9611-013 (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
% i 2i �44E I3
MUM
1 f -. `rteContractor./
Date - �
D Signature of
OWNER -BUILDER DECLARATION J
1 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).
( ) I, 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.
j{), 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 apt Policy No.
NIONI
(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 with those provisions.
Date:;? t a `i f Applicant w " `
,.• ^ t3 d
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 property for inspection purposes.
Signature (Owner/Agent) +-t 'a "'r Date j ' f�' ei
� F �
PERMIT # CONTROL #
BUILDING PERMIT ?31f, 3.491113 4497
DATE #7�r� VALUATION fey liti2,3 00 LOT TRACT. i
ADDRESS 79-900 UIGHWAY 1.3 P JOB SITE
APN
OWNER CONTRACTOR / DESIGNER / ENGINEER
ft()Atr Dtrf<T.rt„f,S.X INC.• 1\.7?PAt)1,IA"0t1n �c;: Sf>J, CNC.
01 S(.�M14 t'!f.^AC1~NTM 18:1.73 S.1'1G;'�;twl fi. �it.��1)., SIT. . el
FUi'..L,i it'YON (A 92631 A ITSLA !":'f1 90710 �
. r"3ti)1Ra5•^HN2 C.�3i.#
USE OF PERMIT
()f:ENA.CRttt IM
p1:
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
L —
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath'WE
Final '1
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste. Lines
-
Neater 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
- W
Gas Test
�-
Appliances
Final
COMMENTS:
GL (.9/�
�iq/L4✓,— C n.1 /L— F`5 `� �{ �G -� ? 9��
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit -/ .Op
Rough Wiring .1
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
LM14 Notice (Perm)
,w
I<raz-,-u-i& ASSUCIATFS INC.
ENGINEERS, GF01.0GISIS AND ENVIRONMFNIAI SPFCIAIISIS 1J't0//V� �[` BGG n0
134 Gal Nnnl- Road • Mike.isilt +I. CAlllomh 933M • (1105) 392-4490 • rAX (805) 393-09$9
Sill,...
September 15, 1997
The Home Depot
Dan Campbell
601 South Placentia Avenue
Fullerton, CA 92831
RE: Concrete & Masonry Testing
Home Depot No. 6630
Hwy 111 & Jefferson Street
La Quinta, California
Project No. 02696392
P.O. No. SPC 662000106
Mr. Campbell,
Enclosed is a progress report of the concrete and masonry compression test results for the
above referenced project.
If you have any questions or if we may be of further assistance, please do not hesitate to
contact our office.
Respectfully submitted,
X& Associates„Inc.
DGr Walker
Projec Manager
GDW/cf
cc: 1 R. "Kirk” Kirkland, City of La Quinta
I Dennis Trosper, Superior Ready Mix Concrete
f
Offices Serving the Western United States
134 E. Norris Road, Bakersfield, CA. 93308 Telephone (805) 392-4490 Fax (805) 393-0989
PLATINUM PROPANE OF LOS ANGELES - CYLINDER EXCHANGE SITE PLAN
2880 NORTON AVENUE Date of plan: %- 9 k
LYNWOOD, CA. 90262 /
310-661-3030 (FAX 310-661-3034 Plan Prepared By: F �>Cp
Retail Location Name: OfT 6 �� �y . Store
Retail Location Address 7 q d %w Y-
it1bs� - .�o CAf) - f
fid" i�FeQ .
C.Ally%k% r
& ��' �ti�RAA1Ct
U o 0
k
LU �-► j
Name of Installer: Platinum Propane of Los Angeles
This site is to be constructed and maintained in accordance with NFPA No. 58 and other appropriate
this installation may not be put into operation until final inspection and approval by appropriate jurisdic
Store
Store Manager/Authorizing Agent
I approve location as drawn
COUM OF RIVFRSID
DEPARTNIENT OF
ON
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isPlay Unit - 88-5/16" L x 25" 0 x 66" H
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C"Zipacity: i��—ro ane Cyiindcrs
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7
Cylinder Exchange Site Pl$n
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Date of Plan 7- �4- 9 7
Plan Prepared By111 NCV/0
Distributor Naive, Address and Phone
Retail Location Nanne /7-/�c- L&±-#6'430
Add.-ess _7990
i//// A_ . //.,.. .1A_ I;./ , /.7/ /)1-,,.
EMERGENCY PHONE NU BER 1-80-258- 7466
Rome,
Prepared for De Po+ displays, etch holding _IR twenty posed DOT cylinders.
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DEPARTMENT OF
,F1'�E PROTECTION
Indicate North on the star at lefty.. NOTe Ns f la y Ur1,' f
Depict area at least 50 feet in each direction. 88 5•//6'/
Show distances fto:n display to doors, outlets, extinguishers. L X,26
Label all itc--s on drawing. Include extinguisher locations. DX b 6 // H
Indicate each display unit of 18 this way:
L,g Ov, '•7
dQ
1A
V,9.6-3
P1t11 1 r)Um
ArO�AnP
r -f L. A.
i//// A_ . //.,.. .1A_ I;./ , /.7/ /)1-,,.
