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0105-289 (RC)LICENSED CONTRACTOR DECLARATION >t I hereby affirm under penalty of perjury that I am licensed under provisions of 1— - Chapter 9 (commencing with Section 7000) of Division 3 of the Business and eel w Professionals Code, and my License is in full force and effect. 61cM [ License # Lic. Class Exp. Date C ;ZI LLf Z4 a-te g` -- 011 Signature of Contractor t� O U OWNER -BUILDER DECLARATION Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's fn License Law for the following reason: Z_ ( ) l,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 ,b -am exempt under Section B&PrC:� , tt sfeason .. 0 N to y- �1� a a� Signature of Owner+., rn FL Q WORKER'S COMPENSATION DECLARATION �j < I hereby affirm under penalty of perjury one of the following declarations: n F2 0 () 1 have and will maintain a certificate of consent to self -insure for workers' K LU �= compensation, as provided for by Section 3700 of the Labor Code, for the D J Q I performance of the work for which this permit is issued. n UU t)� I have and will maintain workers' compensation insurance, as required by Q Section 3700 of the Labor Code, for the performance of the work for which this L' H permit is issued. My workers' compensation insurance carrier & policy no. are: ? Z Carrier Policy No. ob 5 STATE FUND �a Q (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' corimpensation-provisions of Section 3700 of the Labor Cgde, I shall forthwith comply w'ih those • rovlslons. yp' i �,a„�h r ate: — Applicaniti ��.. 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 hist 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 f r inspection purposes. ,,Signature (Owner/Agent) `_ ��.-_1n> �} Date cl '� BUILDING PERMIT PERMIT# i DATE VALUATION LOTS ^� TRACT �q�q� pyo '{1Fk7Ji6 dl�tiil. 1AiF TiYa�s�d6741 - � JOB SITE APN ADDRESS 78_15;!L15 5;!L15 WGHW Y I I I, Surrit :7100 .. OWNER l` CONTRACTOR / DESIGNER / EN (NEER IAX 7 6.750 MIAN CIR 420 N. MCKNLEY iM 01 14.394 .A,Qpi'i�'U% C:�}.: 922-33 f:C7f�t +'.c�e��: + C.'a''. 92.g'!86� (909Y17ii-05 3 USE OF PERMIT Trmkly;ir m1PRO-V1rm 1' 3I.e1')(1. 4 AT LA QfJx'T3TA COURT FOR DiCHMTE - 2,443 VQ, FT, � VALUATION 101000.09 LS 1 UnMA117D COST OF C:f3RNMUCITON IMMIX) 1 01 �10I�3"�r-41,D4q q399-31 �8 AMf��qq,,AN yy�yy:--�kt*�g;//CyKr)�xZl.,�"?I �7. S� i.�aW �7 J�iti.S,JTy-8 Ze1 A'F:;Y�. SS 1--0008'i.�ii53 MECNL.WICALYZE 101-000-.424-000 �tiU,0i1 'LIXc:'ERIC iLVZF, 101-000420-000 $65.00 K"UMBINO FEE 101,QW-419-000 $105.00 A U�.�`i'.[c3 S �sYEDP7C,J�,3�-C>' WIr. �'1,7C,7.1a f I. LE.,S:a P k .PPXDH= w$':11,00 t I AUG -7 ?�Ol.$,� " ' -mm Im -.1,767,18 st :` Irp"n w i.,:.N r RECEIPT DATE iY ]]]](( r �n .r DATE FINALED INSPECTOR Now 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 _ Framing 2� /5 F.A.U. 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 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 /�ZG Utility Notice (Gas) < ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixturres Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: .� .- t SPECIAL INSPECTION SERVICE REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION I I 1 PERFORMED U REINFORCED CONCRETE ❑ OST TENSIONED CONCRETE ❑ REINFORCED MASONRY ❑ STRUCT. STEEL ASSEMBLY ❑ ASPHALT ❑ FIRE PROOFING ❑ OTHERf:.�IkIL J08 LOCATION. j/K- REPORT SEQUENCE NO. TYPE F STR,p� U.RE, ` s V V' PERMIT NO. D T DAV OF WEEK MATERIA�CRIPTION _ ' ARCHITECT I MRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL DATE CONTRACTOR ALL SUB CONTRACTOR C� I &Q,,j } ►lbs: ' o - L �-S o`� 3 COPY SENT TO CLIENT ❑ CoN NU ON NEXGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. ,IGN�T RE OF REGISTERED INSPECTOR I so-,( �z� 6'1 '9�`7`i DA E OF .REPORT REGISTER NUMBFR A a h REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ O POST TENSIONED CONCRETE O ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING REPORT SEQUENCE NO. TVPE/OF $ji{AICTUR� , ,' ��j '�� PERMIT NCS A / r� �> D (3f DAY OF WEEK MATERIAL DESCRIPTION / -3�IC�J ARCHITECT ECTOF( r HRS. CHARGED [> I-II 17,6.194J' ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE ENERAL CO TRACTOR fA64Q-,, SUB CONTRACTOR" COPY SENT TO CLIENT O CONTINUED ON XT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. SIG TURE OF REGISTERED IN E TOR DATE OF REPORT REGISTER NUMRFR REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT O REINFORCED MASONRY ❑ FIRE PROOFING O OTHER 1�-'010C'A JOB LOCATION REPORT SEQUENCE NO. TYPE OF STRUCTURE Co '` m- G PERMIT N0. 