9609-107 (RC)H
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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.
Lice se # Lic `Class Exp. Date
620242. A C8 C210 Y1 1.P)5
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V ate !` %° f' Signature of Contractor e"
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). _ .
( ) 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
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.
,(
)-'l have and will maintain workers' compensation insurance, as required by
S&tibn 3700 of the Labor Code, for the performance of the work for which this
permit is fissued'P0''0w"8rkers' compensation insurance carriP,r8 0&1idVtho.-are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 cr 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 a4`"
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 h ;reby authorize representatives of this City to enter upon
the above-mentioned prop'er2i for inspection purposes.
XSi nature (Owner/Agent) " , t. 7 f' ! Date
PERMIT # CONTROL #
BUILDING PERMIT
9609-107 4036
DATE 9111/96 VALUATION $17,414110.011 LOT TRACT
JOB ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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USE OF PERMIT
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PLAN r14ECt . FVr 1 f)1 -OW -+139-W $87.75
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13 JY,'.'[RJC;'AL f €1?. 101_000_4iol ft) f.•1 $4.5,In1.
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TOYA1, 39N;Rj4I:1`.1' FEES D(I1? NOW
RECEIPT
DATE
eBY J e f
DATE FINALED
INSPECTOR
. JY uJ.
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
Drywal - nt. 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
r
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring - 6
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
oz. C O UN T Y �✓s,,
RIVERSIDE mA-7.
J. M. HARRIS
�5 FIRE CHIEF
Desert Cities Development
46-100.1/Z Washington St.
La Quinta, CA 92253
Re: Plot Plan 90-434
RIVERSIDE COUNTY
FIRE DEPARTMENT
210 WEST SAN JACINTO AVENUE - PERRIS, CALIFORNIA 92570 - (909) 940-6900
TENANT IMPROVEMENT PLAN CHECK
September 10, 1996
You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN
OCCUPANCY PERMIT. Prior to opening your business, you must contact the Fire Department Planning
& Engineering office to schedule an appointment for a Fire Safety Inspection. You must be present at time
of inspection.
THE FOLLOWING CONDITIONS MUST BE MET PRIOR TO OCCUPANCY:
1. Install Knox Lock Boxes, Models 4400, 3200 or 1300, mounted per recommended standard of the Knox
company. Plans must be submitted to the Fire Department for approval of mounting location/position
and operating standards. Special forms are available from this office for the ordering of the Key Lock
Boxes. This form must be authorized and signed by this office for the correctly coded system to be
purchased. If the building/facility is protected with a fire alarm system or burglar alarm system, the lock
boxes will require "tamper" monitoring. - ,
2. Any modification of the Fire Sprinkler system must be done by a licensed sprinkler company, with plans
approved by the Fire Department.
.3. A minimum 2AIOBC Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible
location within 75' walking distance from any point in your building or suite.
t ,
❑ RIVERSIDE OFFICE
3760 12th Street, Riverside, CA 92501
(909) 275-4777 - FAX (909) 369-7451
-1-
FIRE PREVENTION DIVISION
PLANNING SECTION
t COUN
DE
FIR
Subsxt coMit
_ SEE
Data a 5 /o
�11NDIO OFFICE
46-209 Oasis Street, Rm. 209, Indio, CA 92201
(619) 863-8886 - FAX (619) 863-7072
printed on. recycled paper
Con't. - Plot Plan 90-434
4. A durable sign stating "This door to remain unlocked during business hours" shall be placed on or
adjacent to the front exit doors. The sign shall be in letters not less than one inch high ona contrasting
background.
All questions regarding the meaning of these conditions should be referred to the Fire Department Planning
& Engineering staff at (619) 863-8886.
Sincerely,
RAY REGIS
Chief Fire Department Planner
By /tk
Tom Hutchison
Fire Safety Specialist
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