RC (0308-112)78010 Main St Ste 105 107
0308-112
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
7I8 a'' l2fS0/2C
,Date •„! _ Signature of Contractor/ice A l
t ` /
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). j
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O I am exempVunder 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 iTATL? FLIN.D 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 those provisions. , ---•-
,Date: l- A % Applicant d - - •- >r' : i ' .
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 D
& 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 ve-mentioned property
✓for inspection purpose !
Signature (Owner/Agent), ►P-%✓ %° '' .: . Date_f/rr
BUILDING PERMIT PERMIT#
}
DATE VALUATION LOT TRACT
y / .-e
7”
JOB SITEq f
ADDRESS "10 MN ST.R.jleEC Koff -10.5 a
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
OIZ TOWNLAQI3ZMALLC
1AARVNHOlb S
78.080 CAUle RU",ADO STEM'-
18-080 CALLS E 700;T0: 201,
:C . C;lUlI3'f CA x 7,253
LK QUINT.A CIA 922 v3
a
(760)771-2567 4'SM4 5407
USE OF PERMIT
CO-NOORdAi, PZMODEL
CON1MXRC1,ALTENAI41' IMPROVIKIMn, 1T 1221 3Q. FT. SKLON M.014TAIz.A;
"El` OCCUPANCY TYI'EVW CONSTRUCTION, 2001 CBC,
CONTRACT AMOUNT' I%"0100 -1.9
LPCr"rMXJ.T.7> OT OF CONSTRUCTION
:P=L r FFF 9UMhI
CONSTRUCTION FER 101-000-418.000 5144.0
PIAN i:i'11rIC: K FEE $157.03
11 ECIINNICALFEE 102.000.421.000 $39,00
;
XIAC 'PJCAi° FZZ 101-000-420-000 $63.45
t
PLUMDING PFIX '1 O1-000-419-000 M50
V RONf3MOTION FE • COMM 1.00-000-241-000 $7.63
ART W 1PIPBUC P'LAC;H 3 - COM? 2701-000.445.660 Stifi ,3tl
,
CON'Smuenow MD P.IAW CMC
I
$5F2.Q3
e I:.tL.93 PRE-PaNW YM, 3,
$0.00
AUG 2 0 2003 ' ' rA?L--PXRW ` FUS DW..NONNY
$562103
CITY OF LA QUINTA
EPT .
FINANCE DEPT-
RECEIPT
'
DATE / /
`
BY
--
DATE FINALED
INSPECTOR
/1
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 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
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 (J
Final
Utility Notice (Perm)
,- Certificate of Occupancy
Tjht ot
1 WM2
G OF Building& Safety
y 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 STREET #105.107
Use classification: COMMERCIAL
Occupancy Group: B
Owner of Building: MARVIN HOMES
30 DAY TEMP C OF O
Building,Official
Type of Construction: VN
POST IN A CONSPICUOUS PLACE
Building Permit No.: 0308-112
Land Use Zone: VC
Address: 78-080 CALLE ESTADO STE 201
City, ST, ZIP: LA QUINTA CA 92253
By: KIRK KIRKLAND
Date: EXPIRES 1-8-04
DEC -09-03 TUE 04:13 PM MARVIN•HOMES
FAX NO. 7607715057 P. 02
!:c4, 4,
:i IN FL►QUINTA )S
B I, t1
I' SAFETY DEPARTMENT
16
"?o 6133 777-7012
- O D•y F " . I'i )N REQU[:ST LINE
w, cia 'et!iMIA 7'77-79534— —
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pn ;lutWill, AMWE SIGNED
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OKAY
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ROIJGI1 11KCI L^11 ("Al_
c,oVt-,.3 NO WORK UNTIL ABOVE SIGNED
CTAS *F1',, i 1"
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kip-^SCMRY iNSPECTIOW) _..–.–
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A'ri0V1' Ai 'f-1kCAfA1-S ()('.) NOT INCLUDE RIGHT TO
'I UFR4 ON LI I'It.,ITlI:!.r (.')R OCCUPY BUILDING