11-0113 (SOTB)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA-, CALIFORNIA 922.53
T4t!t 4 4v 4-04h&
BUILDING" & SAFETY DEPARTMENT
BUILDING PERMIT
[Application Number:
11-00000113. �
Property Address:
79295 HIGHWAY 111
APN:
.600-340-027- - -
Application description:
STRUCTURES OTHER THAN BUILDINGS
Property Zoning:
REGIONAL COMMERCIAL
Application valuation:
125000
Applicant: Architect or Engineer:
Lo,✓Til�.o�zolt � Rt�wa� r4. STiG4�tJ�
G e4976./
-----------------
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 Professionals Code, and my License is in full force and effect.
License Clasps: B License No.: 948816
Date: ! I wContractor.
OWNER -BUILDER DECLARATION
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, 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).:
(_ 1 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.).
1 1 1, 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 Name:
Lender's Address:
Owner:
WALMART REAL ESTATE BUS. T
PO BOX 8050.
BENTONVILLE:, AR 72.712 1{lU
Contractor:
CORESTATES CONSTR SRVC, IN
3401 CENTRELAKE DRIVE, STE
ONTARIO, CA 91761
(909)467-8907
Lic. No.: 948816
VOICE (760)J77-701-2
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 4/07/'11
e
APR 19 2011
CITY OF LA QUINTA
FINANCE DFPT._-_..--
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 and policy number are:
Carrier PRAETOIRAN INS Policy Number AQW001470
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
(j 3700 of
the Labor C e shall forthwithhccompl/y/wiith those provisions.
/Date: /'� applicant:
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION 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 Director of Building and Safety 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, indemnity 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 co stru-tion, and hereb authorize representatives
of this county to enter
upon the above -mentioned property r i pection purposes
Date: 11' ` VSignature (Applicant or Agent): l^ W
LQPERMIT
Application Number
11-00000113
Permit
BUILDING PERMIT
Additional desc-.
Permit Fee . . .
727.00 Plan Check Fee ..
472.55•
Issue Date
Valuation . . .
. 125000
Expiration Date
10/04/11
Qty Unit Charge
Per
Extension
BASE FEE
639.50
25.00 3.5000
THOU BLDG 100,001-500,000-
87.50
Permit .
ELEC-MISCELLANEOUS
Additional desc
Permit Fee
157.00 Plan Check Fee
39.25
Issue Date
Valuation ..
0
Expiration Date
10/04/11
Qty Unit Charge
Per
Extension .
'BASE FEE
15:00
1:00 45.0000
EA ELEC PWR APP.>100
45.•00
1.00 75.0000
EA ELEC SVC >600V OR >1000A
75..00
2_00 11.0000
EA ELEC MISC
22.06.
Permit
MECHANICAL
Additional desc .
Permit Fee
34.50 Plan Check Fee
8.63
Issue Date
Valuation
0
Expiration Date
10/04/11
Qty Unit Charge
Per
Extension
BASE FEE
15.00. --
•3.00• 6.5000
EA MECH OTHER MECH EQUIPMENT
19.50
Permit
PLUMBING
Additional desc .
Permit Fee
39.00 Plan Check Fee'.
9.75
Issue Date
Valuation . . .
. 0
Expiration Date ..
10/04/11_
Qty. Unit Charge
Per
Extension
BASE FEE'
15.00
1.00 3.0000
EA PLB-WATER INST/ALT/REP
3.00
2.00 3.0000
EA PLB GAS PIPE 1-4 OUTLETS
6.00
1.00 15.0000
EA PLB GAS METER
15.00 -.
Special Notes and Comments
NATURAL GAS FUEL CELLS
(2 QTY);
LQPERAI[T
-
-
Application Number
11-00000113
--- -
Special Notes and Comments
ELECTRICAL DISTRIBUTION MODULE
(1 QTY)
AND WATER DEIONIZATION MODULE
(1 QTY) AT
THE EXTERIOR SOUTH WALL FOR THE WALMART
RETAIL BUILDING. 2010 CODES.
