0107-339 (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 ` 3 fI Signature of Contractor!Xwv � o v
f...� .
OWNER -BUILDER DECLARATION i
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).
O I am„ temp 'under Section , B&P.C. for this reason
Date '/ [/ F} Signature of Owner
c �
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.
9TATE FUND
(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 p"rovisions of Section 3700 of the Labor
Code, I gh �I.forthwith comply with�gse'° ro,,,v1fdisiJons�,,r:
Warning: ailu?e"to se'cOre WorkeFs'"Compensation coverage is unlawful and
shall subject an employer to criminal penalties an civil fines up.to $100,000, in
addition to the cost of comperisation, 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 applicator 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 propertrtyAor inspection purposes.
f#r
Signature-(O.wne.rLAgent).�f fA i ` �="- "t Date
BUILDING PERMIT PERMT#
DATE rJr VALUATION LOT 0107..339. TRACT
JOB SITE . APN
ADDRESS
70.4 i"_ H 5'.' $ I I 'l:": IJANG.3) -
OWNER I CONTRACTOR/DESIGNER/ENGINEER
7900 RE 2WFIA 72-764 ARBOLMIA
1WERCku L.A. 9;;3W110 PALM D 9ER- " CA 92260
(760)340.94 CSF 10, 05430
USE OF PERMIT
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C M. .11N D.ER YORS' LIL PFIR t1.PPRO L' D P1.043+'S V j 7.akiINO 3
RiA3AWflow
X001 Do U3
OF LA
ESTWAlm) COST UP CONSINUTC1,10N 310W
.RAW r.��ICK reUne. 3487.50
CO. NSTRUC!'PL7NfreFl f03-000.418-.000 $34.0
STRONO MOTION P -W - COMBI 1005 000-241,000 5.63
LESO PRE PAM rEZ3 M00
Wr l, a ERIPYffr FEIES DU fill NOW, I i�, 4211'+ 3
RECEIPT DATE -' �` f ..,I BY I D�UIJ"/(�� INSPr
4.
INSPECTION RECORD
OPERATION j
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade
Steel
Ducts
Return Air
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing rf _
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:
I -t y X r
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-
.
Bin
City of La Quints
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
bX
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit
Project Address:.; 8 M s'
Owner's Name: ; —0
A. P. Number:
Legal Description:
.Contractor:
Address:
�� �,
Address: ?�� S ��' ?'
City, ST, Zip: (f'�2
Telephone:
Project Description:
City, ST, Zip:
Telephone:
e.
(6 pp
t
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'StateLic. # : 2- It
5
City Lic. #;
Arch.. Engr., Designer: -
Address:
City. ST, Zip:
Telephone: h
one:
Con t uctton Type: Occupancy:
anc.
State'
Lu. #
Project hPe (circle rcl
e on Neww
e). Add' n Alter Repair
Demor
Name'of Contact Person:
Sq. Ft.:
#Stories:
#Units:
'Telephone # of Contact Person:
Estimated Value of Proiect: �c
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount .
Structural Calcs.
Reviewed, readv for corrections
Plan Check Deposit
Truss Coles.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2°d Review, readv for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
- Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
CITY OF LA QUINTA
PLAN CHECK CORRECTION LIST
Theodore E. Anvick
1015 E. Chapman Avenue Suite C
Fullerton, CA 92831
PLAN CHECK NO.: 0107-339
JOB ADDRESS: 78-525 Hwy 111 Building #3
AREA-S.F.- : Spherical barrel wall
August 23, 2001
FINAL CHECK — Revisions to
plan check 0010-007
OCCUPANCY: M
TYPE -OF -CONST.: V-lhour
The submitted plans and specifications have been reviewed by VANDORPE CHou AssocIATES . It is
our professional opinion that the plans are -in substantial conformance with the building codes and
regulations adopted by the CITY OF LA QUINTAand the State of California Amendment.
I
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by:
Dorothy Leever, P.E.
VANDORPE CHOu ASSOCIATES.
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780 VCA File No. LQ -13351
1