EMERGENCY PHONE NU BER 1-80-258- 7466
Rome,
Prepared for De Po+ displays, etch holding _IR twenty posed DOT cylinders.
n,r,
lou ir9
0i:vc Thw
O O O
0001 1/17
FTTTT1 �l -� • X10 � �S f„
PAIrm�
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DEPARTMENT OF
,F1'�E PROTECTION
Indicate North on the star at lefty.. NOTe Ns f la y Ur1,' f
Depict area at least 50 feet in each direction. 88 5•//6'/
Show distances fto:n display to doors, outlets, extinguishers. L X,26
Label all itc--s on drawing. Include extinguisher locations. DX b 6 // H
Indicate each display unit of 18 this way:
To: -
The Home Depot
Dan Campbell
601 South Placentia Avenue
Fullerton, CA 92831
COMPRESSION TEST REPORT
(ASTM C39)
Project No.: 02696392
Re: Home Depot No. 6630
Hwy 1 I 1 & Jefferson Street
La Quinta, California
P.O. No. SPC 662000106
MIX DATA
..........................................:..............................:...............:...............:
Specimen: Grout Mix Design #: N/A
Supplier: Superior Ready Mix Cement Factor, sack: N/A
Ticket #: N/A Max. Size Agg., in.: N/A
Admixture: N/A
SAMPLE DATA
Specimen sampled from: Screen Wall at Jefferson Street
LABORATORY DATA
Specimen No.
BIR -1
Slump, inches (ASTM C 143):
7.5
Date Cast:
07/17/97
Air Temp. - Fahrenheit:
97
Date Delivered:
07/19/97
Mix Temp. - Fahrenheit:
86
Sampled by:
M. Kallinz
Unit Weight, pcf (ASTM C138):
N/A
Design Strength, psi:
2000
Air Content, % (ASTM C231):
N/A
LABORATORY DATA
Specimen No.
BIR -1
BIR -2 BIR -3
Date Tested:
07/24/97
08/14/97
Age, days:
7 -
28 Hold
Nominal Dim., in.:
3x6
3x6
Area; sq. in.:
9.0
9.0
Ultimate Load, lbs.:
33000
48500
Comp. Strength, psi:
3670
5390
Type of Fracture:
Shear
Shear
Tested By:
MJ
MJ
Average Strength:
Date of Report: 08/18/97
Remarks:
Respectfully submitted,
KRAZA & ASSOCIATES, INC.
Materials Testing Division
1=
COMPRESSION TEST REPORT
(ASTM C39)
To:
The Home Depot Project No.: 02696392
Dan Campbell Re: Home Depot No. 6630
601 South Placentia Avenue Hwy 111 & Jefferson Street
Fullerton, CA 0831 La Quinta, California
P.O. No. SPC 662000106
MIX DATA
Specimen: Concrete Mix Design #: 520-C2500
Supplier: Superior Ready Mix. Cement Factor, sack: N/A
Ticket N: 108662 Max. Size Agg., in.: .375
Admixture: N/A
SAMPLE DATA
Specimen sampled from: STA 879+10 to STA 880+50, Sidewalk Placement
Average Strength: 3830
......................................
. ........................................................... ; ............. a .......
.............................................................................................................................
Date of Report: 09/12/97 Respectfully submitted,
Remarks:
GA�
KRAZAN & ASSOCIATES, INC:
Materials Testing Division
Slump, inches (ASTM C 143):
4.0
Date Cast:
07/17/97
Air Temp. - Fahrenheit:
89
Date Delivered:
07/18/97
Mix Temp. - Fahrenheit:
84
Sampled by:
M. Kailinz.
Unit Weight, pcf (ASTM C138):
N/A
Design Strength, psi:
4000
Air Content, % (ASTM C231):
N/A
................
LABORATORY DATA
............................................................................
...................................
Specimen No.
131W-1
131W-2
131W-3
131W-4
Date Tested:
07/24/97
08/14/97
08/14/97 09/11/97
Age, days:
7 -
28
28
56
Nominal Dim., in.:
6x12
6x12
6x12
6x12
Area, sq. in.:
28.27
28.27
28.27
28.27
Ultimate Load, lbs.:
78000-
107000
109750
135000
Comp. Strength, psi:
2760
3780
3880
4780
Type of Fracture:
Cone/Shedr
Shear
Shear
Shear
Tested By:
ML
M!
Mi
Mi
Average Strength: 3830
......................................
. ........................................................... ; ............. a .......
.............................................................................................................................
Date of Report: 09/12/97 Respectfully submitted,
Remarks:
GA�
KRAZAN & ASSOCIATES, INC:
Materials Testing Division
V)
(Certifica'te of Occupancy0
City. of La- Quinta
Building and Safety Department .OfN°°`�Q
• 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:
Use Classification: COMMERCIAL
Occupancy Group: M Type of Construction
Owner of Building: HOME DEPOT U.S.A. INC.
Building Official
79-900 HWY .1 1 1
Bldg. Permit No.: 9.611-013
VN Land Use Zone: REGIONAL
COMMERCIAL
Address: 601 SO PLACENTIA
City: FULLERTON CA 92631
By: KIRK KIRKLAND
Date: 7-29-97