9804-062 (RC)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
04 W 1: Professionals Code, and my License is in full force and effect.
O. ch r License # Lic. Class Exp. Date
541464
i
Z t- vDate Signature of Contractor_.,._ -'-�=--------'^-"'
o � . f
00. ,
J U C:) OWNER -BUILDER DECLARATION
W aLU r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
L
I! 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.
(4 1 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 Policy No.
S:1 -NTL FUND ; iolp*096.98
(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.
i0ate: A /i(_, : / ' Applicant /...,
r � j )
Warning: Failure to secure Workers' Compensation Coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
/Signature (Owner/Agent) - -- " = Date 4 14 w r 1%1
PERMIT # CONTROL #
'BUILDING PERMIT
9804-062
DATE 4/1.61 VALUATION ����� 0 00 LOT TRACT
/
ADDRESS _73-245�'�IGsIRVI V., III S�YITE1.1124 JOB SITE
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R013 PARKER
B17E3,GESS'SUIT,i'S:WS
PAIAi ll1~ S1 ICr C.A. 9:2255
(7.60)3478521 CULM "212
USE OF PERMIT
ir�00 S.F. TONA,NI' ii�iF'f2G`%.t"e�its%f i' tF3.ti140J3As.E_'8i
10.0W.00 LS
3'nD$il iDA, 1.9flsf�"�.'«a96.,7•.�'OF 4.6,/.1 �S y,la .aaYU'i,,.6AVJ�'}..
14. 0ftP..W
PLAN CI=li:'C'Io FEF 101-000-439-318
l-,`.�.-�''e�.�'�•�.!f'"i'irl°� �` �:�: ! �1.-���-'� ��- �n d�e !
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311ryryC.VE13 101-OW42I-000
1
E,LEGrIG CAL 1 f 101-000-420-000
PLLf' O31:NOY.FE 101-000-4:19-M) 105.53
4iTf.!Nli'Li[�'i1�?I�F.{#•z_`,r)1S[1rt 1Q:rf}1i(1�41-L) 52.10
i4
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.bi
a �
4
t., CGjdS1':I O{[ IQN _A;,� D PLAN C❑t�FCK
$318.65
LEM } S
APR 1 g 1998 '�'$�TAI,PRANUT. p C�'�iCllsiVOW
$08.65
�I T� left � •
OFLA
QUIUTA
RECEIPT,
DATE
BY
DATE FINALED
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
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Insulation
!
Compressor
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
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
i• �'f-ZX
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
Final 5- g
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
x
Final
Utility Notice (Perm)
COMMENTS:
CALIFORNIA DEPARTMENT OF FORESTRY
:. `RIVERSIDE COUNTY FIRE DEPARTMENT < ,
f. f
210 WEST SAN JACINTO
" PERRIS, CA.=92370
(714) 657-3183
• �,�,.. ?r (619) 347 -2480 --
INSPECTION LOG
COMPLIANCE ORDER Page I of
` 1'
Page -
Notice -No
FACILITY— AM �?�"�' o�► ¢ 6 Date: 5 Z
ADDRESS' �fL'y City n Phone:
The items listed below are in violation of one of the following:
UNIFORM FIRE CODE UNIFORM BUILDING CODE:
RIVERSIDE COUNTY FIRE ORDINANCE CALIF. HEALTH & SAFETY CODE (TITLE )
OTHER f ff -- /
4y5an� � fyar- exit Joo(' k4Kn
5 P�P�e< dowrrrlo✓� uuf eA t
1
FS5
Measures shall be taken to correct listed violations. A reinspection will be conducted
on or about nO A 9 .FAILURE TO COMPLY MAY RESULT IN LEGAL ACTION.
Received B Titl�l��51��
Fire Inspector
FOR FURTHER INFORMATION PLEASE CALL
Phone 2(-3 • %(e
RCO 26.11 (Rev. 1.87)
Certificateof Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 78-285 HIGHWAY 1 1 1 SUITE. 32-4
Use Classification: COMMERCIAL
Occupancy Group: B Type of Construction:
VN
Bldg. Permit No.: 9804-062
Land Use Zone: CR
Owner of Building: BOB PARKER Address: 748-100 DESERT GROVE
City: LA QUINTA CA 92253
77
�;" By: RICHARD L KIRKLAND
Date: 5-29-98
Building Official
POST IN A CONSPICUOUS PLACE