0106-305 (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. Classy I Exp'`Date
Date �/f r 1` Signature of Contractor)''_ •�" , -
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.
( f) I have and will maintain workers' compensation insurance, as required bq
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 yy E FUND
Policy No. 161.1200
(S
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 with those' provisions.
L
Date: Applicant,
Warning: Failure -to. -secure Workers,,Compensation-•coverage is unlawful and
shall subject an employer to criminal penalties avid civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
k* application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becumes null and void if
work is riot commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this�application and state that the above information is
correct. I agree to comply with;all City and State laws relating.to the building
construction, and hereby authorize rept esentatives of,�ihis City to enter upon
the above-mentioned propert ,1for inspectiotn purposes'
1 Signature (Owner/Agent) i V. � � Aflv ''Date
PERMIT PERMIT#
,)3VILDING
DATE �r VALUATION LOT 0J.'J)6T A:j TRACT
JOB SffE y'
APN
ADDRESS
�r�e��.'�..js:�..�.�.er3t.���Y `.�.�.�i n.0��.��i. STE j0O
.�•�`-'®:P$P
OWNER
CONTRACTOR/DESIGNER/ENGINEER
M0
7 2-17 64 ARB 0MA
:fir9 �°iCiE a "4%/:A 98027
PAL 'MA-E-Ekf C'A 92260
Q60)340-9423 0-9423 C) 1.4 , 015430
USE OF PERMIT
01-D TKULIKLMIUMN-10.
Xfi M'L DF1, TO .?ADD 1 A90 Wlart C!:" LAR. TO 10S SUPlSY.'2iOUSE
VAIXAM ON
PLO Ck EMIX :t?�T: D �� • �vt S�n34 � � 6 .43
CONS' MUCT:Qd'3NFEE 101-000-41.8-000 $437,00
-
r
�7K` 3 FIEW'..,P W FIM
$0,00
11'OrSAL P213M T'�`�i s Jim NOW
RECEIPT
DATE �'
BY
DATE FINALED
INSPECTOR
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
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
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
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
-'
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 8/14/01 -
No. 22375
Owner NameJDD, LLC
No. Street Highway `78-525 Hi hwa 111 Suite A
_
city La Quinta
APN # 643-020-006
Jurisdiction La Quinta
Permit # 0106-305
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 1290
Type of Development Commercial No. of Units 1
Comments
building is a remodel to add 1290 sq. ft. wine cellar to LG's Steakhouse.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Commercial Building
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
.33 X 1,290 or $ 425.70 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be,issued
Fees Paid By CC / First Community Bank - Gerard Murphy Telephone '760-340-9423
Name on the check
w
By Dr. Doris Wilson'-' '
Superintendent
Fee collected /exempted by Annette Barlow Payment Received $425.70
Check No. 102124
•Signature '
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the Distdct('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all wai.c�-
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
.�Y 1