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BCOM2016-0011• �i a� VOICE (760) 777-7125 78-495 CALLE TAMPICO � . U FAX (760) 777-7011 LA QUINTA, CALIFORNIA 92253 COMMUNITY DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153 BUILDING PERMIT Date: 6/6/2016 Application Number: BCOM2016-0011 Owner: Property Address: 79295 HIGHWAY 111 WAL MART REAL ESTATE BUS . ES APN: 600340027 P 0 BOX 8050 0 l� Application Description: WALMART R.E BUSINESS TRUST/ REMODEL BENTONVILLE, AR 92253 Property Zoning: C Application Valuation: $300,000.00 v p -A 'y O Applicant: Contractor: DEACON CORP DEACON CORP o f 7745 GREENBACK LANE 250 7745 GREENBACK LANE 250 D rn CITRUS HEIGHTS, CA 95610 CITRUS HEIGHTS, CA 95610 z C� (916)969-0900 . LIc. No.: 760475 LICENSED CONTRACTOR'S 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 Professions Code, and my License is in full force and effect. License /Class: A. B/ License No.: 760475 Date: 10�`� Contractor: 41 OWNER -BUILDER DECLARATI I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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, Ar 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 Contractor's 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).: ( ) 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 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.). (_I I am exempt under Sec. . B.&P.C. for this reason Date: Owner: 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 Lender's 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 t o for which this permit is issued. I have and will maintain workers' compensation insurance, as required by Sectio 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier and policy number are: Carrier: Policy Number: _ 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, ode, I shall forthwith comply with those provisions. Date: to_6 — G Applicant: WARNING: FAILURE TO SECURE WORKERS' CO PENSATI IV 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. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official 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 Quinta, 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 information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon) e above-mentioned property for inspection purposes. „ n/� Date: Signature (Applicant or Agent) DESCRIPTION,.' FINANCIAL INFORMATION ACCOUNT QTY .AMOUNT` PAID. ;. PAID DATE HOURLY PLAN CHECK - YES 101-0000-42600 4.25 $297.50 $0.00 PAID BY METHOD tt RECEIPT14 " CHECK,# CLTD BY DESCRIPTION , PAID PAIDDATE' HOURLY PLAN CHECK - YES 101-0000-42600 1.75 $122.50 $0.00 - �• s ' PAID$Y Y,w r , q ? METHOD "RECEIP-T 4- , ��_- �' €CHECK #� CLTD BY Total Paid for BLDG CITY STAFF - PER HOUR: $420.00 $0.00 .;DESCRIPTION` . ,"• r ACCOUNT ,%QTY AMOUNT ""PAID $' .PA ID DATE BSAS SB1473 FEE 101-0000-20306 0 $12.00 $0.00 " ,PAID BY' ; ' > .; , METHOD �`- RECEIPT # _ k CHECK # • CLTD.BY ,. Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $12.00. $0.00 DESCRIPTION w .. ACCOUNT CITY. AMOUNT' # ° PAID " 'PAID DATE APPLIANCES, NON -RES 101-0000-42403 0 $942.63 $0.00 PAID BY METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION; �` ` _ -<ACCOUNT QTY` : -AMOUNT ; PAID. 'PAID DATE° APPLIANCES, NON -RES PC 101-0000-42600 0 $942.63 $0.00 PAID BY F= METHOD RECEIPT # CHECK # , _CLTD BY DESCRIPTION ,` t _,'ACCOUNT .„QTY" AMOUNT PAID %' PAID DATE' FIXTURES, ADDITIONAL 101-0000-42403 1 $2.42 $0.00 PAID'BY s v' METHOD RECEIPT #;. •CHECK #. CLTD BY DESCRIPTION r " N 'ACCOUNT QTY' '. AMOUNT 'PAID, PAID DATE FIXTURES, ADDITIONAL PC 101-0000-42600 1 $0.60 $0.00 ' :PAID BY r„ METHOD - ' �" .' RECEIPT # CHECK # CLTD BY -` M DESCRIPTION : _z: ACCOUNT,, - ,, QTY:: AMOUNT PAID PAID DATE FIXTURES, FIRST 20 101-0000-42403 1 $24.17 $0.00 ° PAID BY rf METHOD RECEIPT W CHECK # CLTD BY DESCRIPTION ` } ACCOUNT "'' >QTY = AMOUNT `; �, �, `' PAID PAID.DATE: FIXTURES, FIRST 20 PC 101-0000-42600 1 $24.17 $0.00 PAID BYz ; + METHOD ` ; , ' RECEIPT # CH.ECK # ` CLTD BY Total Paid for ELECTRICAL: $1,936.62 $0.00 �' DESCRIPTION. ' ` t. ACCOUNT'' AMOUNT r t PAID ' PAID DATE CONDENSER/COMPRESSOR 101-0000-42402. 0 $145.04 $0.00 PAID BY', METHOD RECEIPT ,# CHECK#w CLTD BY. DESCRIPTION - ACCOUNT ,t QTY= ` AMOUNT :. PAID PAID DATE CONDENSER/COMPRESSOR PC 101-0000-42600 0 $96.68 $0.00 PAID BY . _ t, c. METHOD �: • '' %'RECEIPT # ' CHECK # ° CLTD BY t 'DESCRIPT16NL + ACCOUNT .'. QTY AMOUNT ;, PAID PAID DATE, VENT FAN 101-0000-42402 0 .$108.81 $0.00 PAID'BY 'METHOD RECEIPT#a• a CH„ECK# CLTD BY J` DESCRIPTION; `ACCOUNT ;"` QTY AMOUNT - PAID PAID DATE VENT FAN PC 101-0000-42600 0 $43.47 $0.00 PAID BY .m r :. METHOD :' a' RECEIPT # CHECK # CLTD BY Total Paid for MECHANICAL: $394.00 $0.00 DESCRIPTION° '. ACCOUNT QTY T AMOUNT' $ ' PAID PAID DATE, FIXTURE/TRAP 101-0000-42401 0 $398.97 $0.00 PAIDBY, :,t +{ r METHOD : RECEIPT # `, CHECK# CLTD BY DESCRIPTION ;'. K . - ,,' ACCOUNT QTY 1 ``` `AMOUNT PAID PAID DATE FIXTURE/TRAP PC .101-0000-42600 0 $398.97 $0.00 PAID BY , `-: METHOD: si " ;RECEIPT # < CHECK # CLTD BY „ DESCRIPTION'- ° AC COUNT QTY i`".°AMOUNT:: :PAID a„PAID DATE GAS SYSTEM, 5+ OUTLETS 101-0000-42401 0 $36.26 $0.00 PAID`BY µ` ` ; ' . METHOD RECEIPT # CHECK # CLTD BY DESCRIPTION ; r ACCOUNT 1 QTY AMOUNT . < , ° - PAID n. PAID.DATE'. GAS SYSTEM, 5+ OUTLETS PC 101-0000-42600 0 $24.17 $0.00 PAID BY METHOD a RECEIPT # ° , ; t CHECK # CLTD BY DESCRIPTION ACCOUNT,. i `QTY `. '-AMOUNT °' '.xi PAID r `, PAID DATE - WATER HEATER/VENT 101-0000-42401 0. $24.18 $0.00 PAID BY METHOD ` 'RECEIPT # . `CHECK # CLTD BY. �-&DESCRIPTION'., •s �. i ;. ACCOUNT QTY < AANIOUNT.' PAID :PAID DATE' WATER HEATER/VENT PC 101-0000-42600 0 $14.50 $0.00 :PAID.AY - .' ; ” METHOD", ' . , _ ', RECEIPT #L CHECK #. CLTD BY DESCRIPTION ACCOUNT ,' ` QTY - AMOUNT PAID ”. 'PAID DATE WATER SYSTEM INST/ALT/REP 101-0000-42401 0 $12.09 $0.00