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BCOM2018-001678-495 CALL TAMPICO, LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT VOICE'(760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Permit Type/Subtype: BUILDING COMMERCIAL/REMODEL Owner: Application Number: 13COM201870016 COLIN:HOLMES Property Address: 7.9295 HIGHWAY 11-1 2001 SE LOTH STREET. APN: 600340027 BENTONVILLE, AR 72716 Applicationbescription: WALMART / AUTOMATED STORAGE KIOSK INSTALLATION Property Zoning: Application Valuation: . $45,000.00 Applicant: 1 Contractor: MIKE SIDES rC. BRYON DAMES HAMAD 10.5 NW 2ND STREET STE 307 9 � 7962 CHAFFEE.ROAD BENTONVILLE, AR 72712 AUG g ® 2018 ) SAGAMORE HILLS, OH 44067 t !� !� (216)544-3072 C' !Q(d!� to Llc. No.: 948312 C^w"1BIIU(�1METELOP�,�E�J��EP RT�IEN� LICENSED CONTRACTORS 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: B License No.: 948312 I1 c . n0 tr" o"r:. OWNER=BUILDECLARATION I hereby affirm under penalty of perjury t at,l 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, 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 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.). (� 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 am exempt under Sec. - , B.&P.C. for this reason Date: _ Owner: Date: 8/10/2018 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' ecimpensati94, as provided for by Section 3700 of the Labor.Code; for the performance Jof e o h this permit is issued. have and will maintain workers' compensation insurance,•as required by Sec on 3700 of the Labor Code, for the performance of the work for -which this permit is is ed. My workers' compensation insurance carrier and policy number are: Carrier: EXEMPT Policy Number: _ I certify that.in.the performance of the work forwhich 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 l should become subject to the, workers' compensation provisions of Section.3700 of the Labor Code, I shall forthwith . comply with those provisions. Dat'� lJ —G /D—Ile Appl Wit: WARNING: FAILURE TO SECURE WORKERS' C PENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRI INAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 0,000). 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. . CONSTRUCTION LENDING AGENCY I certify that I have read this application and state that the above information is correct. I hereby affirm under penalty of perjury that there is a construction lending agency for "' I agree to comply with all city and county ordinances and state laws relating to building the performance of the work for which this permit is issued (Sep. 3097, Civ. C.). construction, and hereby authorize representatives of this city to enter upon the above - mentioned property for inspection purposes. Lender's Name: Dat : GQ- �Si� (Applicant or Agent). r� Lender's Address: t •�ti Now DESCRIPTION ` ` ' ACCOUNT QTY :',AMOUNT •y 101-0000-42600 .,,($2.00) DESCRIPTION ` :ACCOUNT QTY AMOUNT.. . " BSAS SB147,3 FEE; 101-0000-20306 --..0 $2 p0 . s Total Paid•fonBUILDING STANDARDS' ADM INISTRATIONBSA: ''* $0 00 .• F ' DESCRIPTION ACCOUNT QTY AMOUNT. 4 .• :A 101=0000 42600 ($26.01)'•• . DESCRIPTION. ACCOUNT- ' CITY' AMOUNT 101-0000-42600 • -; ($26.01) DESCRIPTION ACCOUNT QTY; AMOUNT °DEVICES; FIRST20 161-0000-42403 0� ' {i .