04-5116 (DEMO)Tihf .4 4 a"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING PERMIT
Application Number
Property Address . . . .
APN:
Application description
Property Zoning . . . . .
Application valuation . .
Owner
------------------------
KOHLS DEPT STORES, INC.
N 56 W 17000 RIDGEWOOD R
MONOMONEE'FALLS WI 53051
BUILDING & SAFETY DEPARTMENT
y, i • ,lti., (760).777-7012
• ' FAX (760) 777-7011
INSPECTION REQUESTS (760) 777-7153
41 .1
.04-00'005116 Date} 6/23/04
78950 HIGHWAY 111
643-080-004-6 -000000-
DEMO - COMML/OTHER
REGIONAL COMMERCIAL
0
-
,Contractor
NEAR CAL CORPORATION~
512 CHANEY STREET
LAKE ELSINORE CA 92530
(909) 245-5400
WCC: STATE FUND
WC: 1669490 01/01/05
CSLB: 230077 01/31/05
CCC: A -B
------ Structure Information INT. DEMO NON BEARING WALLS -----
Construction Type . . . . . TYPE III - NON RATED
Occupancy Type . . . . . MERCANTILE
Flood Zone . . . . . . . . NON -AO FLOOD ZONE
----------------------------------------------------------------------------
Permit . . . . . . DEMO PERMIT
Additional desc . . �F� .
Permit Fee 45.00 Plan Check Fee • ..00
Issue Date _
,N�,.;*.P..Valuation 0
Expiration Date 12/23/04
Qty 'Unit Charge Per �� j ��'; j Extension
BASE ,FEE- - °S2 "r,. ., s -145 . 00•
------- ----------------------------------------------- \tel --
------
Special Notes and Comments
DEMOLITION INTERIOR WALLS ,EXTERIOR 0
FACADE, HVAC EQUIPMENT,SIGN,PER APPROVED
PLANS.
Fee summary-----_ Charged
Permit Fee Total 45.00
Plan Check Total .00
Grand Total 45.00
Paid'
.00
.00
.00
v �
Credited j
---------- ---
m
.00
45.00
`" � •;•..'rte'`- ..i -
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number: _ N - 511 (o I Date -
Applicant:
Applicant's Mailing Address:
I hereby affirm under penalty of perjury that I am licensed
Code, and my Licen,� .WiNU force and effect.
icense Class //``'�t,� 1114;;1
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' 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 Contractors' 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).):
U 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 or 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.).
U 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.).
U I am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' 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
-16of 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. P6 6workers' compensation mp+rdlice cam d
�
�arier J.c-Rr -4ZJ 06 ol•P licy Number J r 44yer are:
_ 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 With thoseREA&.
isions.
at `q� ?Ap
'plicant
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.
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
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 Ouinta, 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 informatio ect. I agree to comply with all city and county ordinances and state laws relating to'building
construction, and hereby authorize representatives of this count er u on the ove-mentioned property for inspection purposes.
ate -Z L nature (Applicant or Agent
KONCS
6/15104
City of La Quitm
Pleasc accept this letter as a Letter of Authorization to allow Pexkowisz & Ruth Architects and Near -Cal Corp,
Genera! CoutractotS to conduct business on behalf of Kohl's Departwnt Stores during the renovation of the old
WalMart store into a new Kohl's.
Kob"s Dcpartment Store is looking forward to becoming a part of your community.
�Resppec/ttiilly,
Gary Bohn
Kobl's Manager of Construction
CORPORATE OFFICES • N56 WI 70M RIDGEWOOD DRIVE • MENOMONEE FALLS, WiSCQNSIN 33051 •(262) 703.7000
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06/23/2004 10:44 9097693122 NEAR/CAL CORP- PAGE 01
Cityof. L&Quinta
Developers PM -10 Approval Form .
Prior to the issuance of a Demolition ,Permit for thE- project listed below, Public Works
approval must be obtained. Please return this form tv the Building and Safety Department
only after approval.
Project Address: f �j' O� (l,%,� �r 0
Applicant Name/Phone#: (� 1 �6
Scope Of /rTi,CdO
To limit dust at this jobsite I will:
o Maintain Adequate Watering at all Times. L 5.1 61,NSo Prevent Trackout I
o Tarp All Vehicles Removing Debris from Site
o Limit Work in High Wind Conditions s 1 !)
O Esc N
O
.O
Department Approval is Hereby granted:
ohn Freeland, Senior
Jate
�/7�
C