0301-001 (MISC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing 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
78:55443 13 /�. 1W1/2(
Date % ^ Signature of Contractor-'
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).
( ) 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 SCIS �sr A,5'�ICj?1 A Policy No. ri 1030 3
(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 those provisions. ,
,/6ate: �A- Applicant
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, 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) fir Date
BUILDING PERMIT PERMIT#
DATE 11t VALUATION tm LOT �- TRACT
JOB SITE- '- APN
ADDRESS S0,9WAVJC,1�yXSJ
OWNER CONTRACTOR/DESIGNER/ENGINEER
81-100 AL�.,I�Vr 55, 9440x. 261' ST10= 41 M
TA AUDITA CA. 92253 3.}i~�+1iNIX AZ 8502
(6(12;956.1327 (;RVt 3484
USE OF PERMIT
NOSCE
SUPta1,.EMENTAL, TO PF1ci1Rrr #o}o2.m 5'I'k:C3A,I. r1gSPY VIOri TO 1"11+fA.L
EXPIRED PERMIT,
n1TLM"T= COST OF COWUREW110N
:P.E.RMT VF%, Si!204ARY
SPECIAL TNS1' FX- 10)4 101-000.423-000 V00.00
s
RECEIPT
D Q
JAN 0 g 2003
CITY OF LA QUINTA
FINANCE DEPT..
0190 1-
•SLA-T()'i'AL COMM TC't` 0-V A11 PLAIT f"MC;, ,' $100.00
(i� IIIIIIIIVIIIIIIVIIIIIII 16
IE
DATE I BY o DATE FINALED TiNSPECTOR
�/L/�3 S�'Ec.ac-�,..��ur�o� ?� lT/,✓q.L Fx/i�sE� PE,�,�,.a— �E.��j'B.
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
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
Finan
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
Final
Utility Notice (Perm)
COMMENTS:
The Hideaway Building Update
November 3, 2003
Items pending on correction lists from City of La Quinta to finalize buildings:
❖ Maintenance facility 80955 Ave. 52
1. Construct guard rail on mezzanine per new structural design from
Langston & Assoc. (was not constructed per original design) Will
complete new construction on Nov. 12, 2003 Approved on 11/6/03.
2. Re -hang handicap grab bars in showers men & women bathrooms. Has
been completed will call for inspection on Nov. 7, 2003 Approved on
11/06/03.
3. Provide alcove fountain protection hall #3 Greg Sutler has waived it
need to sign off on correction list.
4. Written evidence from Fire Dept. final. Need to connect to domestic
water for final approval
5. Community Development Approval. Need to construct screening
around air conditioning on roof for final approval
❖ Pump House 80905 Ave. 52
1: Community Development Approval. Need landscape & irrigation
installed, perimeter wall approval & wall to be installed for final
approval.
2. Public Works Dept. Approval. Need to re -pour driveway for final
approval.
Comfort Station *2 80630 % Ave. 54
1. Connect building to domestic water. Need to install main water line and
water meter on 54 for final approval.
2. Install building address. Has been completed, need to call for
inspection. Approved on 11/6/03.
3. Install approved hardware at men & women restroom. Hardware that
requires no special knowledge or key. Has been completed need to call
for inspection. Approved on 11/6/03.
4. Toilet partition doors needed to swing out per plans. Has been completed
need to call for inspection. Approved on 11/6/03.
5. Public Works Dept. Approval. Has been approved on June 26, 2003
need to give copy to building dept. Approved on 11/6/03.
Comfort Station ft 8&260% Ave 54
1. Construct refreshment station per plan or accommodate ADA
requirements. Will need to complete November 30, 2003
2. Connect building to domestic water. Need to install main water line and
water meter on 54 for final approval.
❖ Range House
1. Need to cut in a new attic access in foyer for AC access that City of La
Quinta has requested. Will cut in by Nov. 12, 2%3,
•'• Ranch House
1. Need to review correction list and revise plans to re -submit to City of La
Quinta for a permit. Will discuss with Nick Fullerton so we can get
ready for submittal.
Respectfully,