0312-085 (RC)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
,Date /` Z 12 �� gnature of Contractor'
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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 & 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.
( ) 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 Policy No.
(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?37 O.of.the/Labor
Code, I shall forthwith comply w th those provisions.
Date:./7 7 D Applicant��.�•^�� i 'd'f/1di
Warning. Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to•criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct' I agree to comply with all City, and State laws relating to the building
construction, and Hereby authorize representatives of this City to enter upon
the above-mentioned p opertyefor inspection/spurposses._.0at?
Signature (Owner/Agent)G'/��+ //�j�`'�$�•�/f%
PERMIT PERMIT#
1a2' R b-{I�I�T
..BUILDING
DATE JV,4,jJ .+ VALUATIONLOT TRACT
JOB SITE ADDRESS �'�. -2915 .��8§d�i� II A STES. 8M-803
APN
OWNER
CONTRACTOR /.DESIGNER / EN (NEER
WAJA1A RT RHAf, Ls 8TMTA 'r1W VF
C R C'OMM� -1101T
303''NNIRBAIMS01115
30RA11 WE IK04115
IRME CA 92618
UWAU-4:61 CA 92619
USE OFPERMIT
AS 9ryr� REMODEL •(
,_. .•-��kJ.l1'i.c'7:L�re.\6.tLi�'aTk.r 3,i�iSYlO.i.+'.�?`L
^a7 Roviv
1.2.212 to ♦..gin. •�a.x.. inic.� a nus. v s sv aw�,e y,rr..ie oils®vriu a i:ssv.ia'av a
' SPACE 802 MITO A BvLI'BLE 5'K9.K1,?T SPACE ,902 AN D 803 AN WAL%4.!',RT
Wf
VALUATION
PLAN CRECK P - ' ( Vol •040-A -6 $35110
6rONSMUC't1LF 1011_0M $34,04
1AECHANIC.:LRE 101-000- -000 $19,50
EL.tcT.R_1CA,L FEE 1,01-000-42,0-00025.50
SITRG1Nt:9 M.OTSW T12 • COMM l 00-000-2411 -000 163
SUB-T(YTAL CCSW.Tr- RIX71`iflN AND PfLAW O JC1:C
JMS
rw ML fil MMITTEEN DU IT NOW
�'YC 99 2003
CITY Or LA Q►lINTA
RE DA FE �
BY
DATE NAL
D
INSP TOR
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
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 APPROVA S
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
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 Wiringj/ 0
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.;C
.x
A
x
M2
Bin # G
City of La Quinta
Building aL Safety Division
P.O. Box 1504, 78-495 Gane Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: 7( a %Jr y / / ' '�aa jj3
Owner's Name: WAJ--M^-;9-7-
A. P. Number:
Address:
Lceal• Description:
City. ST. Zip: i1
Contractor. C S CO/V jQ � �"Z�
ITelephone:
Address:
Project Description:
p
City. ST, Zip= I kVIM L: GA 012 6 r U
GG%� rf= i3 : liGYU S� O til O ,� S'1�16L
Telephone.
"*
. .;-
T S O'er N2—
State Lia #. City Lic. #:
Aich., Engr., Designer:
Address:
City. ST, Zip:
Telephone:``''
• ,' _�. ;V �- ::;�
�,- ` _ :
Construction Type:.Occupancy:
State Lia if:
Project type (circle one): New Add'n Alter Repair Demo
Name of ContactTerson: �t �u M?ffl v
Sq. FL:
#Stoner
#Units _
Telephone # of Contact Person: (
ed Value of Project: 3000
APPUCANT: DO NOT WRITE BELOW THIS uNE
X.
'Submittal ' � -
- Req'd
Reed
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item
Amount
StructuraPGies.
Reviewed. ready for eorreetionf / Plan Check Deposit
Truss Cales
Called Contact Person Plan Check Salaace a
Energy Cala.
Plans Picked up Construction o'.
t%T, 06.
Flood plain plan
Plans resubmitted Mechanical e
Grading plan
2'4Review, ready for cw. eeti s Issue /ZIZ, Electrical p
60
Subeontaetor 1.1st
filled Contact Person �� Plumbing
Grant Deed
Plaits picked up S.ALL C,, o
.6-3
H.O.A. Approval
flans resubmitted Grading
IN HOUSE:-
'"' Review. ready for corrcetionsrissue Developer Impact Fee
Planning Approval
Called Contact Person A.LP.P.
Pub. Wks.Appr
Date of permit issue
School Fees
^*a
Tot al Permit Fees
�f %3
VCA Aut'. 144,
-t�t T -A
4�Q�rw
To: Greg Butler, Building & Safety Manager
From: Oscar Orci, Planning Manager
To CDD: 12-09-2003
Due date: 12-16-2003
Status: 1 ST review
Building Plans. Approval
(This is an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for
the following project:
Description: REVISION TO WALMART PLANS FOR CONVERSION OF A
SINGLE TENANT SPACE 802 INTO A DOUBLE TENANT SPACE 802 AND 803
Address or general location: 79-295 HWY 111 WALMART SUPERCENTER
Applicant Contact: CSI CONSTRUCTION
The Community Development Department finds that:
❑ ...these Building Plans do not require Community Development
Department approval.
..ahese Building Plans are approved by the Community Development
Department.
❑ ...these Building Plans require corrections. Please forward a. copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
65O car Oki, Planning Manager D to
'J
o
0
I
CITY OF LA QMTA
PLAN CHECK CORRECTION LIST
Perkowitz + Ruth Architects
111 Ocean Blvd 17`h Floor
Long Beach, CA 90802
PLAN CHECK NO.:
0312-085 (Walmart)
JOB ADDRESS:
79-295 Hwy 111 #802/803
SCOPE OF WORK:
Convert to 2 units
PLAN CHECK FEE:
2 Hours total
December 11, 2003
FIRST/FINAL CHECK
OCCUPANCY: M/S3/A3
TYPE -OF -CONST.: V -N sprinklered
The submitted plans and specifications have been reviewed by VCA Code Group. It is our
professional opinion that the plans are in substantial conformance with the building codes and
regulations adopted by the CITY OF LA QUINTAand the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by:
Hue uu =
VCA Code Group
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780 Ext. 114 VCA File No. LQ -15814