0306-302 (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
655861 13 FT`dC O IrC
Date - i if�lr� Signature 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 S1'AtIsF ND Policy No. 4610681
(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 Applicant.. +i».
Warning: Failure to secure Workers' Com pensation,�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') Gate
,n,
P
B; PLD��NG PERMIT - ERMIT#
Iii -=-
DATE } I VALUATION3a•00 T TRACT
- '
JOB SITE
APN
ADDRESS 49.421 A.Vi+. WA O)BRE GOM
OWNER
CONTRACTOR/[ / EN INFER
xsL 17aG' ??.y'T RE>o1R'T'� INC".
TOTAL CONSTRUCTION
49-49903.INI HC>WER DR
/3091 COFJrN'MY C:LiT—B UR `,,ITEM -2
LA. QITLt rA CA 92253
PALM Ill1<WRT CA 92260
(760)350.8453 MLA 496E
USE OF PERMIT
COTtfis vffRCW,RLMODEL
RNTERJOR RF€;'a1t2F1EL OFADOBE UR1L1.:.2001 CSC.
V ft;WATION d�,flf)�J.Op Ih�
EY471I1P34aiA L'''N D C09T Off° CONS'I:11siTC'd'((. N
49,(M.00
P '' . . u !k"E.Cv' 9Y3M&UiRY
PLK0 CHKICK HE $260.93 ,
C01dSTRLICTION FEE 101-000-418-000 $u►tli.3G
ELECTRICAL. YZE 101.000-420.000 $28.50
S't 1?OMG MOTION "Er, • COMM 1 U0 -1200-2A 1-000 $10.08
D Q
JUL 11 2003
CITY OF LA QUINTA
FINANCE DEPT.
i'1 1B.."AL CONc1T. UC" IOM AND PIAN (M1vC.K
$701.06
IMS'PRR-PAID FLEW
$0.07
(YEA3., FERAMf'(.1 ES DUE NOW
$7:01.06
RECEIPT
DATE
BY,
DATE FINALED
INSPE OR
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 -
-POOLS-SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
To: Greg Butler, Building & Safety Manager To CDD: 6-17-2003
From: Oscar Orci, Planning Manager Due date: 6-23-2003
Statu's: 1 ST review
Building Plans Appro'val
(This is an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for'
the following project:
Description: Interior re -model of the Adobe Grill
Address -or general location: 49-421Avenida Obregon
Applicant Contact: Connie Galati 578-1212
The Community Development Department finds that:
❑ ...these Building Plans do not require Community Development
De rtment approval.
...these 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.
Ofcar Orci, Planning Manager Date