5512-042 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. 460707 C39 8131196
License # Lia Classe
Date i1 :;777015 Signature of Contractor �/
"'
OWNER -BUILDER DECLARATION
I hereby affirm 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 ARGr NRU Policy No. 21551185494
(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 tho��Zqs. D t -
e: �� �� �.� 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, intarest 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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),=-rt. ✓ . w� �. / Dams
ALC0i�a
_BUILDING PERMIT
PERMITi��,��.F
'DATE
VALUATION ` „ .rvr LOT TRACT
JOB SITE ADDRESS 74483 11VVY 1$3
APN
OWNER
CONTRACTOR
PMONELL,A ROOFING
TRU REPIUfMT:ER
68320 KIELE Y RD.
_74-493 HWY I I1
COSTAMESA CA 92627
f,A QUINTA CA 92253
(63.9)324-5482 1`, 0131,4
DESIGNERIENGINEER
USE OFPERi1101E VEl--Al,'5tt a JtfVt!'
l2Js"12f3c.)f�
FEE DESCRIPTION
FEES
C UNTRA,C T Ei[i OUNT 7'stN1.00 .L3
ESTIMM"i'13 D COST U.F" COINSTRUCTION
7,€00.00
PKI111MI'1 .f'14,*E S1.lM1MeiR
REROOFF FE 101--M-418-000 $30.00
SLS -TOTAL CON1S'iRUCTION AND PLAN CHECK;
$30.00
OLESS ME -PAID FEES
$0.00
< < J�'
o 1iUTAL PEfdMIT FD.. S D1JE N0'%r
$30.00
RECEIPT
DATE r
BY
DATEFINALED
INSPECTOR
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 U—
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
Final
Utility Notice (Perm) .
4
78-495 CALLE TAMPICO — LA QUINTA, CALIFORNIA 92253 - (619) 777-7000
FAX (619) 777-7101
July 28, 1995
To Whom It May Concern:
Please be advised that the Beer Hunter Restaurant, located at 78483 Highway 111
in La Quinta, California is an occupancy group A-3 per Table 5-A in the Uniform
Building Code 1991 Edition. This is based upon an occupant load of 99, as
determined by the Riverside County Fire Marshall.
Please feel free to contact me should you have any questions.
Sincerely,
BUILDING & SAFETY DEPARTMENT
Mark Harold
Building & Safety Manager
kt
r
I
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253
REVISiOr-eS BY
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