0304-293 (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
76Z199 A 05/3112C
D�aie J,Signature of Contracto
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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
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 �TME FUND Policy No. 1557214-02
(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 complywith'fti6se provisions.
?ebate: r, �ApplicAnt_
Warning: Failure to secyr� Workers' I Compensation coverage is unlawful and
shall subject an employ6i�jo 11 &riminal 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 property for inspection purposes.
I Signature (Owner/Agent) Date
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
STAMIKO Dr-.VM.0FrKMT CO.
STAMM DTNFJ,0P.W2JT CO.
2205 n POINTSE17MAVIL
2205 riP0JN1'v`M*f1AAVH'.
NIANHAnAN BEACH CA. W266
14 AMMf TANBEACH CA 90266
cmo .2172.
USE OF PERMIT
GMIRV, RUIUANG
rffi 1,1?, 61 11ARDIM WALL-(7SOUTH PROP. LMI PM."PROVED
PLAN, ORCO SYSTEM
6FT, WALL M.00 Lp.
ESTEKATF.D COST OF CON&I'MC-1101V
21,7W.OID
CONSTRUCTION M- 101-000-41R-000 $225.00
n5TOTAL ANDMA),4 CTIEMC
M -PAID M19
$225.00
$0.00
L. RWX
ApR 2 3.2003. Fy
CITY F LAQUINTA
FINANCE DEPT.
.06
RECEIPT
DATE' 00
_Ij
I Q �
1BY
DATEfINA)fED
INSPEAtOR
y
.. � _3 "
a
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
OX 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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs I I o
Electric Bond
FootingsMain
Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVA S
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS. .
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
EOMMENTS:
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
4.
Beaumont
4.
Calimesa
4.
Canyon Lake
4.
Coachella
4.
Desert Hot Springs
Indian Wells
4.
Indio
Lake Elsinore
:•
La Quinta
.;.
Moreno Valley
4.
Palm Desert
.;.
Perris
r.
Rancho Mirage
`e
San Jacinto
:•
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley
District S
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection `
210 West an Jacinto Avenue • e s, a i om a Fax (909) 940-6910
June 3, 2003
Perkowitz & Ruth Architects
111 West Ocean Blvd., 21st Floor
Long Beach, CA 90802
Re: Non -Structural Building Plan Review — CCD #1
LAQ-03-BP-008 / Walmart — McDonald's addition
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project changes. Please be advised the following conditions apply as a part of the conditions
for the issuance of a building permit.
1) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
2) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A1 OBC in rating.'
Contact certified extinguisher company for proper placement of equipment.
3) Install a Hood/Duct automatic fire extinguishing system. System plans must be submitted, along
with a plan checkfinspection fee, to the Fire Department for review..,
4) Room capacity shall be posted in a conspicuous place on an approved sign near the main exit from
the tenant space.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Applicantlinstaller shall be responsible to contact the Fire Department to schedule inspections.
7uests for inspections are to be made at least 24 hours in advance and may be arranged by calling
) 863-8886.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
tCc: La Quinta City'=Building Dept.-�
H.%PE2WP Da UA 0Aft PROJECTMBdit PCLLlW4)1BP-Md).doo
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
I9 NS
MEMO
DATE: June 25, 2003
TO: Jcrry Hamilton
FROM: Hien Auong - KPFF Consulting Engineers
SUBJECT:' Wal-Mart #1805 La Quinta
Job # 12-0342
According to the typical detail 1/S5, a bond beam with (1)#5 continuous fbily grout two courses
above and one course below should be provided where the emibedded plate occurs. Since the CMU
wall is fully grouted, therefore just need to. provide (1)#5 right at the middle of embedded plate.
For the locations that the embedded plates in different elevation, provide the reinforcing lap splice
for this (l)#5 bar as indicated on Reinforcing Lap Schedule - detail 7/S4.
Please feel free to contact me if you have any further question.
MFMWWALMA tTLAQUWA/12.03Q= //,, %f)
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AAMMG As ALdc THISTHISs/F
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'
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3/1'
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CONSTRUCTION
SET 05-08-03