9709-0053 (CSCS)46600 Adams Street
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
(16 A05-1 B 36 i iSn
Date 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()6 I, as owner of the property, am exclusively contracting with licensed
ntractors to construct the project (Sec. 7044, Business & Professionals
) I am exempt under Section B&P.C. for fs reason
Date'-//, -9'7 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:
Carver Policy No.
i.it4 :r . .,a:ai►:,.,ea .°. ♦.gviv [.tlr..f-.. -
(Thissection need not be completed if the permit valuation is for $100.00 or less).
fir
( 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
s bject to the workers' compensation proves ns of Section 3700 of the Labor
ode, I shall forthwith comply with those p• visions.
Date: ? Applicant A eg: - +' --
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 property for inspection purposes.
/Ignature (Owner/Agent)_I - • ?' A -. ate `w''-9
BUILDING PERMIT PERMIT '/t
'5451237.411
CONTROL97".0.535894
DATE j IJ VALUATION LOT TRACT
JOB SI E -40 ADWS ST i *.,i,'
APN "9_02 401
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
's'UE NVI'LUAM, WA2iRI"I'l CROUP
:iFIDIIIENI MJILFJI:f.S+ 2113t:
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010 CAMPUS S DRIVE, Svi i'4 1W
SAKI'A MONICA, CA 19-0 11. 0"1,4
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USE OF PERMIT
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RECEIPT
DATE
BY
D /FI
INSPECTOR
f'"7
t -
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
OX 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.APPROVALS
POOLS - SPAS
Stee6,
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
OX 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 Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
F,
Final
Utility Notice (Perm)
COMMENTS:
a'
_ s CITY OF LA QUINTA
OF -AUILDING &SAFETY DEPARTMENT
,��o ��QQ'�• 777-7012
�GMSPECTION REQUEST LINE
777-7153
Owner ellE WILLIAM WARREN GROUP
Contractor HEDLEY BUILDERS INC
Permit Number 9709-053
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 46-600 ADAMS STREET
LA QUINTA SELF -STORAGE
BUILDING B f2ja-P cMT e D 134be
RtJ 1zJSF.
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
3ROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
MNCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
)O NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
nPYWAI I INTFRIOP
=y-u!9r1rtlea Ww❑
II POOL PRE PLAS
II CFWFR AFPTIr."
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 'of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance* with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS:
Use Classification: COMMERCIAL
46-600 ADAMS STREET
Occupancy Group: R3&B&S1 Type of Construction: r.:VN
Owner of Building: THE WILLIAM WARREN GROUP
Building Official
Bldg. Permit No.: {9703-105 } {9709-
052-058}
Land Use Zone: CR
Address: P.O 130X 2034
y .
City: SANTA MONICA CA 90406-2034
By: RICHARD L KIRKLAND
Date: 5-19-98