0 to _ DATE t45 0 61 DAY OF WEEK MATERIAL DESCRIPTION Q ARC�HITYE^CT W - INSPECTOR HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL DATE CONTRACTOR SUB CONTRACTOR `N r� ' o cP1dw .oho/dl V7'f -, f/ iM.. T 6 <Ur d. loll6ki 03 Gr.v Ali An 6, 1 d 2- A134-- LAO hol c. , -i5,4 P. {J. COPY SENT TO CLIENT 0 CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE - TO THE BEST OF Md KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS, SPECIFICATIONS. AND .APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. d" jDa,," SIGNATURE F REGISTERED INSPECTOR ,fiS2 Zo � 32- US-�3Z�az�48b ATE OF REPORT REGISTER NUMRFR t ... �%� �� LQ�.� $ 5-.-75' ?S -•S� ' � � ... �Y M4 -1 ANY P.O. BOX 1504 78--8 Id 9 .._-,. 78-495 CALLE TAMPICO APPLICATION ONLY Address (. at f ( (�y ,.,x_1C.. t }r( y LA QUINTA, CALIFORNIA 92253 Owner f Aa- Mailing BUILDING: TYPE'CONST. OCC. GRP. _ / � �?' ,t �i Address isG�� C�Z>T� 1 V r A.P. Number City Zip Tel. ic,� Legal Description Contractort M M E, Project Description f-1^+ Address TM N 1) sWTI2Z61 � 3Qo1 ' 2 State Lic.' ) City & Classif tQ 37 2 (�'" Lic. #USq •`� Cj Arch., Engr., rr tt -� Designer �x-�1J mvv C 1 its 11, Address . , l �. r State / Lic.If CONTRACTOR'S DECLARATION under provisions of Chapter 9 (commencing with Section and Prolessio�r�tjCode, and my license is in full force and OWNER -BUILDER DECLARATION I hereby affirm that ram exempt from the Cont'ractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code. Any city or county which requires a permit to construct, alter, improve, demolish,aor repair any structure, prior to its issuance also requires the applicant for such permit to file a°signed abatement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code. or I . he is exempt therefrom, and the basis for the alleged exerQption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500). I"! 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, Buisness and Professions Code:The Contractor's License Law does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) I 1 I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-7 1 am exempt under Sec. B. & P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION I hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed it the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of lhp 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. Date Owner NOTICE TO APPLICANT., If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above. mentioned properly for inspection purposes. Signature of aQplicant - — Date Mailing Address City, State, Zip RA/ __2�40 - Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ -7-07, >timated Valuation PERMIT AMOUNT Plan Chk. Dep. "t t< ? oiry) or—, Plan Chk. Bal. f �° Const. Mech. Electrical Plumbing S.M.I. Grading' Driveway Enc. CArr Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION O I 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: 78-555 HIGHWAY 111, SUITE 200 Use Classification: COMMERCIAL Bldg. Permit No.: 0105-289 Occupancy Group: B Type of Construction: VN Land Use Zone: CC Owner of Building: LARRY & BARBARA LETHCOE Building Official Address: 78-750 NOLAN CIRCLE City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: APRIL 4, 2002 POST IN A CONSPICUOUS PLACE if Certifica'te'-pf Occupancy - City of L� Building and Safety Department. OF 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 200 Use Classification: COMMERCIAL Bldg. Permit No.: 0105-289 Occupancy Group: B Type of Construction: VN Land Use Zone: CR Owner of Building: LARRY J. & BARBARA LETHCOE TEMPORARY CERTIFICATE OF OCCUPANCY SEE EXHIBIT A, ATTACHED Building Official Address: 78-750 NOLAN CIRCLE City: LA QUINTA, CA 92253 By: KIRK KIRKLAND Date: 11/28/01 EXP. 03/15/02 POST IN A CONSPICUOUS PLACE r Certificate of Occupancy City of La Quinta' Building and Safety Department',. . r 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 HWY 1 1 1 S, j t 2- Use Use Classification: COMMERCIAL Bldg. Permit No.: 0105-289 Occupancy Group: B Type of Construction: VN Land Use Zone: CC Owner of Building: LARRY J & BARBRA LETHCOE Building Official Address: 78-750 NOLAN CIR City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 11-28-01 POST IN A CONSPICUOUS PLACE TEMPORARY CERTIFICATE OF OCCUPANCY - 30 DAYS Certificate of Occupancy City of La Quinta- Building and Safety Department �`Fo.TME 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 HWY 111 Use Classification: COMMERCIAL Bldg. Permit No.: 0105-289 Occupancy Group: B Type of Construction: VN Land Use Zone: CC Owner of Building: LARRY J & BARBRA LETHCOE Building Official Address:' 78-750 NOLAN CIR - City: LA QUINTA CA 92253 By: KIRK KIRKLAND Date: 11-28-01 0 I POST IN A CONSPICUOUS PLACE