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0101-250 (OFC)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9a(commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # L.riic. Class $ j Exp. Datte/. i C_J / d Dat I ` / Signature of Contractor 7l 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 (. ) 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). ( ) I, 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. I have and will maintain workers' compensation insurance, as required by Section 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 .13TATE :AMID Policy No. ,229-0022A83 (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 with thoserovisiosem. Date:. "t �? 'wz Applicant— Warning: pplicant � . M E Warning: Failure 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, daq ages 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. E 2. Any permit issued as a result of this application becomes null and void if f 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 herPhy authorize! representatives of this City to enter upon the•above-mentioned property for inspection purposes. S' t re (Owner/A ent) � Date � Igna u g ,. BUILDING PERMIT PERMIT# ' DATE, VALUATION LOT TRACT /I f 2 ��il� K00 G JOB SITE ADDRESS 15 �iS'J�T-ifs& APN •%€, OWNER CONTRACTOR/DESIGNER/ENGINEER 'EI.Z„ TM1044 001115 i. ' 1y .A&q IC1M11Q1 VAMAGE P0101 (: I)1R�.rRU i x 13.0 FOBOIX4774 4-1-15 0 3AN JAC'WTO PALM11F82- T CA 92260 PADA DIRMU CA t22CyC1 t C ;ti4 2 ar CM U.f..�. USE OF PERMIT 215 SIS L:tYiTR�,.0XH_K QATF E�C`?'USE, INO IMNA�A. ff4S}yI=9'10H OR C OF O UNTIL �7WP. d`6S's.CoT 9?iEpOVEWENT KR1' .rr i5S1< D BY PUBLIC i"ii►'ORIKw E&P`i•. . MC — COMMERClAl, 3F CONTRACT T AYt/IWNT 9.s AMMA'ATM COST OF CONVIRMVOIT 1241%.00 CP. N01TRU(' TION RE 10! -000-4 `! 81,000 $144.01) PLAN CHECK l "r, 101- ]0Ury+439.218 314121 FER DEPOSIT 101.000.4:39.318-5250,t?t3 MZCXC1_1)t1", We 101.-000-421,000 SSP. a0 VLECTIVITC.AL atm 101-000-470.000 549.50 }�L211?�£ididf } •f�1 101-0004.19-000 $69.00 S'PRcsM T'4OTiOR a -7-Z- COMM 1004$00-241.000 12.6-4 Giq.i,.;"aF.:t 0 FEE, 101 -OLIO -423-000 $20A) OE'EW.t 1:;R.IMPACT VXF $2.42,25 .A.RT 1141'Cf 131.X PLACES . COMI 2110-000-445-00 X63. �c •rt �'/''j'� (� �} '( y�jf�AA�� j/ �S ��j j� fit / �(�'[ 1�•IJ.1., TOTAL L.!�.iN 01AZ ..i0l 110M � Gv.D .1—IL 'iM `+:LM1.'ii IX (� f� j'� �1 ,rJ � •/ il..:r 2 MAS 12 '1007 - �TYURAI kklp --- IIIIIIIIillllllllllllllll ,3 IE RECEIPT DATE -, BYE - DA EFA D 7 o v INSPECTOR 3/.f /!, ? . , t INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs A.11 I Underground Ducts Forms & Footings .O Ducts Slab Grade Return Air Steel Combustion Air Roof Deck H .cOZ Exhaust Fans 0. K. to Wrap F.A.U. Framing Vt Compressor Insulation • --0 y je,44L, Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wail 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 Water Piping _ �' �� Heater Final 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 4 -2 -az, O 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) Z 1 -CII THU 4:20 PM RIV. CO. FIRE P&E INDIO'., FAX N0. 1 760 863 70-19 Torn Tisdale Fire Chief Proudly scrvinbthe Unincorporated Areas of Riverside County and the Cities of. 13anning DcauMllt A Calittre;a ti~ Canyon Lake Coachella Desert 110t SPings w Indian Wells indi4 ' b bake Elsinore La Quinta Moreno Vallcy Palm Dvqcd :• Pc1,65 0. Rancho Mirage w .;an Jacinto Temecula i3oard of Supervtsors Bob BUSlcr, Dimlict t )c,itn Tavaglionc. DISIrict 2 Jim Venable. District 3 . Rov wils'on. Diglflct 4 Tom Mulicn, 17istrict 5 RIVERSIDE COUNTY FIRE DEPARTMENT jn cooperation i iih the Cali forma 17elxmrtmerlt of Forestry and 'ire Protection • ax _ an . gun o venue • erns, 8 omla November 1, 2001 To: City of La Quinta Building Department K I Re: Release for Building Permits Building Permit* 0101-2501 gatehouse with work station The Riverside County Fire Department hereby releases the above referenced project for issuance of a building permit at the discretion of 9 Respectfully, Dale . Evenson Fire Safety Specialist K,P1-11C ERALTOAM21810 PM+d Fetaee-LO.cbc eAERG6NCY SERVICES DNISION • PLANNING SG ON -MIO OFFICE 82 675 HtghWaY 111,1' FI., Intlo, CA 92201 - (760) 863.8886 • FAX (760) 863-7072 „ IE 11-01-01 15:47 RECEIVED FROM:1 760 863 7072 P•01 . Certificate of Occupancy City of La Quinta 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 following: BUILDING ADDRESS: Use Classification: COMMERICAL 78-715 AVENUE 52 Occupancy Group: B Type of Construction: VN Owner of Building: TRADITION COMMUNITY ASSOC. Building Official Bldg. Permit No.: 0101-250 Land Use Zone: RL Address: P.O. BOX 4774 City: PALM DESERT, CA 92260 By: RICHARD KIRKLAND Date: 06-18-02 POST IN A CONSPICUOUS PLACE III�III��I��IIIIIII 16 IE Certificate of Occupancy City of La. Quinta 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 following: BUILDING ADDRESS: Use Classification: COMMERICAL 78-715 AVENUE 52 Occupancy Group: B Type of Construction: VN Owner of Building: TRADITION COMMUNITY ASSOC Building Official Bldg. Permit No.: 0101-250 Land Use Zone: RL Address: P.O. BOX 4774 City: PALM DESERT, CA 92260 By: RICHARD KIRKLAND Date: 06-18-02 POST IN A CONSPICUOUS PLACE