0106-167 (COMM)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
597975 B ;TH3112C
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 N 1ATE I+tlND Policy No. 229-90-0003716
(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.
Date: 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) Date
BUILDING PERMIT PERMIT# Py
01(36 1467
DATE( VALUATION $1 ()yq,7Z _ LOT AC y j
MINIM.
ADDRESS S. 0 tU f2 AWNN. 54 JOB SITE
APN ,F7, -32.". ("'
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MT, LQLP, fix,R
ARM 0 CAPRITR.ARO DEVIEWE NTNT
8 i -100 AV.t` LYE 5 3
79687 COU1\ fRY C IATB UR #201
LA QUWA. CA 92253 3
BERMOD A DUNM CA 92201
(/60)345-7755 CS114 1969
USE OF PERMIT
Y9
456 Sr CO.MFORIT STATION( PPR APPROVil) P1,AVS
A ,0T 1%,d o, Ar Y�
PORCF»ikTIO JS3.00 3F
-
f:d-61.0E CARPS IRT .136.00 SF
MUMV FJW MliWalRY
CON TFtUCTJOH RE 1.01.1000.418.000 $126,00
PLAN CHECK.'FEE 101-000-439-318 $35.fil
1M I CHANXCAL FRE 101-000-421-000 $34.50
E1, YrTPJCAi., FZZ 101.. -000-420-000 $57.63
NIUMB11,1) Me 101-000.419¢000
TR.ONQ MOTION IEEE - COMM :00-000-241-000
01RAD111•it31 UE, 1.01-000.423.000 220.00
1:7L'1 EL.OPRR IMPACT FZF $5139,3:4
ART IN PUBLIC PLACES - CONI.1701-000-255.000
STM-WrAL LC'9NgrRUC110N ANA PLAN MY=
$954.04
1815 P!<1~ -PAW) F&M=3
MOD
M1rA1l PlIVIRA�`.T1;'. EES VDtjr, NOW
� $.JK4,04
t
Ll
IIIIIIIIVIIIIIIVIIIIIII 33
IE
RECEIPT
DATE
BY
DATE IN ED
INSPECT
rA
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
- Q
Exhaust Fans
O.K. to Wrap
- .p 51
F.A.U.
Framing
'p 5
z
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
POOLS - SPAS
BLOPKWALL APPROV S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
. p y
Approval to Cover
. p < . •
Equipment Location
Underground Electric
Underground Plbg. i est
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
, O
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)
OF*
CI L QUINTA
`cFyoFo UII� G ��AF DEPARTMENT
S� 7-7012
s N ON REQUEST LINE
Q Q� 777-7153
Owner
, LLC
Contractor NgdoCAPISTRANO DEVELOPMENT
Permit Number 0106-167
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 80-630 V2 AVENUE 54
456 SF COMFORT STATION(#2) PER
APPROVED PLANS
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL F,- TE
SEWAR SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
TING - A/C
JSE NUMBERS_
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
TYPE OF INSPECTION
DATE INSP.
FOUNDATION 8 SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
ot S /
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
D
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
OT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING 8 VENT - A/C
FIREPLACE
ROOF
aj0 O
BOND BEAM l -OL
VC, •o
O.K. TO WRAP /Aff
! S
GROUT ❑ 4' ❑ 8'
FRAMING
" f3 •J
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL F,- TE
SEWAR SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
TING - A/C
JSE NUMBERS_
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
6
Permit #
Project Address: f)(ApL}-
A. P. Number:
Legal Description:
Contractor G
Address: L too A
City, ST, Zip: L QG ��
Telephoner
State Lic. #�
Arch., Engr., Designer:
Address: 14,
City, ST, Zip: ')PrL A
Telephone:l4go--l'11 —19,
State Lic. #: — ! � g�
Name of Contact Person: 02,
Telephone # of Contact Person:
M Submittal Req'd
Plan Sets
Structural Calcs.
Truss Cales.
Title 24 Calcs.
Grant Deed
School Fees
Subcontactor List
Planning Approval
Pub. Wks. Appr
H.O.A. Approval
City of La Quinta 11
— o_, _ IE
City Lic. #:
f
9ZZ 53 -
..... .......
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: 456 #Stories: #Units:
Estimated Value of i'rojcct:
APPLICANT: DO NOT WRITE BELOW THIS LINE
Reed TRACKING PERMIT FEES
Plan Check submitted Item
Amount
Reviewed, reedy for corrections Plan Check Deposit
Called Contact Person Plan Check Balance
Plans picked up Construction
Plans resubmitted Mechanical
2" Review, ready for correctionsrssue Electrical
Called Contact Person Plumbing
Plans picked up S.M.I.
Plans resubmitted Grading
' Review, ready for corrections/issue Developer Impact Fee
Called Contact Pers
Total Permit Fees
on
A.[ P P.
Date of permit issue
Total Permit Fees
Certificate of Occupancy
Tomt 4XPau&fa
Building & Safety Department
W
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: 80-630'/2 Avenue 54
Use classification: Commercial — Comfort Station
Occupancy Group: B
Owner of Building: ND LQP LLC
Building
Official
Type of Construction: VN
IN A CONSPICUOUS
Building Permit No.: 0106-161
Land Use Zone: RL
Address: 81-100 Avenue 53
City, ST, ZIP: La Quinta, CA 92253
By: Daniel P. Crawford Jr.
Date: 2/4/04