0307-390 (ELEC)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
031's1/2(
Signature of Contractor
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).
( ) 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 SI'Ih7, Policy No. 0460300126.00
i
(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 adee that if I should become
subject to the workers' compensation p�rovlslonsf Section 3700 of the Labor
Code, I s all fo hwith comply with those, prow Islo s.
,,Date: d_ Applicant o n`
Warning: Failure to secure Workers' Compe sation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. "
IMPORTANT 'Application is hereby made to the Director of Building and Safety
for `,a permit subject to the conditions and restrictions set forth,.on his
application. �'°
1. Each person upon whose behalf this application is made & each -person at
whose request, and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & "shall,. indemnity
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of.this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this app p'lication and state that the -above information is
correct. I agree to comply withl'all City, and State lawsirelating to the building
construction, and hereby .autWorize representatives of this City to enter upon
the above-mentioned prop r4for inspec 'onur-pokes.
Signature (Owner/Agent), . Date
BUILDING PERMIT PERMIT"._
DATE ` r .VALUATION LOT TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MADISON DEV. ..
DEB CONSIRUC'M. W.
71361 SAN GORG NII HT1.
-11210 A 3 TMON' 90
RANCHO AGE CA. 92270
AWA0MM CA fly (
(7141632.6690 CRTA 3275
USE OF PERMIT
COMM • :NrW L10 I`l' ST.AfvD.AP,1D FOR. BANK 01VA o`BRIC? SUILDINa
MUMATED COST OF CONUMMION
0.00
PUM.MT FEE ifr fi&$lb%�uf` RY
PIAN Ct3EWK PRE moo
ELECTRICAL 1W• '101-000-420-000 $26.73
STROW0 M011014 i4 COMM 100-000-241 -000
AUG 2 6 2003 :.
CITY 01- LA QUINtA ,
FINANCE DEPT.
CONWUmow Alm! plix CHEM
TOTAL F31MUTFIES VW? NOW
RECEIPT
DATA
t.<
BV y <. --- --.,
DATE FIN LE
INSP R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
' BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
17
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
lolek I
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:
;
- -
E
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 / 3
Utility Notice (Perm) '
A
:X
Bin #
City of La Quinta
Building at Safety Division
Permit # P-0 i P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
0367 - MO uilding Permit Application and Tracking Sheet
Project Address: —Ig— A 00 ";;,w "Oe 40%%mer'sName:
A. P. Number:
gAddress: 713 61 <!SeW (30/,!Z G-4NeCl
Legal Description:
;(city.'
ST, Zip: IWA6"O M11QW17
Contractor:
FTelcphone: 7�, 77/ -
Address: AF/21 —D
XProject Description:
City, ST, Zip: I-TMAIIEIM
� /`Wd 7
Telephone:
is . . . . . . . .
&A"r 77)
State Lic. #
City Lic. #:
CAf5A-11T1Q
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
IF
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Name of Contact Person:* IQ),VA.1l.E - OIA4 4,4
Sq. Ft.:
4 Stories: # Units:.
Telephone # of Contact Person:
(Q615d — g7 I?
nstimated Value of Prqiect:
APPLICANT: DO NOT WRITE BELOW THIS LINE.
N
Submittal
Req'd
Rec'd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
31 Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cales.
Called Contact Person
Plan Check Balance
-Energy Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correctio
I rl/Issue
'Electrical v,-,-
Z 675
Subcontactor List
Called Contact Person -e
Plumbing
Grant Deed
Plans picked up
V11*-
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for cor.rAtions/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
7E) .&0'
School Fees
Total Permit Fees
14 ON. W"'015fo —Y1 pl--*Wd Ir z/A F 0.
M
I/j,/
, I
Need , #rfwj
I i� F LA QUINTA
qe�l
ii IM SAFETY DEPARTMENT
GJ 777-7012
INSEC ION REQUEST LINE
L 0-11, A 777-7153E�
Contractor_DF.R C nN4TRTT('TrnN
Permit Number 0307-390
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-400 HWY 111
COMM - NEW LIGHT STANDARD FOR BANK OF
AMERICA BUILDING.
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING /WASTE
U/G ELECTRICAL/ GROUNDING
-00 INGS /STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
./ r-nc-nl,
OKAY TO WRAP
FRAMING (COMBINA
RnIIr;H m FrTQir
wURK UNTIL ABOVE SIGNED
WATER FEATURE INSPECTIONS
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
a
31
i
ContractorDEB CONSTRUCTION
Permit Number 0304-211
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-368'/: HIGHWAY 111
CONSTRUCTION TRAILER PER MUP 2003-
385
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC/ GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER .
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED zx a 6 /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
os
CITY OF LA QUINTA
oFMOFr
BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
Owner MADISON DEVELOPMENT
ContractorDEB CONSTRUCTION
Permit Number 0304-211
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-368'/: HIGHWAY 111
CONSTRUCTION TRAILER PER MUP 2003-
385
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF
OKAY TO WRAP
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC/ GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER .
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED zx a 6 /
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
'f, . /
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (7760) 777-7153
TO: DATE: m�.43
ADDRESS
CORRECTION NOTICE
INSPECTION: �i PERMIT NO.:
x
r
BUILDING DEPARTMENT
CITY OF LA QUINTA
OFFICE: (760) 777-7012 INSPECTION REQUESTS: (760) 777-7153
TO: DATE: El b
ADDRESS: G 0 Z ��`✓"'� �w
CORRECTION NOTICE
INSPECTION: �/r�L PERMIT NO.:
i
Inspector
OCT 09 2003 10:02 AM FR GENSLER
949 553 1676 TO 17607777011
P.02/02
** TOTAL PAGE.02 **
BAOK or A:/%�-) 151vc A
71--ennses for the City of La Qui.nta
ocontractor
Contact
Phone Number
Status of License
SMS Paving
Celia
909-357-0711
Application
Received
Briggs Electric
Barbara
919-863-9901
Application
Received
Cal -State -Renta
Fence
Remy
800-499-5757
Received
Coast Signs
Rosie
714-520-9144
Received
Earth Systems SW
Jud anne
760-345-1588
Received
Fleming Painting
909-944-7976
Received
Henry's Masonry
760-775-6807
Received
Inmar West
909-592-7070
Received
Insulcom
Vicki
949-830-9395
Received
K & SA.C.
Renee
714-685-0077
Received
MDS Consulting
Becky
760-771-4013
Received
O.C. Glazing
Wade Watson
714-630-0207
Received
Pacific Wall
Systems
Jennifer
7147-630-2580
Application
Received
Poe's Construction
760-645-7339
Received
Prime
Waterproofing
Paul
714-522-5506 714-
528-1200
Received
Professional Diver.
Flooring
Mimi Wygrin
949-457-8660
Received app.
P.S. Fire Pros
Willa
760-320-3245
Application
Received
Seawright ,
Nancy
760-398-1515
Received
Sinicro e
Sandy
323-283-5131
Received
Southwest Plumbin
Dann
760-343-2345
Received
Tandem West Group
760-360-1599
Received
Tidwell Concrete
760-772-2544
Received
Tile King
909-898-9319
Received
Valley Wide Sheet
Metal
760-341-3745 Received
W.C. Froelich
714-552-1115 Received
White's Steel
760-347-3401 Received
L.