9802-068 (SOTB)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chlapter rbmmencing 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
v ate 2 7 Signature of Contra -Von' ° ''� -nk.0
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, as owner of the property, am exclusively contracting ,with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section B&P.C. for this reason
Date 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.
Se( ) I have and will maintain workers' compensation insurance, as required by
ction 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:
Carrier Policy No.
CAI., CO& x� AL'S"$ i t.3; "64Ciii
(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,
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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply 'ith those provisions.
�6ate: Alz�pplicant,�� + -„,rQd
Warni4 Fai ure 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.
Signature (Owner/Agent) . c, f-. r> •b \, �. m, Date
PERMIT # CONTROL #
BUILDING PERMIT
f
DATE T VALUATION LOT TRACT 6 Q A 6
vvov
S /8 50.5— �a�'��'�(ili.�E 52 JOB SITE
ADDRESS
APN
7(#15-IR4 403
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'i'#;.•tDI"I'll ;'S..fit) .;VSSt.3C'i.
! T aA``lif'E?,;T•.f'
:X.'50 AVENUE, 52
-1i&O BOARDWALK 92104
l.A.(-,)01N"161 1 A `, 021'1
111k 114I)EShR i'A. O I11
r,7c>{1+a,14)-Olt E'i3t,ff ;it1"1
USE OF PERMIT
COMM
CART WASH CAN611Y ONLY
vAi.1fA►t 014 ",ifii.f iI,s
Mflq NIATED Com' OF CONSTRWf TON
PEWIT VCE fit3lbb)IN.ARV
PLAN CHECK FFY 1014ft-439-3111 $6435
r5nV—s (`R 1:1T(`TI0N FFF 1111-N)0-4 19- !('yf} ;99. (10
3410T10NVrTi Tr>lt&i 100 -000 -241 -OW
*3 113=1't)1A(,. F `f"►1k' 1'�it.fC"t,9t 1\I r1A11)34.AN
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Ctlt?(3
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r
I IIIIIII III I I I II II IIII 05
IE
RECEIPT
DATE
BY
D77A D
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
f BUILDING APPROVALS
MECHANICAL APPROVALS
Net 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
Final '"
BLOCKWALL APPROVALS
POOLS - SPAS
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
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
C
Final
utility Notice (Perm)
COMMENTS:
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Rivers:de
County and the
cities of:
Beaumont
Calimesa
Canyon Lake
Coachella
Desert Hol Springs
Indian Wells
Indio
4
Lake Elsinore
z
La Quinta
Moreno Valley
Palm Desert
Perris
-1
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tont Mullen,
District 5
r
RIVERSIDE COUNTY FIRFI' DE PARTME_,NT
!�i cuul,c ru�iu,�
with the
CQIlfblwita Depal-11new vf'Fui•estq} Cold 1"ire Pl-olecfrun
210 West San Jacinto Avenue • Perns, California 925710 . (909; 940.6901) • FAX (SX 9) 940-W,. io
February 18, 1.998
To: Winchester Development
41-865 Boardwalk
Palm Desert, CA 92211
Attn: Mike Rowe -
Re: Traditions - Maintenance
Shade structure
Fire Department personnel have completed a review of the plans submitted for the above referenced
project and have no conditions or corrections to be met prior to issuance of any permit.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Applicantrnstaller shall be responsible to contact the Fire Department to schedule inspections.
Requests for inspections are to be made at least 24 hours in advance and may be arranged by calling
(760) 863-8886. '
n
Sincerely,
RAY REGIS
Chief Fire Department Planner
. By
Walter Brandes
Fire Safety Specialist
FIRE PREVENTION DIVISION
PLANNING SECTION
I\1. IO
43.209 Oasis St., 2nd Ft, Indio. CA 92201
(7(A)) h0 -88u6. FAX (7aU)ti6J-707]