0212-100 (COM) LICENSED CONTRACTOR DECLARATION ' PERMIT#
S I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT ��l%: •
Chapter 9 (commencing with Section 7000) of Division 3'of the Business and DATE VALUATION LOT TRACT F',�'AUKILL ONL{`
N Professionals Code,and my License is in full force and effect.
O ch ' License# Lic.Class Exp.Date p
�/ '� �'�z��'7 Yi f` 7redL3 JOB SITEADDRESS 76-9kXl.A1'•1vwY'WF4f APN �,���}�+•-0d6
+ %t.•° .. /`� OWNER
6 CONTRACTOR/DESIGNER/EN INEER
Z ti Date `' Signature of Contractor J. ,I
~ o OWNER-BUILDER DECLARATION 5-52"f'�.V1W1'TI.' ;.f��"�T. ;ty-301 �) .1Or��:;;�ra�ll?:�Z?.3{)�
J U m <
Wa I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1 �r„Fy d h;}3 ;;a�°jy';Zt�l 9j�”.• ;.,b�' C; C_J2201;
�. .
U) License Law for the following reason: 760,) s -$•663 `,�t31.,+j' ?3S
Z ( ) I, as owner of the property, or my employees with wages as their sole '
compensation, will do the work,and the structure is not intended or offered for
sale(Sec.7044, Business&Professionals Code). USE OF PERMIT - --- - — `-�
( ) I, as owner of the property, am exclusively contracting with licensed vali$A.i.£C 1.. IIIIIIIIIIIIIIIIIIIIIIIII 02
contractors to .construct the project (Sec. 7044, Business & Professionals
Code). ia1..%s, saa cry.i'. riF Vi\ . IE �
() I am exempt under Section B&P.C.for this reason 41.1L;f fig 4)N�tdY3 Y7E:t"<�f•k�f'1`.�VTk2UtU'!'IQWI,RPRINKt,C{t�iM,
N Date Signature of Owner
ON
CL Q WORKER'S COMPENSATION DECLARATION
p Cc I hereby affirm under penalty of perjury one of the following declarations: FOO
).,:3✓ ,1 t3 31'
Lo Fa- O O 1 have and will maintain a certificate of consent to self-insure for workers' 1'VW t:t'L>�E Amon SY.
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the 004'1;kk"' •RyMOUNT Lll�
m � Q performance of the work for which this permit is issued.
Q 0 (./) I have and will maintain workers'compensation insurance,as required by
QLO
U Q Section-3700 of the Labor Code, for the performance of the work for which this
Z permit is issued. My workers' compensation insurance carrier & policy no. are: QN ,t
Carrier «7`r''a'1'Iv 17ft3d : Policy No. f"e�2 '2 .2 I" MUDD)0011 , �alt'CS1111.[Z:I4�"s;0 4 � �•'aa '�yy
Q (This section need not be completed if the permit valuation is for$100.00 or less). (X)N.STRUG„10'1;FE!",
J ( ) I certify that in the performance of the work for which this permit is issued, K.n N CHECK Ire., 01-0.00-'+4 39-3 IS oP-66 .0
I shall not employ any person in any manner so as to become subject to the F?'[ MOSSIT $ +l'000•4,UI-31 C _0040M
workers' compensation laws of California, and agree that if I should become � H 1twGL� f� ;,fit:-t't?�i•• 9-061fr $ya.Lt0
3 subject to the workers'compensation provisions of Section 3700 of the Labor FLEC j,i CAL FEE. 1�1I n C"t?� ?CItC�(f �a�af?.40
Code, I shall forthwith comply with those rovj`sions�
PY P t f>�.'J1�3kit1i0k�1�7& 1W-()0-4I9••Qt)0: 31�.ti.S�t
;.•Date:•�" !.••; ./;• "•' Applicant r' �. .� , .�-..,..
STROM Ma:7�'lOt�'k�9 .4,%1 100,000 0(0 yq�S�.sSG
Warning: Failure to secure Workers')Compensation coverage is unlawful and j�f�tr7.rJFF,.:ft1•A�3?�a i "E $ ! ti a
shall subject an employer to criminal'penalties and civil fines up to$100,000,in ART 1N PUBLIC PLACES=COW it•O :0-445-0,00 1!3 t��i e,tS2
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 Slip-','OTAT..t;''i7 T�1°1�5:r `.l'lf5ka"Al14),1puJ. i"CT•11"+.cl w r)`� '• t"
whose request and for whose benefit work is performed under or pursuant to X-:"YTY?
any permit issued as a-result of this applicaton agrees to, &shall, indemnifyW
& hold harmless the City of La Quinta, its officers, agents and employees. Cylfar• 4rft :C�i3��re'�7�� f2.Any permit issued as a result of this application becomes null and void ifwork is not commenced within 180 days from date of issuance of suchpermit, or cessation of work for 180 days will subject permit to cancellation. 3I 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 buildingTA .construction, and hereby authorize representatives of this City to enter upon .
the above-mentioned property for inspection purposes.
