ _ 7 53 Totals 27 134 56 14395 DE Fater Clean 2.z5 Sodium Bisulfate _ Leslie's DE Filter Clean 7681-38-1 corrosive Corrosive 27 61 Sulfamic Add _ 5329-14-6 _ _ Totals 27 61 57 14420 Hardness Plus 4 D 4 Calcium chloride (9497%) _ Calcium Chloride, anhydrous 010043-52-4 liq Irritant Irritant 10 40 14423 Hardness Plus 8 D e 07732-18-5 Water reactive 1 11 88- 14425 Hardness Plus 15 D 15 _ � 0 • 0 _ 14427 Hardness Plus 25 D 25 - ------ - 0 0 ' 14428 - Hardness Plus 45 D 45 0 0 Totals 21 128 58 14540 1 Ib. Fresh N Clear 1 Potassium Peroxymonosulfate (43%) Leslie's Fresh N Clear 10058-23-8 sol Oxidizer 1 Corrosive 149 149 _ 14546 25 Ib. Fresh N Clear _ 255 Potassium Bisulfate (23%) 7646-93-7 6 150 14547 40 lb. Fresh N Clear 40 Potassium Sulfate (29%) 7778-80-5 6 240 14550 2lb. Fresh N Clear_ 2 Potassium Peroxydisulfate (3%) _ 7727-21-1 10 20 _ Magnesium Carbonate (2%)_ 546-93-0 _ _ Totals 171 559 60 woo Sand Filer Revbalizer 1 qt 12.25 2-Butoxy ethanol 31.5%) Sand Filter Revitalizer 111-76-2 II Irritant Irritant 32 72 Totals 32 72 61 14825 Tile Cleaner 1 g1 2.25 Poly(oxy-1,2�thanediyl), atpha-(nonylphenyl}omega-hydroxy (27%) Leslie's Tile Cleaner 90164_59 Iiq Corrosive Corrosive 14 32 Hydrochloric add 4.796 _ 7647010 3/18/03 3 • Retail Display and Storage Gtonfidertial Leslie's Swimming Pool Supplies Hazardous Materials Inventory Statement (HMIS) LA OUINTA, CA # 468 ft LPM Description Lbs. Hazardous In radiants Trade/Product Name CAS 0 Ingred. Of 9 Max Oty TOTAL Hazard Class Hazard Class (Units) Max Ory TOTAL (lbs) Totals 14 32 62 14900 VinyVSolar Cover Cleaner 1 N -!1902 2.25 Poly(oxy-1,2-ethanediyl), alpha-(nonylphenyl)-omega-hydroxy (2.5_%) Vinyl & Solar Cover Cleaner 9016459 liq Irritant Irritant 13 29 _- VinyvSolar Cover Cleaner 112 gay - - --� 4 -- Sodium silicate (15%) --_- _Leslie's — _ 6834-92-0 _ 48 216 — _-- - -- — _ - Totals 61 245 91 14012Black Algae goer qt. __ 14021 --_ Black Algae aver trz gal. ^ _ - _-- - _ 2.25 Copper Carbonate _ __ - _-_ _ -- --- Leslie's BIaCk Algae Killer _ - 12069 69 1 lig Irritant Irritant 4.5' - Monoethanolamine - - - ----------- 13 59 Triethanolamine ------ - _141-43-5 102-71-0 -- - --- -- - - n -Alk 50%C14,40%C12, 10% C16).dimeth ben ammonium - 31075.24-8 chloride ------ ---------- ------- - -- - -- - -- Totals 23 81 95 48728 - - spa Metal x u qt. --- - - - _. --- (1_Hydroxyethane) 1,1 diphosphoric add —_-- - -- --- Leslie's Super Metal X II - - 2809-21-4 --- liq corrosive Corrosive 12 27 - Totals 12 _ 27 99 74780 --- Scale a c«e-- - 2.25 Hydrochloric Add --------- - Scale -B-Gone -- ----------- -- 7647-01-0 1 Ig --Corrosive Corrosive 15 -- -- - -15- 34 Totala -34 102 14!25 pH Lock Ot _-- - _----.----- - _-- 2.25 _-- None Listed -----------_---- ---__-pH Lode -- -- N/A --- Iiq_ - --- irritant Irritant 30 - 68 -- --Totals-- 30 - 68 - 107 14037 Sitver Algaecide at_- -_ -- --- ---- 2,25 Colloidal Silver - ------ --- - ------ Silver Algaecide -- -------- 7761 88 8- liq irritant - - _ Initant - - 13- 13 29 29 _1110 26540_ _ Ramuc Acrylic Deck Coat (ADC) 26542 Ramuc Au)gc Deck Coat (ADC) - 26544 RemucA ---- crylic Deck Coat (ADC).,- _ 9 Silica -7596 _-.—. —_____Deck Paint - Dune l gal Deck Paint _ Silver 1 at _ Deck Pelnt - Cayman 1 gal -- 1317-9_5-9 liq irritant___ irritant 4_ 36 B- 9 _-_ ---_- Ethylene Gly c01 <$%--- —_- -___---111.1—___---.-..1111.-_--_ _ 107-21-1 Iiq- _ _ toxic 0 0 --- - - _ _ _tOXlc ----- carcinogen carcinogen— -- - 26546 - Ra_muc Acrylic Deck Coat (ADC) 9 -._. -- Deck Paint - Blush t gal - - - --_------ -"- 1 -- g _ — _26549 --Ramuc Acrylic Deck Coat (ADC) _-- _9 --'---- _-_ _. _--- Deck Paint - White 1 gal - — -- ---- 0.- - 0 _--__ --- ----- Totals 5 45 • 3/18/03 C�. Certificate of Occupancy City of La Quinta Building and Safety Department This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code, certifying that, at the time of issuance, this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following; BUILDING ADDRESS: 78-595 Highway 111 Suite 150 Use Classification: Commercial "Leslie's Pool Supply" Occupancy Group: M Type of Construction: Owner of Building: Dale Frank & Associates Building Official VN Spklr Bldg. Permit No.: 0304-103 Land Use Zone: CR Address: 7900 28" Street, Suite 405 City: Mercer Island, WA, 98040 By: Daniel P. Crawford Jr. Date: 4/16/03 POST IN A CONSPICUOUS PLACE