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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.