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0109-074 (RC)LICENSED CONTRACTOR DECLARATION 1.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 LU C Z r�__ Date "/ 2 Q Signature of Contractor J U � OWNER -BUILDER DECLARATION HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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 w' Code). ; � ,O I am exempt under Section B&P.C. for this reason N Date_ Signature of Owner " 0 Q ,�` WORKER'S COMPENSATION DECLARATION C2 I hereby affirm under penalty of perjury one of the following declarations: r O () I have and will maintain a certificate of consent to self insure for workers' X W compensation,' as, provided for by Section 3700 of the Labor Code, for the m� Q performance of the work for which this permit is issued. Q U ,p(:�) I have and will maintain workers' compensation insurance, as'required by O 0, Q Section 3700 of the Labor Code, for the performance of the work for which this li rn H permit is issued. My workers' compensation insurance carrier & policy no. are: 7t Z Canier Policy No. ob, O H'!".1 U F'T.#'kaY ++ J (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 withthpseTprovl i ns. �p Date: �1 • r a•-L�e Applicant 7Go _Warnin'g`s`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 isperformed 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 ins e tion,purposes. Signature (Owner/Agent)Date 9! K>-13 �1 k BUILDING PERMIT PERMT# '. r/ DATE J VALUATION LOT , .0109-074TRACT .% r� , ! � 1.! �'�€F 28'� alt! :�: JOB SITE APN ADDRESS 7 -4W E OYMA.Y 111 601-Q! 13 OWNER CONTRACTOR/DESIGNER/EN INEER TARKEY-1, MAL MU HOLCONSMDERS INC 0ANTAAdYA cA 9"6,102 o":oO 0111TI}i. CA 92879.-1-1 USE OF PERMIT 1 :5200 SF 'C'ENANT ,IMY� RO1t'FMYNT.P9It APPl'2OV ,0 P A"4S r V.dsi.A)A ION' 000,00 U. , A� Ei'STd35IAUD COST UP (:CJSWINE7M10Y �€➢,41�<iPi3 PLAN CBEC7, ng 103-000439-318 $32;p 93 C014STKf. CTIO4 W PRY., 101-000-418-000 $504.30 L7,11.0 ' CAL FF.t, 101-000-420-000 fp9.1)%2.BING,fr'f f 8TR0WVMo°.f10N FER- COMM 100.000-241.000 $14.70 t D Q S Durk, now X7.3 SEP 12 2001 CITY OF LA QUINTA P Ne! :BY DATE FINALED INSPECTOR yr/�_, s_ 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 OX 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 tel- _ BLOCKWALL APPROVALS Final POOLS - SPAS 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 Final ELECTRICAL APPROVALS Temp. Power Pole Underaround Conduit Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors . Temp. Use of Power Final Utility Notice COMMENTS: M- I L%� Din # City of La Quinta Building ar Safety Division P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # o 00 Project Address: lj Owner's Name: A. P. Number: Address: Legal Description: Contractor: Address: 410 &1C—r—L—r-----JT> 0:�, City, ST. Zip: IJ -06- AJ C1.1. Telephone:(7)q) 01-7--a 0-7— Project Description: City, ST, Zip: Cc) /J A Telephone: CA ..J/94. I I ........... ...... ....... .02 I--- A 1— 15. -rxN, T-19-7 State Lic. # 0 $$4( City Lic..#: Arch.. Engr.. Designer: Address: City, ST, Zip: Telephone: Construction Type: Occupancy: StateLic. #: Project type (circle one): New Add*n Alter Repair Demo Name of Contact Person: Sq. Ft.: # Stories: I # Units: Telephone# of Contact Person: 114 —?>o-/( Estimated Value of Project: -70- © o o - APPLICAI T: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT 11111T I PERMIT FEES Plan Sets Plan Check submitted Item Amount Structural Calcs. Reviewed, ready for corrections Pl. Plan Check, Truss CaIcs. Called Contact Person Plan Check Balance 2— Title 24 CaIcs. Plans picked up Construction w Flood plain plan Plans resubmitted Mechanical tt Grading plan Subcontactor List Grant Deed 2"' Review, ready for corrections/issue Called Contact Person Plans picked up Electrical Plumbing S.M.I.—,C— 40 Ir H.O.A. Approval Plans resubmitted Grading '0 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 7Ec# sly S Total Permit Fees Z Tom redale Fire Chief RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 21DWest est an. acro o Avenue,-* -Perris,- oma 6900-yax (9W) WF91 February 14, 2002 City of La Quinta Building Dgpartment Proudly serving the unincorporated areas of Rivers'¢' Re: Fire and Life Safety Clearance County and fl - 7 g- y -So IA,y 111 Cities of: Banning The Riverside County Fire Department is granting a fire and life safety clearance for Beaumont ' Tarbell Rea�tY- Point Happy Building 4 SDP 2000-688. Calimesa Canyon Lake 0 Coachella Desert Hot Springs. :0- Indian Wells Indio M ' Lake Elsinore 0 La QQuinta. Moreno Valley- Palm alleyPalm Desert ... Penis - Rancho Mirage San Jacinto Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 Tim Venable, - District 3 Roy Wilson, District 4 Tom Mulley District 5 � � r Respectfully, FRANK KkWASAKI Chief Fire Department Planner By '� Terry Fire System lnspectors EMERGENCY SERVICES DIVISION • PLANNING -SECTION i ADiO OFFICE IWA 7 �'d Zb8�9LL09L i 'Aaa 1 2P1H auialN d6o:21 SO t'Z Uer