0111-058 (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
B TUC,
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.
(w) 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,XEMPT 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 forthwith comply with those provisions.
Date: ✓ Applicant' --
Warning:
-.
.i......w prr fr •�� _�
Warning Failure to secure Wor'ers' Compensation coverage is unlawful and`�
shall subject an employer to criminal penalties and civil fines up to $100,0001in�.)_r
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. 11 1
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 emplogy ees.
2. Any permit issued as a result of this application becomes null and Vold 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 tliat.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 purpose.
Signature (Owner/Agen4)` ✓' ✓ xv Date 'a Z..
BUILDING PERMIT PERMIT#
DATE )f �l / VALUATION e�;Bst•� LOT 0.11"0= TRACT
JOB SITE
APN
ADDRESS 78-•4595 110"111 WE XW
«
OWNER
CONTTRACTOR/ DESIGNER IEN61NEER
iIDD IC
MOVAC •vpMMU``TIRN
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:2�1.g:�RUO U11I.X90 V+'A 9,8I40
PAUx.DESEt.,RT CA. :32260
(760YI'79-0790 +;"'Bldi 6448
USE OF PERMIT
-.z
BA`'HRMU T) (ONLY)
C014"Flip,` AMOUNT t1is0,ttf! Ls
LFBMATED COST OF COM'STRUC ETON'
.
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�c.x£AyJ�t.a,p�.cS'SSxilxY'�+yiybtttr
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fitSO
KLAN CHEP—M f'A t ( k 51'1 -Obf) 439-3 f e i�FDO"
C:i91A4 S`ii'ec r l `.(' X53 i a�3? a 01-'00-13-41 te, 000 VrA.00
M,WI-LIIWICFi,L 01 •000421 •���(i $2!I,bt3
R111KCI1'd.fY.'.A1.: Na BFT9T GJ'�= P-E1f1iF i .uU
1�i.,f;1b??;'11�� 1��„'� « P�: ����src.➢u•�1s,�na ��9,0t1
NOV 0 7 2001
L.AQUIRWYA
. �....
C6 Y OF
-II�9A CIE DEIN:
)ESS IMRAIDMIS!
WC.00
w
TOT" 111yyiLINEy6S NOW
SIO RG
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
r e
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS • SPAS
BLOCKWALL APPROVALS
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
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)
EXI5TIN6 OUTSIDE SHELL WALL
�o
om
1(1 r
r.60"WHEELCAHA61
r
NEW WALL— 32 rr
M
2.9/r2"
. A RE -INSPECTION FEE OF
WILL BE CHARGED IF THE
PLA(dSAND SITE 1OB A
RD FOR A SCHEDUIEJi -
NOT ON
THE
INSPECTION.
GNO EXCEPnoNSI
SCALE: 1/4" = 1'-O" BATHROOM — PLAN
°' I 1 o
NEW WALL
EXI5TIN6 DEM151N6 WALL
CITY OF LA QUINTA
` BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTI
GATE d(- BY
Al0 BLD6#Y2
DRAWN BY BOB SIPOVAG
BANNER -MATTRESS T 1-' 51POVAC CONSTRUCTION
LA GUINTA:CO.URT_Z. - 72651 THEODORA LN. -
1`'18595 HWY'i11 5UITE�l00'm^r PALM DESERT GA. 260
LA QUINTA CALIFORNIA 760-60 -7538
f- - A
SCALE: 1/4P = 1'-O`
IV OAOAIL (99 OR 04ROME)
D' MAXIMUM
is,
T.P.
52
lE
CITY OF L.A.QUINTA
I BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTI
DATE BY
ADA TO I LET --SECT I ON
A10 'BLDG. # 2
BANNER MATTRESS T.I. DRAWN BY BOB 51POVAG - .
QU
INTA COURT 51POVAG CONSTRUCTION
LA
LA GU NWA 111 SUITE 100 72651 THEODORA LN.
' LA QUINTA CALIFORNIA PALM DESERT GA. 42260
. '160-804-'1558
SCALE: 1/4'•' = 1'-0"
i
�B
I CITY OF LA QUINTA
` { BUILDING & SAFETY DEPT.
N Iat . j5,, 17 1 PN
61,DG.'I 2
BANNER MATTRESS T.I.
LA.QUINTA COURT; `-
'�65�i5 f4w. 1.11 5UITE .100
LA QIJINTA GALIPORNIk
APPROVE®
FOR CONSTRUCTION
DATE BY
&RI�iVdK EKY- fib8j51POVACr
31POVAG. i1�lJGT(ON
'1`2661 TIEOE�ORA LN.,
PALM D1=5>=RT 6K c12260
'f 20=boq-l538
i
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_ —�_+_ _�t''�.'.°�„�g. r- t�.,-��`'�`.'"�,., "'Bi��K.�:,Z,� _ � �-:.�''�F�N4.-'c,,�bs=rF3�'7!6�ia fµo-:...�:�.:4F'�.wrt �.�,•�,.. %?F' 3:i. 4`�.'.. 'i'..'x.1'P'ix .
DALE FRANK & ASSOCIATES, INC.
7900 SE 28" Street
Suite 405
Mercer Island, WA 98040
Dale F. Fra* Jr
October 25, 2001
City of La Quinta Building Department
.PO Box 1504
La Quinta, CA 92253-1504
Re: Banner Mattress Bathroom
To Whom 1t May Concern:
JDD, LLC, owner and landlord for La Quinta Court is responsible for performing certain
improvements for Banner Mattress under our lease agreement. The improvements that
are Lessor's responsibility for the bathroom are as follows:
"One (1) restroom on the rear wall of the Premises equipped with one (1) commode, one
(1) lavatory, one (1) exhaust fan, one (1) standard light fixture and one (1) electrical
outlet. Lessee is to provide hot water, if needed, or required by government agencies.
The only finishes that Lessor will provide within the restroom are a four foot (4' 0")
marlite wainscot, painted walls and ceiling, vinyl tile flooring and rubber base. Restroom
dimensions and fixtures shall be in full compliance with all codes, including those that
may relate to access for the handcapped."
We have hired Sipovac Construction to build these improvements in accordance with the
City of La Quinta codes.
Thank you.
Si cerely,
1
Dale F. Frank, Jr.
Manager for JDD, LLC
Email.- d ►•2 c, ome.com
Telephone: (206) 275-4130
Fax: (206) 275-4131
. -1