0105-231 (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 y
Date Signature of Contractor
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 Policy No.
(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+abor
Code, I shall forthwith
with comply with'those provisions. •,.
' f
Date: i�-�^ ' Applicant
Vllarning: Fafltire 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. r
Signature (Owner/Agent) -Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �Lk TRACT
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2 i 3:100MMOD
JOB SITE �"""�
APN
ADDRESS
-61 V IIII AD T6.2. �v
-
OWNER
CONTRACTOR/ DESIGNER/ ENO INEER
44-311 , )NUREY ME
72651 THBODORALAME,
PAUADUSM,V ak 92260
PALM DESERT Ch 92260
(760)779..0790 CBLY 64JIS
USE OF PERMIT
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VALUATION LS
1.1..E:7IM "FLIP MATMAR
PIAN �`�• ECK FRE '101 -000-439-318 "14,63
161-000-419-000
1~S.r.C:Ti.3. CAL .'�', R 101-000,420'-0M rmoft
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M AY- 2 2 2001
��gYyZarr mi�nnt}yy qq ��ryY�+�yyp�q CITY OF LA QUINTA
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1X33 PRE-PAU) M-315
$ NO
,A
t
RECEIPT
DATE j< /
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
_% /8L 62
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) 4
COMMENTS:
Q
Bin #
L
Permit #
D, a5, ?-�►
Project Address:
A. P. Number: --�
Contractor: �� o
Address:
City, ST, Zip: F
Telephone: KO 779 07f
State Lic. # : -S-191 3
Arch., Engr., Designer: S
Address:
City, ST, Zip:
Telephone:
State Lic. #:
�O Name of Contact Person: 0�^
Telephone # of Contact Person: i
# Submittal Req'd
2 Plan Sets
Structural Calcs.
Truss Calcs.
Title 24 Calcs.
Grant Deed
School Fees
Subc ntactor List
anning Approval
,rub. Wks. Appr
H.O.A. Approval
City Of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78.495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
l r wner's Name: 13Fc e,1
Address: �j/j3j�O/J f
City, ST, Zip: ESc� 6 �dl , 1
uZ G
Telephone:
70
— �
9
,f Project Description:
City Lic. #: .
� C
Construction Type: Occupancy:
anc
Y•
................ .. . ...]Project hPa (circle one): New
Add'n Alter
Repair Demo
v q. Ft.: 20 4 , Z # Stories: # Units:
(� Q 7S-3 F Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
5L'd TRACKING PERMIT FEES
2- Plan Check submitted y Ql, Item Amount
51led Contact Person
Plans picked up
Plans resubmitted
2"" Review, ready for corrections/issue
Called Contact Person
Plans picked up
Plans resubmitted
3'd Review, ready for corrections/issue
Called Contact Person
Date of permit issue
,fv,Z--
Plait Check Deposit
Plan Check Balance
Construction
X"
Mechanical'
Electrical
�� sc
Plumbing
S.M.I.
Grading
Developer Impact Fee
A.I.P.P.
Total Permit Fees
Lu
Co "79 5-75 .9— 13 �1
CITY OF LA QUINTA SUB -CON TRACTOR LIST3
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CITY OF LA
BUILDING & SA TY DEPT.
�� _
APPS
FOR CONSTI LJCTION _
O Y m
DATE
........................................................... ............................................................................. :........................................ :......................... ...................................................................................................... ....................... .................................
1
EXHIBIT A Permit # o 5— Z3 I
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 Z(o B
Certificate of Occupancy
City of LaQuintaAff
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:
78-575 HIGHWAY. 111, SUITE 200
Use Classification: COMMERCIAL
Occupancy Group: B Type of Construction
Owner of Building: BECKER & BECKER REALTY
—7-&
�'Yt
Building Official
►Tj-,II
Bldg. Permit No.: 0105-231
Land Use Zone: CC
Address: 44-311 MONTEREY AVENUE'
City: PALM DESERT, CA 92260
By: KIRK KIRKLAND
Date: APRIL 4, 2002
POST IN A CONSPICUOUS PLACE
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: B Type of Construction
BECKER & BECKER REALTY 78-575 HIGHWAY 111, STE 200
Owner of Building: BECKER & BECKER REALTY
TEMPORARY CERTIFICATE OF OCCUPANCY
SEE EXHIBIT A ATTACHED
Building Official
AIM
Bldg. Permit No.: 0105-231
Land Use Zone: CR -
Address: 44-311 MONTEREY AVENUE
City: PALM DESERT, CA 92260
By
Date
RICHARD KIRKLAND
01/11/02 EXPIRES 03/15/02
Certificate of Occupancy
City of La Quintal
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: 78-575 HIGHWAY 111 SUITE 200
Use Classification: COMMERCIAL Bldg. Permit No.: 0105-231
Occupancy Group: B Type of Construction: VN Land Use Zone: CC
TEMPORARY CERTIFICATE OF OCCUPANCY. SEE EXHIBIT A ATTACHED.
Owner of Building: BECKER & BECKER REALTY Address: 44-311 MONTEREY AVENUE
`7� dot
Building Official
City: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: DECEMBER 19. 2001 /EXPIRES 01/19/02
POST IN A CONSPICUOUS PLACE