9903-003 (RC)s> '' LICENSED CONTRACTOR DECLARATION
N. U ` 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
C%4 w Professionals Code, and my License is in full force and effect.
O .� ch License #,!-Lic. Class Exp. Date
UJ
U) / 6202.4 B CS C20
Za' to Signature of Contractors -4
J U OWNER -BUILDER DECLARATION
W LLI (,.hereby affirm under penalty of perjury that I am exempt fro he Contractor's
~.a 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
Code).
" C0( ) •1 am exempt under Section B&P.C. for this reason
LO
N Date Signature of Owner
N
a. Q WORKER'S COMPENSATION DECLARATION
O 'QI hereby affirm under penalty of perjury one of the following declarations:
F p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J* Qperformance of the work for which this permit is issued.
CO Q' U ( ) I have and will maintain workers' compensation insurance, as required by
CZ'U. Q Section 3700 of the Labor Code, for the performance of the work for which this
rn f permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carrier Policy No.
�D'� 0f:,N IN?iV'%'RLC s w�rifl7 tri^ ^
";C3
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
3 9de,[shall forthwith comply with those p`rovisions.
t,Date: Applicant y f �/
Warning: Failure to secure Workers' Compensation covrrage is unlawful and
shall subject an employer to criminal penalties and civil 9fies up to $100,000, in
addition'to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth tion his
application.
F,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
q work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have,read this application and state that the above information is
• correct. I agree fo•complywith all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for, inspection purposes. ,
t . % Signature (Owner/Agent) YD Date'_s�"
0
t
BUILDING PERMIT PERMIT#
�l'.�t;3•i31?,�
DATE VALUATION S6().04;0.00 LOT •TRACT
-_-311,14 4 '4
JOB SITE
ADDRESS 18-:SF3QT131ICsI'1;�VWEkY AAI
APN , -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
DIR. P.$ll..zlOSKAS
DRSf;ft'fT1'I` ES f wV.L�6..tI (1ff�te
78. 00:fiti<,;I•iW.t Y 11
39725GJ1UANC'I,lNNCE 1/.ti
1,A. QUIN1A. ("A. 92253
PALM Dusp;12'0" CA. 92211
f 70AT 11-3345 f.: HI A, 2108
USE OF PERMIT
��Iv1��� kto�.la►.i. R�l�ii'.i.1�1Y�,,
w
WANT 1MPROVDIEN!' FGJilc Mlt;AU*SKAS F3VG INSTITUTE
v t1 - KrioiN 60,000.00 I'S
E,S`1.A1AT1,?D CO.W OF CON STIZUCTIO
('0,000.4m
PLAN C;HEQK kms 101-000-439- rt 18 S�'9h.68
r'ONSIrWrIlrI(, N FTE 101.000-40 4 -OM R459,Mi
M .CI>JVJJCAJ. FM 110 1 - (A00-42 1 -000 $30:00
)sL C:'l dalC AL. F�J.3 i (i 1-000-42.i -000 5201.65
f�I�1./PVii3lJdc� :l^L.t� 1�1<-r3tw-aa�-tw13 ��.��t
s1333-"1 IWAL i, r(*1 ti "ff.C1 °2IoNN� Pf.,Aw C: 1110
1,(39G fS i
�.rr„,�� 1'RT'•'? iT) iilt'.I�
R511 LJ
�t3.00
MAR 011991.0fAl. kPIRINairr F.VXS DUTE NOW
S1,094.83
WIT`( OF LA Ui� e �.
RECEIPT
DATE
BY J
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 v
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
Fbrtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
APR -06-99 TUE 12;52 DESERT CITIES DEV
RIVERSIDE COUNTY FIRE DEPT.
,FIRE PROTECTION
JOB CARD
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
SET OF PLANS
Owner_P4.,leaus)(6, e� Z -1"i Date
% (Issue)
Location f ' SZ:0 IL. )1
FAX N0, 7607714431 P.01
1'(q, 7-77- 711
CITY OF LA OUINTA
BUILDING & SAFETY DEPARTMENT
7n-7012
INSPECTION REQUEST LINE
777-7153.
pl.ID
Owner DRNIILAUSKAS
ContractorDESERT CITIES DE ELOP N
Permlt Number 9903-003 ; ' ()1-1 A �X.j.' N~•
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACE:
JOB ADDRESS 78-560 HIGHWAY III t
TENANT IMPROVEMENT FOR MILAUSKE
EYE INSTITUTE
Case No.
Inspector
Date
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK
FOOTING $TEEL
MAIN GROUND SYSTEM
_
Sprinkler Companyr
rC _ —
+t
I�1 GROUND PLUMBING C
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGN
Undergmuno Static
Date
Inspeaa CONCRETE SLAB
.09
y
EEC TGIRDERS
( 1 .
S'laliic
—'
/ � ELECTRICAL GROUNDWORK
O,erhead
DSte
Insmw
DO NOT POUR CONCRETE UNTI ALL ABOVE HAS BEEN SIGN
FlushDai
pe=r
i �' ROUGH ELECTRIC
A,sTY
ROUGH PLUMBING
tR
net
Date
L
Inspector
ROUGH GAS & GAS TEST
I \..�.«..,.-..�.._ .._
Fre Main Installer_
Underground Stalic
Dale Inweaor
Final Date Inspector
Hood/Duct Installer
Final Date tnspedor
Alarm Installer
Final Date Inspector
Tank Installer
Final
FINAL for OCCUPANCY
lnspeddr
Date
Inspector
Date
1
DO NOT. OCCUPY THIS STRUCTURE UNTIL
.'59 (4w AFTER FINAL INSPECTION.
g
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR �Wjg4r!C �r
EXTERIOR LATH rJ
POOL PRE PLASTER/
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING -A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHTTO
TURN ON UTILITIES OR OCCUPY BUILDING
I
James M. Wright
Fire Chief
Proudly serving thi
unincorporated
areas of Riverside
County and the
cities of:
Banning
4
Beaumont
O
Calimesa
O
Canyon Lake
9
Coachella
A,
Desert Hot Spring:
A
Indian Wells
A
Indio
O
Lake Elsinore
O
La duinta
Moreno Valley
O
Palm Desert
O ,
Perris
O
Rancho Mirage
O
San Jacinto
Temecula
Board of Supervisc
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE. COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 *(909)940-6900 • FAX (909) 940-6910
April 5, 1999
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance for the group
B occupancy known as Milauskas Eye Institute located at1i7$'560"HlgEiw a 1y1f
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
F:\PE2\WPDATA\LAQUINTAWISC\RLS99-82.WPD
EMERGENCY SERVICES DIVISION O PLANNING SECTION O INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 O (760) 863-8886 O Fax (760) 863-7072
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: 78-560 HWY 1 1 1
Use Classification: COMM Bldg. Permit No.: 9903-003
Occupancy Group: B Type of Construction: VN Land Use Zone: CR
Owner of Building: DR MILAUSKAS,
Building Official
Address:
78-600 HWY 111
City:
LA QUINTA CA 92253
By:
KIRK KIRKLAND
Date:
4-20-99
POST IN A CONSPICUOUS PLACE