Loading...
0403-001 (RC) LICENSED CONTRACTOR DECLARATION PERMIT# I hereby affirm under penalty of perjury that I am licensed under provisions of _ BUILDING PERMIT ..,F_ Cha ter 9 (commencing with DATE 0403-0010403-001S! p gith Section 7000) of Division 3 of the Business and �9' L ; /, EVALUATION LOT TRACT N W Professionals Code,and my License is in full force and effect. / V / �+„�,+�'P[)•f '' License# Lic.Class Exp.Date ! p r- 0 LO °'..-.�. ,\ JOB SITE APN 745690 1;G-29 i 0����21 ADDRESSLLJ rl t` f J OO Date %Signature of Contractor .- OWNER VISTA CONTRACTOR/DESIGNER/EN INEER t` H o OWNER-BUILDER DECLARATION VIS LA. �•A. .+PDE'td LOPYR.%rl.' J `r° 12.912'�P:I I1101H i��a `12.912 I.,i)W�MEE W W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a License Law for the following reason: PALM DEET.�RT• CA. 92260 .l;'.��..M�1.F81,7WIf C�? 922260 Z ( ) I, as owner of the property, or my employees with wages as their sole (760)346.5020 CB!A' :314, compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT I II�IIII�IIIIIIIIIIIIIIII ( ) I, as owner of the property, am exclusively contracting with licensed CCiMM IMC. 4L R1 MODEL. 1 contractors to construct the project (Sec. 7044, Business & Professionals 7 11 IE I Code). COMMFMC1A1.REM00ft i, H ";;rlr . 9— 1''1"A•3"OCCJFfiLI VY, () I am exempt under Section B&P.C.for this reason T Y P K V N 9PRINK1,F17,0 C U P A X T WD 7o,2001 C8C. N Date Signature of Owner Ov 0) C• CL Q WORKER'S COMPENSATION DECLARATION O2 Cc I hereby affirm under penalty of perjury one of the following declarations: tT1I.L'A2'1C3'id ,IJ. Ca.Si[S 1.9r O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' X W compensation, as provided for by Section 3700 of the Labor Code, for the O _ Q performance of the work for which this permit is issued. m Q U ( ) I have and will maintain workers'compensation insurance,as required by O � Q Section 3700 of the Labor Code, for the performance of the work for which this 11 L Z permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier 31'.A*E 1v(14D Policy No. 045-00109% Esi1wrm i (wr O.P.Gf?N►'�'[`mined r �Q (This.section need not be completed if the permit valuation is for$100.00 or less). PL4N Ci` WIF 1F13 101.000.439.318 t ( ) I certify that in the performance of the work for which this permit is issued, COMS'1 RLTCTIaN ME 101-000-4.18-000 ( I shall not employ any person in any manner so as to become subject to the MBfi' ANICAF..1L 101.000-41^000 $64,00 p!• workers' compensation laws of California, and agree that if I should become subject to the workers'compensation provisions of Section 3700 of the LaborL.1�1tG.c�1.1�l;P 101-f1C1f1-4?£3-©C3fa �3a.4� ,.,,Code, I shall,forthwith comply with those provisions. PL1,tTl 8tNd1FRE, 1fJ%�i�L •43�'•©UO $109,50 J Date: v.S 0/0/Applicant f S' RO140 MOTION M10 r C014AM 100-000-2.41-000 $13.651 ` Warning: Failure to secure Wofl rs'Compensation coverage is unlawful and shall subject an employer to criminal peKalties.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 STUD-TOTAL CONSMUMOMA13D€LAN�£X.,CE'. 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 CXI " � ''�" �� U11 0 $0.00 & 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 rE 1 IERWIT TIMS�S 11 UE NOWwork is not commenced within 180 days from date of issuance of suchpermit, 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 isMAR 3 0 2OC-, • correct. I agree to comply with all Citthgy,,,and-Sfa"te laws relating to the building Ei ti construction, and hereby aurize epresentati`ves of this City to enter upon ---_..- the above-mentioned property for inspection purposes. Cirf OF LA OL•E•,�Tp �--' tFiEGE1�T i�YsHt %itr DATE+"^ BY DATE F ALE INSP - R Signature (Owner/Agent) / `- Y/^� Date „ , C-/ 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 Q 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 / p Heater Final Water Piping Plumbing Final Plumbing Top Out Q Equipment Enclosure Shower Pans O.K.for Finish Plaster Sewer Lateral / P1 Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: jr AV,& o— Ftp��ae xaT Final � 1 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) J � COUNTY OF RIVERSIDE COMMUNITY HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # DATE (�_o SUBJECTGv f/ I y�e cel Cc4 - PERMIT NO. - ADDRESS g 0 b �ve • ( S}e I()V &Z(+C INSPECTORI-DtAi i. REMARKS: � 1 X12 �r�� -� q,�f q� !►���►,~, �ull�cte�� o„-�.,�� dt�te. ��joS',o� �cat+/�iClr'68M� Y t F,l l Scree, Wes at leC -t-. "o..,, or r wvu� f; 2 Co P� sP�l haw ec. ca�f' *`tt,or nld - SGP �tfe� c�r� c�c cl ��ePim(X r -trCS 3 c� +oL, qew!ncif gf all S�eIL J^ LrFckPfS . - 5Al2Sre L L / t I CfGCUS Ott oaL Gl UOr fr``<1, e*<(uSL c 7v ql'Uw . 4" A u. e- ('C.k4 I GfPti a S) �S' s -441-4 lU r\r5+i SI•�� rOL('r� N^anher . rote dW erm l at 1 o cliQr_< - I I c1�er � • �l . L um arc 4o oer �• y� S�� oc iiot 04 Val f, aN 4z� rove0( ( e ( OK ,"U%A.. c( 4`u <Lll zzraved POP ol2u)a* 4r rA 6AAe-,- f 0o1-� c�)Sti'e,V; L.01 �or,req ce p I 1, c,40 A�re-,.mm &¢ clea (te, lex 114 " 01r4,( UlIrPc e — �� Pro��r�ecl (uv�S�,,,k . �o,frC'G'�' ����t �o f-►rSf' r �u1-��t �� �f��� , 44 Vlh DEH-SAN-1 18(Rev 8102) Distribution:WHITE—Office;CANARY—Owner; PINK—Office de• "- • n -a- �-� Certificate of Occupan ,CY0 .moo TA 4 J4P kT 1 INppppN� � ti. i 19tt t G� 9ti5 OFA Building & Safety Department 1 4 4 This Certificate is issued pursuant to the requirements of Section 109 of the California Building Y Code, certifying that, at the time of issuance, this structure was in compliance with the � y provisions of the Building Code and the various ordinances of the City regulating building psi construction and/or use. 4 . � BUILDING ADDRESS: 78-900 Avenue 47 Suite 100 x Use classification: Commercial (Coffee Break Cafe TO Building Permit No.: 0403-001 a Occupancy Group: A-3 Type of Construction: VN Sprinkled Land Use Zone: CR ` Owner of Building: Vista La Quinta Address: 72-912 Willow Street City, ST, ZIP: Palm Desert, CA 92260 , € ji t r i r By: Daniel P. Crawford Jr. Date: 7116/04 Building Official i tit r + t E POST IN A CONSPICUOUS PLACE +:4 •