0109-239 (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
Date . 7 ��f Signature'of Contractor —' "� v
OWNER -BUILDER DECLARATION
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.
( ) 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 vmwgi" Policy No.
4..
(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. 101
' Date: ` /" Applicant—
Warning:
pplicant 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 inspegtion purposes.
J jry`
Signature (Owner/Agent) r"�>' r Date
BUILDING PERMIT PERMITk
pt
DATE ! VALUATIONLOT 010-13-9 TRACT
JOB SITE
APN
ADDRESS ?S -K- JU 4 ri Y 112, MILE 10,
OWNER
CONTRACTOR/DESIGNER/ENGINEER
MIZIRCITA IM ".D WA 99-340
PATU IYESE.KC CA i=60
(160)779.0790 ! CSTaff 0.448
USE OF PERMIT
234E S.4 THRA T 1A4PR£3VKMl`?d7'("i'0DD Lm.f' did CIO ,Y Cali€Q'S) PER ;
APPR ��9D PLs ° M" OcCVpAgC j
VALUATION 17,tf{ti al I's
'numNno CO'F d7 wr C:o11wYsrRUMOV
17,000:oo
M4 MOT M SUMMARY
PIAN tti HIECK FEE 101-000439.318 S11711CIU
("Z03ST'WUCTION IUM 101-000.-419-000 $180.00
STROM MOT1011 FEE - MMM i, k3i3-GUft-241.000 $317
,M&Zi4A'N1.(:A1,P- 9 .01-006421•-000
101-000420-000
PLUXUDIO VER
NOV 0 9 2001
CITY OF LA QUINTA
FINANCE DEPT
�'`�T.L�••`C.�C'�r9�:.. C"C'1w,�r'Cl� �(.'',Cjff.�l�T �^,Y*i1.3 ..k��!?�s'�b 4>',T31:. � ..:b�
�':� G�.?!q
1IESS PRE-PAT.0 FRUS
$0.00
XIC IT&L PERAlb=1m" rS TWE 1 'ONY
R .
RECEIPT
DATEBY
L%
DATE FINALED
INSPECTOR
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 Wail Insulation
Condensate Lines
Party Wail Firewall t
Exterior Lath
Drywall -Int. Lath
Final
Final 2 - 2rU
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.FJ.
Smoke Detectors
Temp. Use of Power
Final Z-Z 7. �!
Utility Notice (Perm) 2 . Zl </G
COMMENTS:
N
..
'Y
z
ff
Tri o �STLIF
Bin #
City of La Quinta
100 Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
uilding Permit Application and Tracking Sheet
PermitfY
Project Address: 1, 2— 4Owner's
Name:
A. P. Number: AAddress:
4eg
Legal Description:
Contractor:
City, ST, Zip:
Telephone: Lia — nn x
.....
...........
Address: L?,,f (2-0 C�,1,9_
Project Description:
City, ST, Zip:
LTelephone:
............
............. .......
.............. ...............
To D b��s O/V
State Lic. #
City Lic. #:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
................. .... ....... .
.................. .............
xxx.. . ........
. . .......
..........
Construction Type: Occupancy:
StateLic.#:
roje
P j ct type (circle one New Add'n Alter Repair Demo
Name of Contact Person:
Sq.
SSq. Ft.,: Z6C;c�? I
# Stories:
F#units:
Telephone # of Contact Person: _341s>_�
st,
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
2
Plan Check submitted 1
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact PersonPIan
Check Balance
10-0
Title 24 CaIcs.
Plans picked up
Construction
122—
0.122—
Flood
Flood plain plan
Plans resubmitted
Mechanical
0"3 J 012
Grading plan
2 "d Review, ready for corrections/issue 1
Electrical
0
Subcontactor List
Called Contact Person III
Plumbing
-
Grant Deed
Plans picked up I I
S.M.I. — C_
0
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for correction 1116-1 IUV4t
-Developer Impact Fee
Planning Approval
Called Contact Person 1
A.I.P.P.
Pub. Wks. Appr
Date of permit issue J
School Fees
7—
L Total Permit Fees
City of La Quinta
Developers Project Approval Form
CONSTRUCTION PLAN/S APPROVAL
Prior to the issuance of Building Permit for the project listed below, please review the Building
plans, return this form and plan/s to the Building and Safety Department with your comments.
Contact applicant for resolution of conditions preventing or delaying approval.