-----------------------------------
Other Fees . . .
---------------------------
BLDG STDS ADMIN (SB1473)
------------
5.00
ENERGY REVIEW
FEE
47.26
STRONG MOTION
(SMI) - COM
26.25
Fee summary Charged
Paid Credited
Due
----------------- ----------
Permit Fee Total ,. 957.50.
--- -
.00
..00
957.50
Plan Check Total 530.18
.00
.00
530.18
Other Fee Total 78.51
.00
..00
78.51
Grand Total- 1566.19
.00
.00
1566.19
i
Bin C �O
City of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address: -7 1-Xr,5 45 #WZ IN %
Owner's Name: (,�Gj _ 1�('eS T I' c l' � Gi
A. P. Number:
Address: I SEI pi�-
Legal Description: !/L1 —Wqr
Con tractor• Core 5%ileS Cor►stLorho►-1 vtees
p
City, ST, Zip: Ben 0(I ul
Telephone: y—/ !may -a.7 g3q
`
Address: l I ! I Plea µ S� ({off
Project Description:]hS�lI Fool ceA aal ne't4jµ
City, ST, Zip: Vw l f�6iA 3 Do`s
c)s m e4e r ':'t n e-C) e�IcCi'cC
Telephone:W - -
D a�f2 �SSO
h ;:::<:::?::;<:<:::;;;:.;:;;;:; •:<::<:>:<:: <.::
r<>}f>::> >:::>::,<:<:>«<:;:::.:>Af:<.:
/
S�i/i r�i�lt /nt�r'coriO� %
State Lic. #:
City Lic. #•: z BP
Arch., Engr., Designer. CD (i� S 1 `Z I-eS v roLj
Address:--/J`
City, ST, Zip:
Telephone:
<Ash<s;.r.:<::r;;;;rriy:;#<.>.;`:;:<;:;:>:;
;r<x.>:<::•:;;•:.:::::•..;;;;;<;;>::.:;:;;:.:;.»
ConstructionType• Occupancy:
State Lic. #: C Q�
pro'ect a circle one New Add'n Alter Repair Demo
Sq. Ft.: # St ries: # Units:
Name of Contact Person: J_v 5e- 6 .� notar cL
Telephone # of Contact Person: •C9 G 9) y6 % 9 07
Estimated Value of Project: If Its orw
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
��i I
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance.
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted:'3
3
Mechanical
Grading plan
2p° Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
Review, ready for correction issue
4-
Developer Impact Fee
Planning Approval
Called Contact Person 6 �
A.I.P.P.
I
Pub. Wks. Appr
Date of permit issue
F
School Fees
Total Permit Fees
,&c -8- IIC
2 2t� l
41ti i N5 a/0P
Ny Are
e
e zz Utz' led y.- �' f
/ S �
v
u��cv
Building & Safety Department
78-495 Calle Tampico
PO Box 1504 ,
La Quinta, CA 92253
(760) 777-7012 voice — (760i 777-7011 fax
r
r
To: Greg Butler, Building & Safety Manager To PD: April 7, 2011
From: Les Johnson, Planning Director Due date: ASAP
Permit #'10-760: Status: 2nd review
Building Plans Approval
(This is an approval to issue. a Building Permit & Assign CVMSHCP Fees)
CVMSHCP Applicable Fee N/A
The Planning Department has reviewed the Building Plans for the following project:
criptiion FUEL CELLS FOR WALMARTNote• fencing has been
Address or general location: 79-295 HIGHWAY 1111
Applicant Contact: JOSE GANDARA r)h•909-467-8907
The Planning Department finds that:
❑ ...these Building Plans do not require Planning Department approval.
these Building Plans are approved by the Planning 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 Planning Department for review.
A'-� Mob 111 11)
Le • J h-M&n, Planning Director Date
NOTE: PLEASE RETURN PLANS WITH GREEN SHEET TO THE BUILDING AND
SAFETY DEPARTMENT
1