0303-020 (ELEC) LICENSED CONTRACTOR DECLARATION PERMIT#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT OISM-q20
H Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATEVALUATION LOT TRACT
04 W Professionals Code,and my License is in full force and effect. ,� 1 �L� ��
O M License# Lic.Class Exp.Date
JOB SITE
LLJ d `o 748137 CIO - 4/30/04 ADDRESS 8 1-6W AVENCE58 APN
oZO r / /D tae 1 Signature of Contractor ` �`' �� '1 ! OWNER CONTRACTOR/DESIGNER/EN (NEER
r- i.— C) OWNER-BUILDER DECLARATION Va1ZON BA's C7CY I!�.I?CMCAL WORKS INC.
-' U LLI 15505 Sl`NU CANYON I12Q8L7SY'P,LAL,ROAD
LLIaW I hereby affirm under penalty of perjury that I am exempt from the Contractor's 1R,My, CA 9261 8 , =E CA 42040
U) License Law for the following reason: ,►14)93fI-82f)f) MY
( ) I, as owner of the property, or my employees with wages as their sole f
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 BjZ(;',ITUCAL
contractors to construct the project (Sec. 7044, Business & Professionals
Code). 1NS' A1A,KhgZRU15Nt;Y 5TAN.Ub T kJ1*.Dt1RA,1 UK Al &K 4i I'lNu(:k:6L:,t 4'iL.
C'') () I am exempt under Section B&P.C.for this reason
N Date Signature of Owner
ON
a)
Q WORKER'S COMPENSATION DECLARATION
iO Q Cc I hereby affirm under penalty of perjury one of the following declarations: "VALUATION I's
r F-� O ( ) I have and will maintain a certificate of consent to self-insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
m _Q performance of the work for which this permit is issued.
Q I have and will maintain workers'compensation insurance,as required by
OLO Q Section 3700 of the Labor Code, for the performance of the work for which this
0) H
CC
permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carrier PREFER; )FAIPL401 Policy No. 630323W76:: Eb"T7.hI&MM COST Or' CONS1R1E7CF ON 12,000.01)
°moo O L'MWI'M'.1 fliiIiV1,11imzy
J (This section need not be completed if the permit valuation is for$100.00 or less). PU)q CHECK IRE 101-fk1Q•-435'•318 $87,7:5
( ) I certify that in the performance of the work for which this permit is issued, EL IKM'RIG AL M 101-.000-420-000 �3D.U8
1 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
3 subject to the workers'compensation provisions of Section.3700 of the Labor
Code,I shall forthwith comply with those provisionsP '.
,-Date: t Applicant �� t i';llrJhl �
f 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 s
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 SUB-TOTAL COI+1S7.7t11CMON ANIS PLAN CIL W- K $11735
whose request and for whose benefit work is performed under or pursuant to LESS PRE-PAID) , , ,r,S VIM
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.
.��I'1MI4'C� BUCIjPa NOW $117.75
2.Any permit issued as a result of this application becomes null and void if n rA
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. (Z �I j IIIIIIIII IIIIII�IIIIIIII 38
I certify that I'have read this application and state that the above information is
EMAR1 20U� ```
correct. I agree to comply with all City, and State laws relating to the building L-1i IE
construction, and hereby authorize representatives of this City to enter upon CITY OF LA QUINTr`►
the above-mentioned property for inspection purposes. L
i1 f 1 REC BY I DATE INA& INS
/Signature (Owner/Agent)" P C 0
Date
1t V� v
" r '
f �,
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 POOLS - SPAS
BLOCKWALL APPROVALS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Pibg.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
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:
i
Smoke Detectors `
Temp.Use of Power
Final:
Utility Notice(Perm)
III�IIIIII�IIIIIIIIIIIIII 39
RIVERSIDE COUNTY 1E
Ffh'GW..o1aTA'AIdF -
f FIRE DEPARTMENT
�. ,.�.., .:. 82-675 HighwayIndio, Fax86.3-7072
Craig E.Anthony May 3,2005
Fire Chief
JBL Associates
Proudly serving the 242 North 8th Street
unincorporated EI Centro,CA 92243
areas of Riverside
County and the
Cities of: Re: Non-Structural Building Plan Review
LAQ-05-TI-03818.1-600-Ave-58 - -----
Banning
%% Fire Department personnel have reviewed and approved the plans submitted for the new shade
Beaumont structure for the existing hazardous materials containment area. Approval of these plans should not be
construed as approval for the classification and quantification of hazardous materials stored.
Calimesa
4.
Canyon Lake Please contact the Fire Department Planning &Engineering staff for final inspection.
Coachella Requests for inspections are to be made at least 72 hours in advance and may be arranged by calling
(760) 863-8886.
Desert Hot Springs
❖ All questions regarding the meaning of these conditions should be referred to the Fire Department
Indian Wells Planning&Engineering staff at(760)863-8886.
4.
Indio
Lake Elsinore Sincerely,
.;.
La Quinta FRANK KAWASAKI
+ Chief Fire Department Planner
Moreno Valley
4.
Palm Desert
4.
Perris By
4. Walter Brandes
Rancho Mirage Fire Safety Specialist
San Jacinto
•. Cc: City of La Quinta—Building Dept.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jeff Stone,
District 3
Roy Wilson,
District 4
Marion Ashley,
District HAPEZIwP DaLYa Qih1PFIQIECTSI7N/W-0i71-WB.Ooe
EMERGENCY SERVICES DIVISION •PLANNING SECTION •INDIO OFFICE
82-675 Highway 111,2^d FI.,Indio,CA 92201 •(760)863-8886 •Fax(760)863-7072