0110-078 (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.
"Licensee�j# gg}}Lic. Class Exp. Date
��! )y
Date f1�""`+°� Signature of Contractor- t /•I
LDER 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).
( ) 1, 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 Y"
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 Labor
Code, I shall orthwith comply with:those provisions. `
Date: , - ✓ Ar mlicant
µWarning: Failure to secure Workers' Compensation coverage -is unlawfuland
•. shall subject an employer to criminal penalties and civil fines up to $1000004., in
n
•addition•to the cost of compensation, damages as provided for in Sectio 3 06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of 13uilding and Sal�t�y� o
for a permit subject to the conditions and restrictions set forth n riy_
application. CI'
1. Each person upon whose behalf this application is.made &each pe •son.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
Ahold harmless the City of La Quinta, its officers, agents and employees.
2.SAny permit issued as a result of this application becomes null and void`if
work is not commenced within 180 days from date of issuarice 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'p rope rty for insp n purposes`
Signature (Owner/Agent) �- �- -�-- 0._,_. —_Date -'27 h
s F
-BUILDING PERMIT PERMIT# —
DATE VALUATION LOT 011 TRACTS
109.1.154190C ALD .4
JOB SITExx��
APN
ADDRESS ' -w-r<v_
7 �Ay A:;..
OWNER
CONTRACTOR / DESIGNER / ENGINEER
31.1A) 3:111
SIPOVAC CONS-111J'ct"10H
v aAa, .;ma WA
PALM'V. STI-rer C„%. 92260
(760)779.0790 w:11W 644E
<
USE OF PERMIT
3 x f Y.[�iff t' dt�tlz,)i,Ud'C.tPri T (A442 S irOit,STSWA I s ITLE
FERAW FRE SUMMARY
COAS"1130111014 101 -OW -418-000 $234.5D
d .r�rti1 +itd" fXpF 121 1014001-421400 $14.$0
'1.Ilil'230 'f?[ ... 1 1-�U�9�1�4i�a13€0 $200
0-000-445400 $130.00
121
2001
N OF LA QUINTA
9NANCE DEPT.
UM v ' ! C'C3M°1'd, �UO".i1.O 1-'N.01TANCI M',
W181.99
MIS, RRE-Prrd4E
$0.00
TOTAL 1A L .PERWAXAt" MES DUR 14OW
RECEIPT
DATE ^y �"• /
BY �}"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor.
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
., ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Y
Bin #
k�D
Permit #
dl 1 o- 026
Project Address: —79
A P. Number: -7$-57
Contractor.
Address:
City. ST, Zip:
Telephone: 369 7S-39
State Lic. # 55W 1!r?l<
Arch.. Ener.. Designer:
Address:
City. ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
Telephone # of Contact Person: A
q Submittal Req'd
2 Plan Sets
Structural Calcs.
Truss Calcs.'
Title 24 Calcs.
Flood plain plan
Grading plan
Subcontactor List
Grant Deed
H.O.A. Approval
IN HOUSE:-
Planning Approval
Pub. Wks. Appr
School Fees
City Of La QUinto , Ec�ev
BLYMIng s[ Safety Division . ! W5
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit ApQlication and Tracking Sheet
Lic. #:
Owner's Mon.
Address: 3
City. ST. Zip:
rsfr� a�
Construction Type: Occupancy:
Project n pe (circle one): New Add'n Alter Repair Demo
SG Sq. Ft.: # Sto ' # ni
rn
7 r -Estimated Value of oie
APPLICANT: DO NOT WRITE BELOW THIS LIN 3o p j�
Recd
TRACKING
PERMIT FEES
Plan Check submitted e26VI64
Item
Amount
Reviewed. readv for corrections
Plan Check Deposit
Called Contact Person
Plan Check Balance
Plans picked up
Construction
Plans resubmitted
2" Review, ready for corrections/issue
2
Mechanical
Electrical
Called Contact Person
Plumbing
S.M.I.
Grading
Developer Impact Fee
A 1 P P
Plans picked up
�C
Plans resubmitted
34 Review. ready for corrections/issue
Called Contact Person
Date of permit issue
Total Permit Fees
C.7 i?DjlrS D a 0 6)1- AS N f elf f%V' I / 0�-ti✓�
EXHIBIT A Permit #0116 . 07$
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:
Date1j
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: 78-575 HIGHWAY 111, SUITE 300
Use Classification: COMMERCIAL - Bldg. Permit No.: 0110-078
Occupancy Group: B Type of Construction: V1 Land Use Zone: CR
Owner of Building: JDD, LLC
Building Official
Address: 1500 18TH AVENUE NE
City: ISSAQUAH, WA 98027
By: KIRK KIRKLAND
Date: APRIL 4, 2002
POST IN A CONSPICUOUS PLACE
Certificate of Occupancy L
City of La Quinta
Building and Safety Department Af OFTMf
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 300
Use Classification: COMMERCIAL - TITLE COMPANY
Occupancy Group: B Type of Construction
Owner of Building: JDD, LLC
TEMPORARY CERTIFICATE OF OCCUPANCY
SEE EXHIBIT A, ATTACHED
Bldg. Permit No.: 0110-078
Land Use Zone: CR
Address: 7900 28T" STREET SE
City: MERCER ISLAND, WA 98040
By: RICHARD KIRKLAND
Date: 12/21/01 EXP. 03/15/02
Building Official
�.\ - 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 Bui/ding 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:
79-575 HIGHWAY 111 SUITE 300
Use Classification: COMMERCIAL - TITLE COMPANY Bldg. Permit No.: 0110-078
Occupancy Group: B Type of Construction: V-1 Land Use Zone: CC
TEMPORARY CERTIFICATE OF OCCUPANCY/SEE EXHIBIT A - ATTACHED
Owner of Building: JDD LLC Address: 7900 SE 28TH ST #405
City: MERCER ISLAND, WA 98040
By: 'KIRK KIRKLAND
Building Official
Date: DECEMBER 21, 2001 /EXPIRES 1-21-2002
POST IN A CONSPICUOUS PLACE
Q
1
I
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont
Cahmesa
Canyon Lake
Coachella
4.
Desert Hot Springs
.;.
Indian Wells
4.
Indio
4.
Lake Elsinore
4.
La Quinta
4.
Moreno Valley
Palm Desert
Penis
.;.
Rancho Mirage
.;.
San Jacinto
.;.
Temecula
Board of Supervisors
Bob Buster,
District I
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
210est San Jacinto Avenue • ems, California 92570 • 909 940-6900 • Fax 909) 94G-6910
May 17, 2001 ,
To: City of La Quinta ,
Building Department
Re: Release for Building Permits ,
Stewart Title T/I @ La Quinta Court
The Riverside County Fire Department hereby releases the above referenced project for
issuance of a building permit at the discretion of the Building Department.
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes 3
Fire Safety Specialist
H:1PE21WPDATALLAOUINTA%PROJECTS%TN IMPRVALAO-0I-BLDG-061 Penle Release.doc
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072