0109-117 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
'Z
- Y 7 ff 1 dry
s� Jf1%"is
Date Signature of Contractor7if`� t
OWNER -BUILDER DECLARATION
.7
1 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).
O 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/ho. are:
Carrier Policy No.
ClAShENI ON, ;owATIC+
411; RO0, 3 00
(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
Applicant d
Warning: Failure to secure Workers' Compensation cov rage is unlawful and
shall subject an employer to criminal penalties and civil dines 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
l ;/,71, ,
Signature (Owner/Agent)! =3• Pate') ' J A.
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
119-0411 MCA�'b�''AY I11 arTIA, all
6040W-014
OWNER
CONTRACTOR/DESIGNER/ENGINEER
LWD"y `. IIIIIAWSRiTMON r:C9WK10F
y 2,q;5sfit: H mux- rpt €i�'° ? _,
2264.2 LAND33 M% RFE, X 09
CA 92130
LAKE FGRE sT C..r. 92630
,
CBVx 4574
OF PERMIT
WMMERC<rAL REM DEL
1 h11 �1 IsrM1.l3 f�iF EA
T,.PNAi+ T YaU PRO'VIF?F, ENT PER .i';P1a1:OM PLANS (H—ST i'i,y Y-Iwl,.:; Flwm)
'VALUATION 1..9
K01I .&TITID Cow 0It_ CoNsm 1ipmos
1 �,�.tC27s#3Cs
PEN bU rVAM 91114A1ARY
PLAN CIPM4X FEIR '101--000.439.316 sips."
CONS:t'ItI:aC3'isIN#fiE 101-000-418-000 $162.00
`
NARC1•IKNIC AL FE18 101-.000-4.21-000 _ WIN
_
i.:9aWTR1,.W..,L1 Ifif.3v' 1011 -000 -420 -MO $8100
~
91ILta'Munli FPi4. 101.000.419.000. t43,00
`
STRt'M0 MOTION FRE - COMM 100-000-:2A 1.
p Q D
CdA ANk� Ai*71.� FXV C't�:G:&�
$410.41
J. I- LESS
CITY OF LA QUIN' :, ` t'�' �� C C
$4101 51
' FINANCE DEPT. _+''r
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
_
Steel
Roof Deck
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U,
Framing
Insulation
_
l�j/
Compressor
Vents
Fireplace P.L.
I _
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
-
Party Wall Firewall
Exterior Lath
Dr_rva11- Int. Lath
�/�
_
Final
_
Final
POOLS - SPAS
BLOCKPPROVAI,S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
_
9�
Heater Final
Water Piping
�_ _
Plumbing Final
Plumbing Top Out
16�i�_
Equipment Enclosure
Shower Pans
!/
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final(Gas)
Gas
_-UtilityNotice
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles.
G.F.I.
Smoke Detectors
Temp. Use of Power
� Of
t
Final
Utility Notice (Perm)
;k
Bin #
//"615S s`�
-City of La QuettaBuilding 8r Safety Division/V91 ,vo.)
P.O. Box • 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
0/
Project Address: -79 417 iqW Y
owner's 'Name:
A. P. Number
Address:
rz?_1 W. o-lpmtL #k)y
Legal Description:
Contractor:
-Address: 64?_
City. ST, Zip: LA 8462A
Telephone -A7. Ot I
Project Description: TON/noj 1489,0V 6A? 6T7J T
City. ST. Zip: L"Ny-o o;Tz(
Fviz-. rA P a> C)
_.1:::
APP D &)4 1 _i -
,/\,r&
Tel
8.
,
. . ....... . ... . ..
7,ftTT-01,J S (,Ajofj 6rNU /X)
( 6,
State Lic. 1 23s
P1-U1q811J(.) PM 7_971MAAF FIXILMarS
Arch.. Ener.. Designer:'
k- i nz Hamm D
tzwke_�,
-z� '
XLa 77Z4LCL.
Address: ILM AL68AMA
-City. ST, Zip: 17k�W(A
Telephone
...................
..............
Construction Type: Occupancy:
StateLic. #:
Project type (circle one): New Add Alter Repair Demo
Name of Contact PPersoA: WISIZ W�Vopl�)
Sq. Ft.:
# Stories:
Units:
.Telephone # of Contact Person: (1 (.9!9 - lz;& q
—
Estimated Value of Project: 1-511900
WPPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
-2—
Plan Check submitted 9L
905
Item
Amount
Structural CaIcs.
Reviewed, ready for corrections
lag
Plan Check Deposit
Truss Calcs. •
Called Contact Person
Plan Check 'Balance
Title 24 CaIcs.
2
P14,,$)
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, readv for corrections/issue
Electrical
� <_
A
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
0
Grading
IN HOUSE:-
WV
Review, readv for correctio
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
* T lir T-_ P101�1,-Jy 1,07Z 01AWC,,r S9,e4-T—'
Ci of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the. project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building acid Safety Department only
after approval. , Contact applicant for resolution of conditions preventing or delaying approval.
Project: Frame Express
TI- add restroom
78-447 Hwy. 111 Suite D
Applicant Contact: Peter Haddad (714) 965-1564
Application / Circulation Date:
Date
Community Development Department
Christine di Iorio, PI a ng Manager Date
Public Works Department
Steve Speer, Senior Engineer Date
Building and Safety Department
Greg Baler, Building & Safety Manager Date
71
l2
RIVERSIDE COUNTY FIRE DEPARTMENT
FIRE PROTECTION
JOB CARD
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
SET OF PLANS
Owner Id :54L„ Date
Location -t8-447 do.- dl A;/. C
Case No. 440 -ml- spff-oho
Sprinkler Company Aer I",L
Underground Static Date ctor
(200 PSI For 2 Hrs. Prior to Inspection Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
AJ IA -
Underground Flush
& 9 1
Overhead StatDeVA, I,
(200 PSI For 2 Hrs. Prior to In
Date Inspector
/0
Datenspector
spection Time
Overhead Final Date Inspector
Fire Main Installer I
Underground Static
(200 PSI For 2 Hrs. Prior to
(Center Load Pipe Only, Jo
Extinguishing System Instal
ate Inspector
ction Time)
and Thrust Blocks Must Be Exposed).
Date Inspector
Final X Date Inspector
Fire Alarm Installer
Final
Tank Installer
Date Inspector
FinaV Date Inspector
FINAL for OCCUPANCY
- MM
S�
LW
InspeI--
DO
NOT OCCUPY THIS STRUCTURE UNTIL
AFTER FINAL INSPECTION.
264.159 (Rev 10/97)
"Certificate of 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: 78-447 HIGHWAY 1 1 1 SUITE C
Use Classification: TENANT IMPROVEMENT, BEST CITY NAIL SALON
Occupancy Group: B Type of Construction: VN
Owner of Building: M & H REALTY PARTNERS
*-U%A-%47
Building Official
Bldg. Permit No.: 0109-117
Land Use Zone: CC
Address:
12555 HIGH BLUFF DRIVE
City:
SAN DIEGO, CA., 92130
By:
DANIEL P. CRAWFORD JR.
Date:
10/17/01
POST IN A CONSPICUOUS PLACE