0306-190 (RC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
hapter 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
.56931,21 0 'r-Rm- ()ire 4 t�l�
Signature of Contractor
OWNER -BUILDER DECLARATION
kl 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 a1`ATF, VkTt�� Policy No. Q710T.EOS12901BQ
(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,
(.`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>fhoe plo sions.�
,/fDate:`.r'-^'�>a�..a.��/ Applicant�;�,?� ��Z-•-mow..
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 property for inspection purposes..
�Slg ature' (owner/Agent) r D ;, r �" � %Ali=��` -bat-
BUILDING PERMIT PERMITk
DATE VALUATION LOT TRACT
2- r'197119 (A
JOB SITE
ADDRESS 78-04 SKICMAVAY II! faE k
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
W." IMP ?.
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USE OF PERMIT
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TY OF LA OWNTA
FINANCE DEPT.
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a4.J'h�X NOt,TV
RECEIPT
DATE
BY`
DAT ALE
INSPE R
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
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation (t/ -38 C y p
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
C ndensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath 3 0
Final
Final
BLOCKWALL APPROVALS
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
-
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS/,�,f,t�
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)
C NTS:
�OL. Gb5S7t/ /D ?&AV— `j,��,e
BSL 0 6t
�OINT �� •
P.O. BOX 1504
Building 78-495 CALLE TAMPICO
Address 21,-D6 0;2 LA QUINTA, CALIFORNIA 92253
Owner
1N�TP T Lj& OUWA Lr,
0,306,12-0
APPLICATION ONLY
Mailing BUILDING: TYPE'CONST. OCC. GRP.
Address %8�1V� „^ �
i e D Alumhcr
CityZip
Tel.
- -- - ---------
Legal Description
Project Description
Contractor
Addres
.220
Cit
Zip
Tel.
�M
iNi
Z
p
%tate Lic.
city
i£ Classif.�$g
Lic. #
Sq. Ft.
Size
No. No. Dw.
Stories Units
Arch., Engr.,
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Designer JHTI
A dress
Tel.
.1 02
City Z'
tate a "�AAd
Lic. #
L ENE C TRACTOR'S DECLARATION
I hereb f ' t 1 I a'81icens d der provisions of Chapter 9 (commencing with Section
7000) of i i of th stn s d Prof slops Code, and my license Is In full force and
effect.
S GNAT
DATE
OWNER -BUILDER DECLARATION Estimated Valuation
I hereby aft rm that. I am exempt from the Contractor's License Law for the following
7031.5,ausiness
n
reason: (Sec. and Professions Code: Any city or county which requires a -
permit to construct, alter, improve, demolish, or repair
.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
r i -5
2
Plan Sets
Plan Check submitted 7 /-) u
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Energy Calcs.
Plans picked"up
Construction
Flood plain plan
Plans resubmitted
Mechanical
�O
Grading plan
2" Review. ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed '
Plans picked up
S.AI.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, read• for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A•I•P•P•
Pub. Wks. Appr
Dat 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
d•
Beaumont
Cahmesa
Canyon Lake
Coachella
Desert Hot Springs
r,.
Indian Wells
Indio
4.
Lake Elsinore
r.
La Quinta
r.
Moreno Valley
.`
Palm Desert
4 -
Perris
4.
Rancho Mirage
.;.
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Marion Ashley
District S
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • • Fax (909) 940-6910
June 13, 2003
Asaro Builders
42-220 Green Way, Ste. H
Palm Desert, CA 92211
Re: Non -Structural Building TA Plan Review
LAQ-03-TI-041 / LA Paloma Senior Center
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project. Please be advised the following conditions apply as a part of the conditions for the
issuance of a building permit.
1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a plan/inspection fee. The approved plans, with Fire Department
Job card must be at the job site for all inspections.
2) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per
recommended standard of the Knox Company or provide key(s) for inclusion in the general building
Knox Box. If the building/facility is protected with a fire alarm system or burglar alarm system, the
lock boxes will require "tamper" monitoring. Special forms are available from this office for the
ordering of the Knox Box, this form must be authorized and signed by this office for the correctly
coded system to be purchased.
3) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
4) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A10BC in rating.
Contact certified extinguisher company for proper placement of equipment.
5) Approved building address shall be placed in such a position as to be plainly visible and legible from
the street and rear access if applicable. In multi -tenant buildings, businesses shall post the
business name and suite number on back doors as well as the front. Suite numbers or letters must
be a minimum of 6" in height. All addressing must be legible and of a contrasting color with the
background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By �
Walter Brandes
Fire Safety Specialist
H:IPEPWP Dda\La 0uNa1PR0JECTS%TPaA0A1TWM1.doc
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2"a FI., Indio, CA 92201 • (760) 86348886 • Fax (760) 863-7072
Certificate of Occupancy
T4&f ot 4 Q"
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 78-474 Highway 111, Suite A
Use classification: Commercial Office (La Paloma Senior Center Sales TO Building Permit No.: 0306-190
Occupancy Group: B Type of Construction: VN Sprinkled Land Use Zone: CR
Owner of Building: Westport La Quinta LP Address: 3801 PGA BLVD St 805
-7-'1'
,7'
Building Official
POST IN A CONS
City, ST, ZIP: Palm Beach Garden, CA
By: Daniel P. Crawford Jr.
Date: 4/26/04