0312-153 (BLCK)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 Exp. Date
�- 1315 C i 03/3 WIC
bate /Jl�� Signature of Contractor w/►'+' Wi L -O)”
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).
(.) 1, as owner of the property, am exclusively contracting with licensed,,4,
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt under Section B&P.C. for this reason
Date 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
Section 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 VIROI23lA SU12kTY Policy No. 1CW5QOS,3Vai<
(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 that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply vyith those provisions. s
'Date: 2 4 eyr-?Applicar ..j.f,d •.ss ;+ i�� "
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the `conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propg rty..for inspection purposes.
Signature (Owner/Agent)°• -e}� Oi�r3 Date % l / i
r -
BUILDING PERMIT PERMT#.
01312-1453 3�
DATE LOT., TRACT
JOB SITE 4
APN
ADDRESS
.OWNER
CONTRACTO •/.9ESIGNER / EN (NEER
WA,•MIM7 RX'SUS. 'MiXf
CROWX 7 JCM Co.
7001 SE, l Y111 S•f
I ,WrOITIJUIE AIL 72716
S.PNTAF• OWN0S Qk 90670
(562)864-5177 CC L$ 4539
USE OFPERMIT
GENERALBUM W'
-1 TfT, We= I'i'fNCE 4X06 11 S
"
WWWATED COST OF CO1VMUMf, IX
,PFJU" ' 1!1E MNl ARY
W9 i1UCT)atd ti KZ 101-000-418-000 833AI
r
DEC 16 2003
CITY OF LA QUINTA
FINANCE DEPT.
STJT-InTAT, COIvS'f'.�.�U TTtlN AND PLAN :C'H1:.M.
$33.00
L19s 1W AM FEL
$0,00
RECEIPT
DATE -
BY,
DAT F A
INSP TOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 3
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
-
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
= r`
_. .
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
.9xterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
a
Sent By: CROWN FENCE CO;
• L�
t
if
356 3581; Dec -16-03 11:59;
0
GOWN FENCIE
since 1(Q3
Dec 16 2003
La Quinta :City hall
ATT: Ed Randall
RE: Wal,mart La Quinta.
CCD 3
Dear Mr. Hamilton,
This letter shall serve as authorization for Jerome Hamilton from CSI
• ;I
construction to apply for any permits,
Sincerely
Gary L. McDonnell
Project manager
CA STATE LICENSE # 1.315
12118 BLOOMFIELD AVENUE, SANTA FE SPRINGS, CALIFORNIA 906704703
Phone; (562) 861-5177 6 Fax: (562) AF 4 -?.529
Page 1/1
1,,"C
Statc CnINI, ftfure Licrnsn 791,5
DETAIL A
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04 w
SIDEWALK PLAN
Project No: SCAWMT.,01-0067
Issue Date. 02-28-03
Prepared By: aqv
me as
D -M 13� C..ftm 1. Th- naw% PM
EXISTING EXIT DOORS
EXISTING- VENDING MACHINE EXISTING BUILDING PILASTER TYP. 41
-------------
(e
EXISTING 4'-6" X 4'-6 01
(TYP. OFEE WELL8) .6" HIGH CURB
FIELD VERIFY
Ln LL_
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120 rl,.7-1,l
CITY OF LA QUINTA
BUILDING & SAFETY DEM
APPROVED
reft eeN"ue"oN
12-1ol -c;5,
DATE � BY
r -EXISTING EXIT DOORS
1110%
SHOPPING CAF
REFERENCE
DETAIL A
fF,
EXISTING
-EXISTING SHOPPING CART HANDICAPPED
STORAGE AREA RAMP
-.----PAINT' ALI, F-C-NUNL7 A_ V/HeA-11te
'51sT T
/r2-1/2" SQ, T.S. POST
1-1/2" SQ. T.S.
RAIL TOP/ BOTTOM
r--PERFORATED METAL BACKING
1-1 /2" SO. T.S.
PICKETS AT 6" O.C.
9.
00 2
�MAX.
4'- 6 , c"_ 3!_ ± 19'-6" TYP
"-FIELD VERIFY -`_-AFIELD VERIFY -
DETAIL 1 04P T.4. F09M
fILL6'r VI LV� ALL, APO#JNV-.
1 /4" P5f- PLATE AND ANQ.Kf_.T0._,C=6R _V
VIAI.- AA9t
LA QUINTA, CA)
rn
SIC.00.1
william parrish
design development
consultants, inc.
1000 lakes ddM suite 405
west covina. ca 91790
p. 626.917.6800
f .626.917.6808
w - www.wp2dr-com
I -t
L ads Li
4\
EXISTING
TABLE WITH
UMBRELLA
PLAN VIEW
1 /4" = 1'
DETAIL A
, e;w
04 w
SIDEWALK PLAN
Project No: SCAWMT.,01-0067
Issue Date. 02-28-03
Prepared By: aqv
me as
D -M 13� C..ftm 1. Th- naw% PM
EXISTING EXIT DOORS
EXISTING- VENDING MACHINE EXISTING BUILDING PILASTER TYP. 41
-------------
(e
EXISTING 4'-6" X 4'-6 01
(TYP. OFEE WELL8) .6" HIGH CURB
FIELD VERIFY
Ln LL_
(D
>
0 -H
Li
0
in Lj
>
(D 0
120 rl,.7-1,l
CITY OF LA QUINTA
BUILDING & SAFETY DEM
APPROVED
reft eeN"ue"oN
12-1ol -c;5,
DATE � BY
r -EXISTING EXIT DOORS
1110%
SHOPPING CAF
REFERENCE
DETAIL A
fF,
EXISTING
-EXISTING SHOPPING CART HANDICAPPED
STORAGE AREA RAMP
-.----PAINT' ALI, F-C-NUNL7 A_ V/HeA-11te
'51sT T
/r2-1/2" SQ, T.S. POST
1-1/2" SQ. T.S.
RAIL TOP/ BOTTOM
r--PERFORATED METAL BACKING
1-1 /2" SO. T.S.
PICKETS AT 6" O.C.
9.
00 2
�MAX.
4'- 6 , c"_ 3!_ ± 19'-6" TYP
"-FIELD VERIFY -`_-AFIELD VERIFY -
DETAIL 1 04P T.4. F09M
fILL6'r VI LV� ALL, APO#JNV-.
1 /4" P5f- PLATE AND ANQ.Kf_.T0._,C=6R _V
VIAI.- AA9t
LA QUINTA, CA)
rn
SIC.00.1
william parrish
design development
consultants, inc.
1000 lakes ddM suite 405
west covina. ca 91790
p. 626.917.6800
f .626.917.6808
w - www.wp2dr-com