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0401-149 (TI) LICENSED CONTRACTOR DECLARATION PERMIT# I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and 41•"�`� DATE VALUATION LOT TRACT WProfessionals Code,and my License is in full force and effect. �- O =) ch License# Lic.Class Exp.Date JOB SITE APN W r 7456190 B`29�. -- rr_''15112J2.8121 ADDRESS 'M-MNMIKIR'.`f9y`i G...�(J��� oZ ill /Date 117/td Y Signature of Contractor-��" OWNER CONTRACTOR/DESIGNER/EN (NEER O � d/ ///d �� OWNER-BUILDER/D ARATION l► +�X,JkQ11•;$�"T�� 1A'1.°.F��•C�P1'"e�,�ly};T,t`.':PUP U r- 5-524��1f► EK S'1RF�T 2-912'4iv'I�.,T..C.DVY V.1'RA-Tri" W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's F- a LA Qt�1$7A CA 9 yw�3 PALAIYE,M<7' :A 9;.:`260 License Law for the following reason: Z ( ) I, as owner of the property, or my employees with wages as their sole k760)346-5020 CHTP 'I`13•D 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 1rO . :'IOW-RE.MO1:MI contractors to construct the project (Sec. 7044, Business & Professionals Code). 39002"?M4ANT IMPROVEMENT FOR Mid;C+ONSULTINCY 689 N () I am exempt under Section , B&P.t.for this reason C7t: UPArlt:4°/661i3M C:oC O N Date Signature of Owner rn CL Q WORKER'S COMPENSATION DECLARATION CD I hereby affirm under penalty of perjury one of the following declarations: L..+ y �a O ( ) 1 have and will maintain_a certificate of consent to self-insure for workers' -Q1v4�rC� 3T,9t1LfN'� �S'�Obl?,r9� X W compensation, as provided for by Section 3700 of the Labor Code, for the O J _J 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 0 Q Section 3700 of the Labor Code, for the performance of the work for which this it rn H permit is issued. My workers' compensation insurance'carrier & policy no. are: 'It Z Carrier STA�`iJ"sFiTl+i€? Policy No. 046-00909h6 ESTUVi'FID co&r OF CONS"RTI(MI ON J (This.section need not be completed if the permit valuation is for$100.00 or less). CON-9- 'Itl9CTION FER 101.000,418-000 $i0210n ( ) I certify that in the performance of the work for which this permit is issued, PL.,AX a IREC;Y I'LS 101-000-339-318 $425.34 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 �'� FI'A �tc" L'F451w 101-000-421-000 $55.00 1 subject to the workers' compensation prov�ions of Section 3700 of the Labor WILT 'JC•A11 FEE, 101 $92.50 ••v7 Code, I shall forthwith comply with-those provisions _--- PLUMBING FEF 101.000-419.000 $LSM /Date: Applicant '7`i'r. ��' STRONG NOTION FEE—C:C?NIM 100-000-241-000 $11.G3 t Warning: Failure to secure Workers' Comp nsation 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 ff[1L.4: '•B-T(Y1'AC52�WRXICTI�?N31tLtt'D k�J..,AT4 CIEWX $1,118.49 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 T`F :� 1�R1�S' 'AI2s �3i '©(1 . & 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 ?w ;�� �f,4? ► work is not commenced within 180 days from date of issuance of such v �, permit, or cessation of work for 180 days will subject permit to cancellation. A� 2 9 200 'lulIIIIII I�IIIII�II I certify that I have read this application and state that the above information is J 46 • correct. I agree to comply with all City, and State laws relating to the building CITY O .A O iC vA IE construction, and hereby authorize representatives of this City to enter upon FIB5AP9CE DEPT. the above-mentioned property for in�ryecii n purposes. REC IPT - DATE BYI DAT F ALE INSP TOR �� Signature (Owner/Agent).�-•�- ,-y-__ �.._� - Dater/'`%/�1tf is 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 6 Compressor Insulation A LWA& Vents Fireplace P.L. Grills Fireplace T.O. Fans&Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall-IM.Lath a 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) If I RIVERSIDE COUNTY FIRE DEPARTMENT IN COOPERATION WITH 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 Date Locat L n Case No._Ldp-od-7-t-oo7 — 1 j. Sprinkler Company -DA%v1 Underground Visual Date Inspector (Joints and Thrust Blocks Must Be Exposed) iV IA - Underground Static Date Inspector (200 PSI For 2 Hrs. Prior to Inspection Time) UndergroundluF sh Date Inspector Overhead Stet+e Date Inspector ( .-ef ib ARS e&AgQ—Tame) Overhead Final Date Inspector Fire Main Installer - Underground Visual ate Inspector (Joints and Thrust Blocks Must Be Exp ed) Underground Static D e Inspector (200 PSI For 2 Hrs. Prior to Inspection me). Underground Flush Date Inspector IIIIIIIIIIIIIIIIIIIIIIIII 45 IE x �•} �!��uwta`a,,c 0 ,0 Certificate of Occupancy0 o 4 Incasoc+isv� roez Com` OF'T9� Building & Safety Department This Certificate is issued pursuant to the requirements of Section 109 of the California Building Code, certifying that, at the time of issuance, this structure was in compliance with the provisions of the Building Code and the various ordinances of the City regulating building construction and/or use. .. BUILDING ADDRESS: 78-900 Avenue 47 Suite 208 Use classification: Commercial Office (MDS Consulting) TI Building Permit No.: 0401-149 Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR Owner of Building: Vista La Quinta Address: 45-524 Towne Street City, ST, ZIP: La Quitna, CA 92253 f�b.•t By: Daniel P. Crawford Jr. Date: 3/5/04 Building Official POST IN A CONSPICUOUS PLACE