$26.01 DESCRIPTIONS ACCOUNT :, QTY AMOUNT DEVICES, FIRST 20 PC 101-0000-42600 0 $26.01 K ' Total Paid for. ELECT ' '$0:00 �. DESCRIPTION' ACCOUNT- QTY AMOUNT: FIRE 'COMMERCIAL TI PC ', :' 101-0000-42420 r 0 " $234.:00 Total P,aid.for FIRETEES: $234.00 DESCRIPT:.ION :ACCOUNT QTY AMOUNT •101-0000-42600 ` !' ($58.38) i DESCRIPTION.. -ACCOUNT CITY AMOUNT PARTITION 101-0000-42400 0 $19.64 . DESCRIPTION - ACCOUNT QTY PARTITION 101-0000-42400 0 $58.38 • DESCRIPTION ACCOUNT,' QTY ., : AMOl1.NT • PARTITION PC 101-0000-42600 0 $143'S6, Total:Paid for PARTITION: ' • $163:20 DESCRIPTION - ACCOUNT"'' QTY AMOUNT r PLAN CHECK DEPOSIT - ADDITION/REMODEL „< 101-0000 42600 1 .$125.00 ; Total Paid for PLAN CHECK:DEPOSIT - ADDITION/REMODEL: DESCRIPTION ACCOUNT. CITY AMOUNT ' 101-0000-42600. ::. ($12 6:0) S DESCRIPTION ACCOUNT CITY AMOUNT SMI - COMMERCIAL 161=0000-20308 Total Paid;foeSTRONGMOTION INSTRUMENTATION^SMI: DESCRIPTION ACCOUNT . QTY 4A f '' AMOUNT" ;E TECHNOLOGY ENHANCEMENT FEE 502=0.000-43611 • 0.• $500 ' - ' Tot id.for TECH OG HANCEMEN E. $5 00, al; Pa NOL Y,EN T,FE x,. _ .. - , o. CONSTRUCTION, S E R V I C E S 154 E. Aurora Rd, #155 Northfield, Ohio 44067 1 P: 440-550-4995 1 F: 440-499-6727 July 12, 2018 City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 UHC Construction Services will be the General Contractor for renovations at the Wal-Mart located at 79295 US Hwy 11 La Quinta, CA 92253. Construction is scheduled to begin Aug. 5, 2018. Enclosed are: • A check in the amount of $402.2.0 for the Building Permit fee. Permit No. BCOM2018-0016 • A completed New Business License Application • A check in the amount of $104.00 for the Business License fee • A letter. indicating UHC Construction Services will have no employees at the job site If there are any questions, my contact information is below. Rick Hamad UHC Construction Services cell: 216-513-4378 fax: 330-467-8677 rhamad@uhccorp.com UHC.Construction Services 154 E. -Aurora'Rd #155 Northfield, OH 44067 5 C rl) 154 .E. at. rora Rd, #155..Northfieid,. Ohio 44067 1 P: 440-550.-4995 I F`. 440-499-672.7 August 8, 18 Bryon James Hamad UHC Construction Services 154 E. Aurora Rd. #155 Northfield, OH 44067 RE: Walmart 91805 79295 US Hwy 111 La Quinta, CA 92253 GC License # 948312 Letter ofAuthorization To Whom It May Concern: This letter gives, Matthew Schardt, the authorization to pull this permit as a representative of UHC Construction Services and/or Bryon James Hamad. Res ctfully, 7 Bryon James Hamad UHC Construction Services CEO On August 8, 18 before me, the undersigned, a Notary Public in and for the State of Ohio personally appeared Bryon Hamad personally know to me X proven to me on the basis of satisfactory evidence to be the person(s) whose name(s) is subscribed to the within instrument and acknowledgged that she executed the same in the capacity stated above. ' Public) My CommllssioK Expires::: jt \ U ( stamp / Seal Cafty Rigby Resident Summit County Notary Public, State of Ohio My Commission Expires: (7 uuu��,�a `�i icy( Z fig 'Z' t(C"pbj4a LP♦.y, F ��% 4'0 .154 E. Aurora Rd, #155 Northfield, 0hio 44067 I P- G40.55041995 1 F. 440-2,99-6727 _ 4 j'une; 5, 2018 «; To'Whom It May Concern, {" ,bis.will )?avesrio employees doing work atthe Wal-Mart located at 79295 US"Hwy 11, La Quinta,"CA 92253.. F j /V�" `draftener _ Bryon Hamad Notary Public e� a. CEO r42e of,, No UHC Construction Services)MmiSSiOnxptiec 0.440-550-4995 C: 216-544-3072`,�' ; TiFa!Ch 2i a02� . bh@uliccorp.com �' w. k -S E I G E w" r •. TIOW WPT�U . a .