RECEIPT DATE / 1 BY DATE FINED INSPECYbF
% r j`'' , I.. I Y.; �l~ .�� f CSS r� J�„i` .4�•.r i"'��.. !/
Date
Signature (Owner/Agent) - �`�� J
s
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
.BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings 1ADucts
Slab Grade Return Air
Steel Combustion Air
Roof Deck 3 Exhaust Fans
O.K.to Wrap / F.A.U.
Framing T 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
Ap liances.
f4W-03- g2 Final
01
COMMENTS: Gi �� 11.2 x -03
Final C
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 77
Temp.Use of Power
Final
Utility Notice(Perm)
- J
Daily Inspection Log Daniel P. Crawford Jr.
Permit#0212-100 Building Inspector II
Commercial . Shell
78-900 Avenue 47
Date Inspection
5/27/03 Footing—Template footings observed @'building foot print.
5/30/03 Ground Plumbing Observed partial building ground waste lines.
6/2/03 Footing—Elevator footing Z/S 12 observed.
6/3/03 Sewer—Main sewer line connection observed by Steve Traxel
6/10/03 Foundation—Building footing & slab observed. Ok to pour.
6/17/03 Bond Beam—not ready, no plans or job card available. Superintendent not
on site.
6/18/03 Bond Beam—Elevator pit top out observed, ok to grout.
7/8/03 .Foundation system (partial) observed at elevator area, slab, footing and
grade beams.
7/14/03 Floor Nail observed at second floor deck diaphragm.
9/8/03 Partial roof nail observed. (second request) Correction notification issued
for as-built roof diaphragm not consistent with approved Plan detail W/S9,
and detail CC/S9 LST24 strap hardware at tower, verbal notification to
observed minimum panel roof sheathing continuous over two or more
spans noted.
9/11/03 Trash enclosure footing observed, 16 If. Ok to pour concrete.
9/15/03 Partial framing inspection was observed at electrical room. Ok to insulate
and drywall interior space for 1600 amp electrical cabinet, hold down
correction noted to be addressed prior to covering wall.
9/16/03 Bond beam inspection observed at trash enclosure, ok to grout.
9/18/03 Second floor roof nail observed. Correction notice issued for engineered
detail approving as-built stacked 1/2" OSB diaphragm at tower(v.s. detail
W/S9), additionally, roof diaphragm (minimum panel roof sheathing
continuous over two or more spans) not observed at reconstructed roof
areas at detail W/S9 as noted 9/8/03 during roof inspection for
compliance. (CBC Table 23-II-E-2)
9/19/03 Roof nail observed at I" story roof areas.
9/25/03 Roof drain inspection observed, corrections pending for signature.
9/26/03 Roof drain corrections observed.
10/13/03 Ok to Wrap inspection completed,partial approval to wrap structure
granted understanding corrections at upstairs balcony and elevator are to
be observed prior to covering.
11/6/03 Partial lath inspection observed, rear and two sides on first floor only.
11/10/03 Lath Nail inspection observed: Building ready to plaster.
11/19/03 , Elevator frame corrections observed. R-19 insulation observed at elevator
shaft, ok to drywall.
11/21/03 Elevator shaft drywall nail inspection observed, ok to tape. Insulation
observed at electrical room.
J
11/24/03 Drywall Nail observed by Senior Inspector Kirkland at Electrical Room.
1/9/04 Steve Traxel reported no one on site to facilitate ground plumbing &
grease interceptor inspection scheduled. No inspection performed.
1/13/04 Sand & Oil interceptor for elevator sump observed. Correction noted to
construct a end of line cleanout for final approval.
1/22/04 Sand & Oil interceptor connection to drywell observed.
2/6/04 Superintendent notified that door swings up stair were not constructed per
plan. The outward swing encroaches into the path of egress more than one
half the required width. Notification was issued to correct.
2/10/04 Partial insulation inspection observed for Shell. Suites 104, 106 and 202
were incomplete for signature. Owner was-warned to not proceed with TI
improvements (@ the Cafd') until plans have been approved and permit
issued.
2/13/04 Insulation complete. Permit 0311-156 CMU garden block wall footing,
1501f observed on site, ok to pour.
