0001-022 LICENSED CONTRACTOR DECLARATION BUILDING PERMIT PERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of 4110411-022
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION S474.1{AS 341 LOT TRACT
Professionals Code,and my License is in full force and effect.
O�j M License# Lic.Class /Ex'p�Dat�e
JOB SITE
d Lr) U 7 0 i d l3 0 iF.?11Zlr ADDRESS 79-6�.►AV EN U E 48 APN 1149.1811-019
LU
1 %
~ f OWNER CONTRACTOR/DESIGNER/ENGINEER
o Z � VDate ` 'r' ��� Signature of Contractor y��� —" ""�
O , R ri,i� `i:��i'�•i'itis Y� a.i�l��li:i`�i ���iii.��� �,�.i*:�iR:i.�:~�it 1��
1— o OWNER-BUILDER DECLARATION
_J U Pu Ui0x 17 i o + 79-1-os R.ANCH0 LA QUiNTA,DR.
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
I— m LA.QUINTA t:'A Y2753
UAt ►U!N"CA (.'A 921~3
License Law for the following reason: ,
Z_ ( ) I, as owner of the property, or my employees with wages as their sole (760)7;1-1041 (1141.01 20%
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 C OMMEW,1AL
contractors to construct the project (Sec. 7044, Business & Professionals
Code). OCAS MAINTENA (M F MC;ILITY
L'') () I am exempt under Section , B&P.C.for this reason
Ln
N Date Signature of Owner
ON
C)
d Q WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations: _
U-) < O ( ) I have and will maintain a certificate of consent to self-insure for workers' �i riCE%I , 1 9-iiJ si
X W compensation, as provided for by Section 3700 of the Labor Code, for the V,iAREHCA_ISIs S40RAUE(SZ) 9.026.W SF
O _ Q performance of the work for which this permit is issued. !i4A1N'4'ENANc:h t 531 I.tW3.UO S}•'
m Q U ( I have and will maintain workers'compensation insurance,as required by E
Ci U-)
3700 of the Labor Code, for the performance of the work for which this
Il F<:H permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
=) STA -TE FUND 446-00 38 ESTIMATED COST OF CONSTRUCTION 474,.E0530
0 PERMIT FLE AffAMAR'Y
J (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, FEE I14I'VSI'[' !QI-OW-43',►-3113 -S 1,Stret.(K�
I shall not employ any person in any manner so as to become subject to the P',AN l'IW(Ft FW i0f-/N1(141 '118 It1,67796
workers' compensation laws of California,.and agree that if` II shoe Id become t.f1*�S f�=•rlt?T.lT� 101-000-418-000 S1,4S:00
1 subject to the workers'compensation provisions of..Section 3700 o tthe Labor
•�•i7 Code, I shall forthwith comply with those provisions. MIssL%l3ANLCAt !Li: 101 t)OE1--121-401) 51:9.01►
,,Date: 1,11-h 130 Applicant _—•J — E�3.IsC7KJCAL FEF 141-Wi}-420-M) $3je.%
Warning: Failure to secure Workers'Compensation coverage is unlawful and 1 n►4Rt�ftl i 1-(1(1(1 41941(N}
shall subject an employer to criminal penalties and civil fines up to$100,000,in r%RADING 117.17 000-421 011 ,
addition to the cost of compensation,damages as provided for in Section 3706 S fRot—,C)N(OTIuN hFll,7-cx.)MMI 100-0010-2$1-OW Svv.3G
of the Labor Code, interest and attorney's fees. AK 1'1N 01BI,IC Pt.Ac'Es- t'{,'tom► 701Ok-2Y4.)(K) S20 71 33
IMPORTANT Application is hereby made to the Director of Building and Safety nFVT-1 CIPAR rMP V'•r HIF S14."7 41
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 Sl fR-'1tY1'AI,t'fl7�f�.1 K1){"}')t)'�I AM0 PLAN('NR('h ''!,""'(th
& hold harmless the City of La Quinta, its officers, agents and employees. Lj? `: I'RU PAP)11:17"'; S;•500 W
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. 101'AV PFR1'11 t f"'i•Y-S OfIV N(YW %241,222.06
1 certify that I have read this application and state that the above information is ) IIIIIIIIIIIIIIIIIIIIIIIII 64
• correct. I agree to comply with all City, and State laws relating to the building
construction, and-hereby authorize represerakatives of this City to enter upon 1 ` IE
the above-mentioned property._foCinspection purpose RECEIPTDATE By DATFI 0 INSPECTOR
%
�
~Signature (Owner/Agent) Date
xt INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs / - Underground Ducts
Forms&Footings Ducts
Slab Grade ,Z -! - Bo 5 T 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 .• —per �'t'
Final _
Final b/ off S7 POOLS - SPAS `
BLOCKWALL`APPROVALS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam �J`�0 5 Approval to Cover
.7 Equipment Location
Underground Electric
Underground Plbg.Test
Final I Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines Heater Final
Water Piping 2, lit Plumbing Final
Plumbing Top Out kEquipment 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) •
-H WED 1 : 27 PM R I V, CO, FIRE P&E I ND I O FAX NO. 1 760 863 7072 P. 1
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Tire Protection
r an acro o venue . peffis,i5llfomla 9z
DIDi
September 6. 2000
Larry Benson
Fire Chief City of-La Quinta
Building Department
Proudly serving the i
unincorporated
areas of Riverside Re: Fire and Life Safety Clearance
County and the
Cities of:
Banning The Riverside County Fire Department is granting a fire and life safety clearance for the
structure known as the Rancho La Quinta Maintenance building located at 79-605 Avenue 48.
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Foot Springs
o.
Indian Wells
Respectfully,
Indio
bake Elsinore- - FRANK KAWASAKI
0*91a Chief Fire Department Planner
La Quint
Moreno Valley
Palm Desert By01
Perris Walter Brandes -
Fire Safety Specialist
Rancho.Mirage
Sats Jacinto
Temecula
Board of Supervisors
Bob Duster,
DiA riot 1
John Tavaglione,
Distrid 1
AM Vrnable.
Distrid 3
Roy Wilson,
DiMct 4
Tom Mullm
D154id 3 '
6MIiRMNCX SERVICES DIVISION•PLANNING sFZMN •rNDI0 OMC16
82.673 Mghwsy 111,r Fl,Indio,CA 92201 •(760)9634886 •Fax(760)363.7072
*Certificate. ofOccupancy -c�-r--
r
Cit of. La Quinta J
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 fol%wing:
BUILDING ADDRESS: 79-605 AVENUE 48
Use Classification: COMMERCIAL Bldg. Permit No.: 0001-022
Occupancy Group: MULTIPLE Type of Construction: VN NON Land Use Zone: RL
RATED
Owner of Building: TD DESERT DEVELOPMENT Address: P.O. BOX 1716
City: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 10-05-00
Building Official
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