0108-191 (COMM)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
Plzressionals Code, and my License is in full force and effect.
License # Lic. Class ExP: Date
"..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&RC. 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 {e" 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 Sec tion 3700 of the Labor
Code, I shall forthwith comply with.those provisions.
Date: .> 6 /'2 ' Al.Applicant--
pplicant "�
Warning Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up_ to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and >restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify,
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. J`
1 �% ~
Signature (Owner/Agent) "�°-- Date_
iw
BUILDING PERMIT PERMIT#
DATE VALUATION LOT�a �Q� TRACT -
f5$. 131n
JOB SITE APN
ADDRESS D
OWNER I CONTRACTOR/DESIGNER/ENGINEER ~
44.3 3 3.MON MRY-71 AVE7 651
PALM '?l��7C CA 9226 P.A{'.V1DERFRKI:' CA 922.60
USE OF PERMIT
YJ'ALU,d TYfM
P1,7XNV''S'�'!'T'Sf.��`
EYM447TV COST OF CO:C1�+'�.'RUCnE W it�aSJ�f�3:t3�D
KM CHECK HEE !0).-0010.439•,:x?8
mgmA,1I1am.::ir1£u 'aC11- QD„42?-C!Y}0 $9Fii10
TOTAL PERMU FEES DUE NOW 1 $174AMS
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
" Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall, Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 72�� ���
BLOCKWALL APPROVALS
POOLS - SPAS
steel,
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas -Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Watgr Piping
Plumbing Final
-Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
Bin #
City of La Quinta
Bmlding 8t Safety Division
P.O. Box 1504, 78-495 Cage Tampico
la Qldnta, CA 92253.- (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
_Project Address:Sw'tG
?,$ .C4 gLD 3
`Owner's Name: 13,CG �o ,`
� er e
A. P. Number:
Address:
Legal Description:
Contractor:
City, ST. Zip:
Telephone:
Address:
Project Description:
City. ST, Zip:
�V C t4
Telephone:
ne:
C l
G✓N.
D
tState Lic. # : 816
City Lic. #:
Arch.. Ener.. Designer:
J
Address:
City. ST, Zip:
Telephone: ne.
on truct� on Type: Occu ancy:
Stat eLis #•
.
Project hP e(circle one): New Add'n Alter Repair Demo
Name of Contact Person: S v "e.
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person: _ S-
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERK T FEES
Plan Sets
Plan Check submitted
p
p
Item
Amount
Structural Calcs.
Reviewed, readv for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance .
a.
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
T' Review, readv for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.l.
H.O.A. Approval
Plans resubmitted
Grading.
IN HOUSE:-
'"' Review, readv for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A,I,P,P•
Pub. Wks. Appr
Date of permit issue
School Fees
fs�vy�
Total Permit Fees
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 Classificat.ion: COMMERCIAL
Occupancy Group: B Type of Construction: VN
78-575 HWY 1 1 1
Owner of Building: BECKER & BECKER REALTY,
-T
Building Official
Bldg. Permit No.: 0108-191
Land Use Zone: CC
.Address: 44-311 MONTEREY AVE
City: PALM DESERT CA 92260
By: KIRK KIRKLAND
Date: 11-28-01
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