0104-092 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
32!7233 B 7pIit) I
Signature of Contractor
Date
-. OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.) 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 exempt under Section B&P.C.,for,thl_sMrea_ son
Date !-)I Signature of Owner _Z
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 L1901 111043 Policy No.
Q WC3, E I9-0i*0
(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 provisigps�gf..Section 3700 of the Labor
Code, I shall forthwith comply with those provisi'o4
Date: Z• ,'!L -4 e . Applicant "� " • ''�
r c {y •ry-
Warning: Failure to secure WorkersCompensation 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 k
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)TI
& 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 suc
permit, or cessation of work for 180 days will subject permit to cancellatio
I certify that I have read this application and state that the above informatio is
correct. I agree to comply with all City, and State laws relating to the buil ng
construction, and hereby authorize representatives of this City to enter u on
the above-mentioned property for.inspection purposes.
Signature (Owner/Agent)" _ Date—
BUILDING PERMIT PERMIT//
DATE VALUATION LOT G�3-'t11i7� TRACT
4127MAO' $W1100
JOB SITEAPN
ADDRESS 78 57..-,- �A„Iacw 5-(( I
OWNER CONTRACTOR / DESIGNER / ENGINEER
Z.ACi#:17atir�'M CA 92253 PALN692260
C110l40�3, Gid (1543#
USE OF PERMIT
;100 SP ".49N.AXT 1?APJ*2(:°a ,f',MV40T PER APf:'.,tNEI) PLANS
I
VAIe13dI TI ON
rJ0,099,00 Lis
�'I'YZ Ct',1.: t'1t:Y.34E�,Z'1�G•t`�'�'1•t�1�!' email kyJ�' t�°��+i�f «T�.
' -
rtffrtm TM.) COST OF COINWrRUCITION
C0"NSTF'.CJt.`Y..T0N ..M, K
101-000-418-000
454.543
101-000-421a4300
A.gt9
lZLJYt"Y'RlC1flL2' 't
tial {}�'ti 4.if?�S di
g6.�Eif
F.'1e1;l1b3'IAVO FW
101. -000-419-f.?W
00.00
LESS PRE-PAID'E'`
rALIn—F-WIT NIKS DUE NOW
APR 2
7. 2001
ECEIPT/hrANCE^0U/rIIDA� f f� B `w_./” DATE FINALED INSPECTOR
$'908.19
$0,00
f< v^
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 �Q Z2 ( �G(/
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
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
-
Set Backs
'
s`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
T`
Final
COMMENTS:
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)
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of.
Banning
Beaumont
4.
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
.;.
Lake Elsinore
La Quinta
.
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
.;.
Temecula
Board of Supervisdis
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
January 8, 2002
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 Fisherman's Market located at 78575 Hwy 111, La Quinta CA.
release_Iq.wpd
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By � 6t_9
Terry D445oucy
Fire System Inspector
RMISs§ENGv 09RVI@g,3 §IVIVON 0 PLANNING MOTION 0 INDIO ®FF199