0006-383 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapier 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
574127 A 08/31 /2(
Date &)/4 `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).
( ) 1,(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
perfor ance of the work for which this permit is issued.
(y)�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 STATE FUND Policy No. 046-00-0007034
(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: ''� !!J//el Applican
Warning: Failure to secure Worker/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 property for inspection purpos/e�s.
Signature (Owner/Agent) -Date-9am-lo,:110
BUILDING PERMIT PERMI�06
383, -
DATE VALUATION �,LOT TRACT
ADDRESS- 49-'451 AW -MA A 0BRF00.K
APN
OWNER
CONTRACTOR / DESIGNER / EN INFER
RL LA QUDTrA RESORT
SrI£iiE DODSON CONSTRUC ON INC.
1535 S. D .11'RE r
73011 COUITP tY C3,UJB DF., SLITY ✓r,4
X31 B:ffiNAR.UINO CA 92408
PALM! DUER T CA 92260
(760)346-4032 CB1,4 1044
USE OF PERMIT
POOL ANDJOR EPA
-
1
ONLY- ALA.FiLtASWARR.IERS SHALL BE rN PL.ACGf' r
OPNAMtrSPA
RE-PLASTRIZ INSPRCTIOId, THIS PERMIT DOES `NOT'DICLUDE BLOCK
WALLS FOR RQU1.Pi Z14T 'E'NCLOSURE.
VALUATION 19,500.001
ESIT, /lATED COis'T OF CONSTRLIU.i'TON
19.5W.00
PERAur bw B1;Ti41] iA Y
,
PLAN CHECK FEE 101.000.439-315 SI34,55
�; t
CONSTRUCTION FEE 101-00041€3-000 $20,00
MECHANICAL Fiji? -- FOOL 101-000.121.000 524,00
; .rAl
ELECTRICAL FEE -- POOL 101-000-420-000 $45.00
PLCl1+A81WG FEE -- POOI. 101-000-419-000 827.00
BUD TCYCAL COA1MUC 100 AND PY AN C111,CK
$4,37,55'
1~3r -•SS RRE-PAM_ r -IM
$0.00 .
• i (/fT AL PERM .S' 2Jd. V DUE
$43 / 64'+0••
RECEIPT
DATE
BY �
DATE FINALED
INSPECTOR
St
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 I 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
�f
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)
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY
DEPARTMENT OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL HEALTH SERVICES
SUPPLEMENTAL,REP.ORT-TO,SAt4..4(ZRM_# DATE
ADDRESS
INSPECTOR
79.4
* ' '
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Beaumont
Calimesa
Canyon Lake
401
Coachella
0
Desert Hot Springs
41
Indian Wells.
41
Indio
Lake Elsinore
. .01
Ld Quinta
4.
Moreno Valley
O
Palm Desert
Perris
Rancho Mirage
41
San Jacinto
O
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaqlione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
. District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
in coopefi7fiOf? with the
California, Department of Forestry,. and Fire' P:.
210 West San Jacinto Avenue *Aeir'ris, Califo�inia921570.*"(909) 91046=-* FAX (909)94D-6910
September 17., 1998
City of La Quinta
Building Department
Re: Fire and Life Safet:y. Clearance
The Riverside. Codn.ty: Fire
l baia'rtmentis' granting
conditional
onditional a, fire and.
nd. life. safety
clearance ce
for the Gi0Up 6cupahcy known as iheEa QuintaReSqrt Spa, Iocated at1U9:5I �a11
Obregon.
,
release—lq.wod
By
R.esp66tfully,
FRANK KAWASAKI
Chief Fire Department PI I anner
Mal* Brand6s
:Fire S6fety. Specialist
EMERGENCY SERVICES DIVISION
N :PLANNING SECTION * INDIO OFFICE
t d, 60),863-8886 4, Fax (760) 863-7072
43409Oasis,S.,2ndFl:,ln io,CA 92201