0310-133 (RC)78010 Main St Ste 100
0310-133
LICENSED CONTRACTOR DECLARATION
!;,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 r .
771P83 ! 1 0/2%
•Date !`> / S gnature of Contractor. j
• f
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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 :1'i u I<a im Policy No. 1440125,03
(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 thoee pro i ions.
Date: i .77; ;' AppIican `i.-i.s
Warning: Failure to secure Workers' ompensation coverage is unlawful and
shall subject an employerjo-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 representativeslof this City to enter upon
the above-mentioned propertyfo'r inspecti onPurposes.
Signature (Owner/Agent)/`' 401 a' /.15y / Date % % • '
BUILDING PERMIT PERMIT /t
0310-111K
DATE VALUATION
18), LOT TRACT
JOB SITE
ADDRESS '} ,..O1±,1 n ,EM• 119ur 1 . too
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
OLD i'#9014 LA QMNTA i TS:'.
MARV19 T -I01
78.090 CAUX RMA M- EFIE 201 -
7 8.080 CSE 17, 1 AbO STA 201
1A Q1: N' TA clk
,Lcf''. QUANTA CA 92253
119225.3
(760)771.7567 CD1.9 5407
USE OF PERMIT
MUMERCIAL ii1"'.MC)1JE,
C0119bAFP,CIA..L.RiMRA't;JJ1F,L(LeftJDI:LAB.0,NK r1) "FI-U'CCUPANCY, TY'PXVi1
CONS'Cit:ljC?'1ON SPRINKUD. OC:°CUP.AINT LOAD 33, 2001 ±v.T1C
VALUATION Is
EbIrIKNM 0:0611 OF C:ONSI.dR1 C -71®3R'
I8"0.00
PTmo r M., S'CTAIMAR.'
T' AN CtlWX PER 101.000°439.118 V128,70
CONSTROC:TE+31, FZE 101-000-418-000 $'08.00
M Ci- ANICAL FEE 101.000.421.000 $19,50
L?1,9CTRJt: AL M '101 -000-420-000 $52.93
PLUMBING M Z 101.000-419.000 $45,00
SY'1t'JW0 fdTOTIOU FEE .• COMM 100-000-241-0M, 0,97
MJB-TOTAL z f.1NM7iUC"T 0kT AND PLAN .CFWPX
$449.15
I:ESS FR1 '-P AD 2RRES
$0.00
[:O7CTT15 2003 }e
CITY OF LA Q JINYA r .
FINANCE.DEPT,
1
RECEIPT
DATE/. r U
(
DA INALEOv ;
INSPgWOR
`
✓//sem
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 1 ozr
BLOCKWALL APPROVAL9
steel POOLS -SPAS
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
OX 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:
- ... _
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jj£
S
Certificate of Occupancy
444
I aovn7m 4!
iva 5
OF Building & Safety Department
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: 78-010 MAIN ST #100
3
Use classification: COMMERCIAL -MERCANTILE Building Permit No.: 0310-133
Occupancy Group: M Type of Construction: VN SPRINKLED Land Use Zone: VC
Owner of Building: LA JOLLA BANK Address. 78-015 MAIN ST #100
,
City, ST, ZIP: LA QUINTA 92253
` By: KIRK KIRKLAND
Date: 5-11-04
Building Official
POST IN A CONSPICUOUS PLACE
F