0208-138 (RC)LICENSED CONTRACTOR DECLARATION
I herebv 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
,Date �i` I'��` ff Signature of Co'tracto •4 %r
OWNER -BUILDER DECLAR' TIN�
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
p rformance of the work for which this permit is issued.
( I have and will maintain workers' compensation insurance, as required by
S ct on 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:.
Cartier STATE. Policy No. S#151 02
(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 Jo become subject to the
workers' compensation laws of California, and�gree that if I should become
subject to the workers' compensation?pr�ovislohs of Section 3700 of the Labor
OCode, I shall forthwith comply wijhrfh se• � ro,�sions.
Date: �'V?7/''O A licant'`p 07 >
pp
Fop
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 property4& inlsp'ection purposes.
Signature (Owner/Agent)': / »�'% '"1-"� ''� Date C.�, 4;
BUILDING'PERMIT PERMIT
DATE a VALUATIONai ryry ++ LOT TRACT
JOB
ADDRESS ` 7 R 11, 1 #1111APN —
OWNER CONTRACTOR / DESIGNER / EN (NEER
&H PRt0PENTO RTC1WW a'RI';HdzX:J''.. 0,014 I'.01r.,(: OIN
1721 & ZVERIAL M'An` 4751 SOC EAWSL>f:.BVM ITM D
LATW
3RA, CA 90631 OCALMME, CA 92056
(160)6301540 rstf 682.1
USE OF PERMIT
CONW!At PEIMODIM
;MOD
twNT (NxW'J C?1b'i'f i'RZ k'
CONTRACT .AMOUNT 4009.00 I
AMIMATED CC= OF (MAN, ITZMTE01N
1?ETWE F MTKIWAM'
CON T.RYCT IQN I9M 101-000-418-000 $369,04
PLAN' CHW,K VEE 101-0(91439"318
139"318
"NAECILKNICIm, VEY, 101.000-21,-AA,00 �4A.OSP
fwi +C`1 i7lC t, . '1:tt
101-000-420-000 30
' •431 BT?Ft3 FEE!, 10 1 -000,41 q-000 oup
S fit%? U .A/ OT OX MeP,» 6.)M M __3 00 -WO -241 �t)fati f3.fl
I
CITY OF lA ®UINTA
FINANCE DEPT
Sup. »'Y'C?'rpL'�`�►I�'�!"i�'CiC;+.1C1t�i'mwivuwd1.E ar,
X. PRV11T%aD?R oll
a ,
a'
r'
RECEIPT DATE BY DATE
$862,48
VX00
S£ ,,A8
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
0. 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 /
POOLS - SPAS
BLOCKWALL APPROVAL
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 UZ_
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)
Permit #
ozob - I �Pe?
Project Address:
A. P. Number:
Legal Description:
City. ST. Zip:
Telephone7 a�-15140
State Lic. p 6WA2
Arch.. Engr.. Designer:
Address:
Cite. ST. Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone q of Contact Person: %/54,r)
City of La Quinta
80ding ar Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quints, CA 92253 . (760) 777.7012
Building Permit Application and Tracking
Toaner•s Name:
Address: Zl
City. ST. Zip:
Telephone56—z —6?1—
Si Project Description:
`City Lic.
S�7
Construction Type: Occupancy:
Project type (circle one): New Add'n .alter Repair Demo
V '�� Sq. Ft.:1729( 0 Stories: q Units:
61-157— Estimated Value of Proiect: boo—
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
O�
Plan Check submitted
?/:Zq/O
Item
Amount
Structural Coles.
Reviewed. ready for corrections
�� g
Plan Check Deposit
Truss Coles.
Called Contact Person /
$�g
Plan Check Balance
Title 24 Coles.
A
Plans picked up
g�gj
Construction
Flood plain plan
Plans resubmitted
Mechanical
Mechanical
Grading plan
2" Review. ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review. ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Cahmesa
4.
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Qumta
Moreno Valley
Palm Desert
❖
Perris
Rancho Mirage
40
San Jacinto
•;•
Temecula
Board of Supervisors
Bob Bush,
District i
John Tavaglione,
District 2
Tim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, Cali omia 92570 • (909) 940-6900 • Fax 909) 940-6910
September 26, 2002
City of La Quinta
Building Department
-Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance for the group
B occupancy known as New Century Title located at 78-447 Highway 111, Ste. B.
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By �C,4'
Walter Brandes
Fire Safety Specialist
H1PEAWPDATA\IA6UINTAU'ROJECTS%TN IMPRVLLAO.02-SP-194 Final.doe
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
RIVERSIDE COUNTY FIRE DEPARTMENT
FIRE PROTECTION
JOB CARD,
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
SET OF PLANS
Owner-116PA Lo E 'dja Date ,
Location :71"N? /j,,,�„ ��► $
Case No. 4AQ-ot-SPK_g7,
Sprinkler Company ?46L ;;n¢.t.e2sKid'—
Underground Static Date Inspector
(200 PSI For 2 Hrs. Prior to Inspection Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
Underground Flush Date Inspector
Overhead StenoDate
(10209 P60 )
1946
�a ��-
Overhead Final t D
Fire Main Installer
Inspector
s�
Ins
UndergroundStatic Date Inspector
(200 PSI For 2 Hrs. Prior o Inspection Time)
(Center Load Pipe O ,Joints and Thrust Blocks Must Be Exposed).
Undergund Flush Date Inspector
Certificate of Occupancy
City of La Quinta.-
B dilding
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:
BUILDINGADDRESS: 78-447 Highway 1 1 1 Suite B
Use Classification: Office - New Century Title Bldg. Permit No.: 0208-138
Occupancy Group: B Type of Construction: VN Land Use Zone: CR
Owner of Building: H & H Properties
Tam►
Building Official
Address: 1721 E. Imperial Hwy
City: La Habra, CA 90631
By: Daniel P. Crawford Jr.
Date: 10/11/02
POST IN A CONSPICUOUS PLACE