Project: TI - Todd Larson Golf Carts - Building 4
78-555 Highway 111 Suite B - La Quinta Court -
Applicant Contact: Rod Murphy 760-340-9423
Circulation Date:
Community Development Department
Christine di Iorib, Planning Manager
This is for approval of the Building plans as per the SDP
Nickie Gormley
Counter Tech. Building & Safety
09/27/20
I ---&—
/o la vj
Date
City of La Quinta
Developers Project Approval Form
CONSTRUCTION PLAN/S APPROVAL
Prior to the issuance of Building Permit for the project listed below, please review the Building
plans, return this form and plan/s to the Building and Safety Department with your comments.
Contact applicant for resolution of conditions preventing or delaying approval.
Project: TI - Todd Larson Golf Carts - Building 4
78-555 Highway 111 Suite B - La Quinta Court -
Applicant Contact: Rod Murphy 760-340-9423
Circulation Date:
Public Works Department
Steve Speer, Public Works
This is for approval of the Building plans as per the SDP
Nickie Gormley
Counter Tech. Building & Safety
09/27/200
//Z -7
D
ate
EXHIBIT A Permit # — 2-3?
NOTICE: THIS IS ONLY A TEMPORARY PERMIT. THIS
PERMIT WILL EXPIRE IN 30 DAYS. IN ORDER TO
CONTINUE OCCUPANCY BEYOND THAT DATE, OWNER IS
REQUIRED TO OBTAIN A FURTHER OCCUPANCY PERMIT.
BE ADVISED THAT NO PERMANENT OCCUPANCY PERMIT
WILL BE ISSUED UNLESS AND UNTIL OWNER HAS
COMPLIED WITH ALL. REQUIREMENTS NECESSARY TO
RECORD THE FINAL PARCEL MAP NO. 29791 AND THE
MAP HAS BEEN RECORDED, AND ALL OTHER
CONDITIONS OF APPROVAL HAVE BEEN MET. WHEN
THIS PERMIT EXPIRES, THE OCCUPATION OF THE
BUILDING SHALL CEASE AND ALL OCCUPANTS SHALL
VACATE THE BUILDING UNTIL AND UNLESS A FURTHER
OCCUPATION PERMIT IS OBTAINED. OWNER AND
OCCUPANTS AGREE TO AND ACCEPT THIS RESTRICTION
IN ORDER TO OBTAIN THIS TEMPORARY PERMIT.
Agreed to and Accepted by:
Date /Z ZZ p�
C.ertificate',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: 78-555 HIGHWAY 111, SUITE 100
.Use Classification: COMMERCIAL - LARSEN GOLF CARS Bldg. Permit No.: 0109-239
Occupancy Group: M Type of Construction: V1 Land Use Zone: C.R
Owner of Building: JDD;.LLC
TEMPORARY CERTIFICATE OF OCCUPANCY
SEE EXHIBIT A, ATTACHED
dj^'t
Building Official
Address: 7900 28T" STREET SE
City: MERCER ISLAND, WA 98040
By;
Date:
POST IN A CONSPICUOUS PLACE
RICHARD KIRKLAND
12/21/01 EXP. 03/15/02
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: 7,9 555 HIGHWAY 111 SUITE 100
Use Classification: COMMERCIAL - RETAIL SALES Bldg. Permit No.: 0109-239
Occupancy Group: M Type of Construction: V-1 Land Use Zone: CC
TEMPORARY CERTIFICATE OF OCCUPANCY/SEE EXHIBIT A - ATTACHED
Owner of Building: JDD LLC Address: 7900 SE 28TH ST #405-
City:
405 City: MERCER ISLAND, WA 98040
By: KIRK KIRKLAND
Date: DECEMBER 21, 2001 /EXPIRES 1-21-2002
Building Official
___._ POST_ IN.A CONSPICUOUS PLACE _.
jodd Came_n
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:
Use Classification: COMMERCIAL
Occupancy Group: M . Type of Construction: V1
78-555 HIGHWAY 111, SUITE 100
Owner of Building: JD -D, LLC
Building Official
Bldg. Permit No.: 0109-239
Land Use Zone: CR
Address: 7900 28T" STREET SE
City: MERCER ISLAND, WA 98040
By: KIRK KIRKLAND
Date: APRIL 4. 2002
POST IN A CONSPICUOUS PLACE