2/23/04 Shell Final inspection scheduled and performed Correction notice issued.
3/5/04 Shell Final inspection performed with corrections pending final signature.
Shell is approved for MDS tenant final.
5/28/04 Light standards final inspection observed and approved.
7/2/04 Shell Final inspection observed.
Respectfully,
aniel' . Crawf_rd J .
Building Inspector II ,
y
l
STATE-OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION 'OF OCCUPATIONAL- SAFETY AND HEALTH
TEMPORARY PERMITrTO'OPERATE AN ELEVATOR
{Sectlons 7300-7322 of the Labor Codec +
Responsible Party,
OTIS
de 2b a
�N a �'�f K4 190
Elevator Number Date of Inspection Void After
A
Location -Streeetet a umber City Ci or Towyn
aN
Load Permissible SU P one In or `
po nds a - s AV A r
as rte+.
P esenger, refight, etc. achine Type
STATE OF CALIFORNIA
DEPARTMENT OF INDUSTRIAL RELATIONS
DIVISION OF OCCUPATIONALHN ELEVATOR CAR
THIS TEMPORARY PERMIT OR COPY MUST B POSTED
; ! OS? 01 62781
RIVERSIDE COUNTY FIRE DEPARTMENT
IN COOPERATION WITH Q �J
CALIFORNIA DEPARTMENT OF FORESTRY
AND FIRE PROTECTION
RIVERSIDE OFFICE INDIO OFFICE
4080 LEMON STREET, 2ND FLOOR 82-675 HIGHWAY 111
P.O. BOX 1549 2ND FLOOR
RIVERSIDE, CA 92502-1549 INDIO, CA 92201
(909) 955-4777 (760) 863-8886
FAX (909) 955-4886 FAX(760)863-7072
JOB CARD
THIS INSPECTION RECORD MUST BE AT JOB SITE
WITH THE APPROVED SET OF PLANS
Owner Jis� L, ,;,, Date S -13
Location �IIJ A 47
Case No. L)Q,• '3.6P•ni_7
Sprinkler Company
Underground Visual Date Inspector
(Joints and Thrust Blocks Must Be Exposed)
Underground Static Date Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
Underground Flush Date Inspector
verhe tatic00a.4 ate Inspector
(2)0 PSI For 2 Hrs. Prfor to(�ispection Time) !t
TU .
Overh ad Final Date Inspector
Fire Main Installer
Underground Visual Date Inspector
(Joints and Thrust Blocks Must Be Ex sed)
Underground Static Dat Inspector
(200 PSI For 2 Hrs. Prior to Inspection
Underground Flush Date Inspector
Extinguishing Syste nstaller
Final Date Inspector
Fire Alarm Install r
Final Date Inspector
Tank Installer
Final to Inspector
FUEL MODIFICATION
Final Date Inspector
DO NOT OCCUPY THIS STRUCTURE UNTIL
AFTER FINAL INSPECTION BY
BUILDING AND SAFETY
264-159(Rev 1.1/02)
Comments:
�I""tuif s
XA
Date Intls.
Date Intls.
4
Date Intls.
Date Intls.
Date Intls.
Date Intls.
Date Intls.
Date Intls.
` ` IIII IIIIIIIIIIIIIIIIIII os "A �.. Vii, �
'E s - Y C.�TOF LA.QUINTA ..'
�F 9 -KALDING &SAFETY DEPARTMENT
b OF 77`7-7012 .
l{ INSPECTION REQUEST LINE
777-7153
Owner
Contractor
URR 13
Permit Number
POST ON JO di ASPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-480 AVEN11 '47'
COMM.-25,240 SQ.FT.2 STORY"SHELL"BUILDING.
BASED.ON M/B OCC.V-N CONSTRUCTION,
SPRINKLERED.
TYPE OF INSPECTION DATE INSP,
i' TEMPORARY POWER
SETBACKS
U/G PLUMBING/WASTE
U/G ELECTRICAL/GROUNDING
FOOTINGS/STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SI NED
ROOF NAIL/PRE-ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH%ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH D $
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC/GREASE INTE CEPTOR
A ONR INSPECTIONS
FOOTINGS/STEEL
BOND BEAM
POOL/SPA/WATER FEATURE INSPECTIONS
PRE-GUNITE/SETBACKS
U/G PLUMBING
U/G UAS
U/G ELECTRICAL
PRE-PLASTER ALARMS/BARRIERS
FINAL INSPECTIQfAS
TEMP. USE OF PERMANENT POWER l*
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMF,,NT l37-
77v-',x-COMMUNITY DEVELOPMENT DEPT.
FINAL/JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
...
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