0206-212 (RC)LICENSED CONTRACTOR DECLARATION s y
,I hereby affirm under penalty of perjury that I am licensed under provisions of
und
iChapter 9 (commencing with Section 7000) of Division 3 0 the Business and
Professionals Code, and my License is in full force'and effect.//
A gl
License # Lic. Class j�/i Ex!Datp
4.9626.5
Signature of Contractor
OWNER -BUILDER D
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.
( ) 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:.
Cartier STATE F1JND Policy No. j14421;p$F Y-bl
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of the workVor 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 Californiand agree�ai if I should become
subject to the workers' compensation,,pfovlslons of Section 3700 of the Labor
o�
Code, I shall forthwith comply with tho e provisions!{
Date :.--or.mg Applicant
�.. r
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 las 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'a�nd state that the above information is
correct. I agree to comply with all City/And State lads'prelating to the building
construction, and hereby authorize,representatives�e'this City to enter upon
the above-mentioned property for.inspection purposes.
Signature (Owner/Agent) Jjl,,r 1% /
Dt
ae /
r _ • a/'
BUILDING PERMIT PERMIT#
020EY.L J�C 1�1�ppry
.e
DATE 08MAK VALUATION-� `� ,4 `�� •�� LOT TRACT
tom^
JOB SITE
ADDRESS IP, 63W 1k4 (�'HW i' 11.1
APN Y
OWNER
CONTRACTOR / DESIGNER / EN (NEER
391 PACIFIC AVE, 4TH Tit OR
2245 a ,LJ%� AW_A 1�.VF.
SA�� ;i+3L�`a°�i'MIC0 4 CA 9.1.163
'fit XRB A.J. "i` A. CA. 928V
G31..4
'
USE OF PERMIT
lerNMI, IJVP";<FOVIT-M>Lq4 rCCC)aM?AER.CI I, PJteMG0Z1.. (TYPE x13.1t;4, 93"
0C C1. PA_XC'`1P, .Nl�.117`Ia,ER1�) WEL1,15 T'ARGO 13-I&K E�Pdn�i:��; Ery -I' 1 mo
s"'i'lt..TZP, HP,0iHERS PtA.l31'�MS.
WkaTRACT MOUNT %13
_ .XrMZitii,t'?i.ED C'i.i'Ff �..�.4 v.:>liiMUCI- Jo.11r
350)0,0_ t+
. i.44MYr FAT, a N."'eWZY�
C4�nl: TRU', f 1033 FES 1 C) � C4C« 1.1191 i5 �3.1'Y 0
'PLAN { H901C FE
MEC4HA?+17CALOR 101.000-421-000.
�1:LCT'i1`1C�;AU:a3��..t� a(J-fi(;i;'.}''•�!2#3-�(;1� ' .��z.'I9
'
ls'A'4 FFY,, - COMM .100-000-24(�y(1,000 35
y t�A�
T#M)!'�UNp+f�+?tlzlr�.t;��l's
�; A:..3&9�;dZ�•ws ,c' I.
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2 o
CITY OF LA QUINTA
FINANCE ®EPT..
8TPI=:t`C3`t"f+LCONYS',17UCTICaNAND CTIRICK..
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i s 1'.A o7nJ 7" .C!r°'
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.1 "Yil.CaL 1. Gil f NIMI' nC'X'S 'ME NOW
RECEIPT
DATE
BY r'�:_
{-
DATE FIN jFD ^„
FIN WD/
INSPE�R
fit,' 1f!3f
. /,�, _
ig,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings p
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 Wail 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 I
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:
Moo,i
4 QUA& -
r P.O. BOX 1504
wl "^ b5• 79-495 CALLE TAMPICO APPLICATION ONLY
Address j 11 WAN �l�
Address OO�o a GT�� LA QUINTA, CALIFORNIA 92253
Owner
Gro SJSA,J AMbfws
Mailing ?
Address2- .5_ J T /, {>
City Zip Tel.
A-6 0* H/ c t_s 9'z 653
Contractor
ress
City lZip I Tel.
State Lic. City
& Classif. Lic. q
Arch., Engr., C4'—' F44",
Designer C S0/J thic,
Address Tel.
lea MoNr&mt .H sl:, 57L • 9°D 415677.0141
CityZip State
$�1 CA. 5-C-0-1CA I Lic. a G (235$
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
Ihereby affirm that I am exempt Irom the Contractor's License Law for the following
reason: (Sec. 7031.5.Business and Professions Code: Any city or county which requires a
Permit to construct, alter, improve, demolish, or repair any structure, prior to Its Issuance also
requires (he applicant for such permit to file a signed statement that he Is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) or
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penally of not more than five hundred dollars ($500).
1" 1, as owner of the properly, 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves theteon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
or improvement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
I i 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractot(s) licensed pursuant to (he Contractor's License Law.)
( 1 1 am exempt under Sec. B. & P.C. for this reason
Date Ownef
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to sell -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
fl Copy is filed with the city, ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed it the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the perlormance 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.
Date_ Owner
NOTICE TO APPLICANT: It, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code• you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address.
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information Is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-
mentioned property for inspection purposes.
Signature of applicant -Date-
Mailing
aleMailing Address
City, Slate, Zip
BUILDING: TYPE'CONST. '111 _tj OCC. GRP.
A.P. Number
Legal Description _ �n1 _
Project Description Lb e�I Ai e xy: sto 0 FS't-
Sq. Ft.
Size
New ❑
2
No. No. Dw.
Stories Units
Add (H' Alter 9' Repair ❑ Demolition ❑
IEstimated Valuation $w-mz
PERMIT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
TOTAL
REMARKS
AMOUNT
SSD �—
ZONE: BY: _
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line--
Side
ine_Side Setback from Property Line _
FINAL DATE
INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
YOUNG ENGINEERING SERVICES
Engineering Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of La Quinta Date: 07/03/02
Project: a
7r -63o /7��(/
Attn: Ed Randall PC #: 0206-212 (1" Check)
Tel No.: (760) 777-7012 Tract No.:
We are forwarding: x By Messenger By E -Mail Your Pickup
No. of Copies Description:
1 Set of plans and calcs
1 Set of existing plans
Comments: Plans are acceptable
Thanks .
This Material Sent for:
Your Files Per Your Request
Your Review x Approval
Checking At the request of:
Other
By: Eric A. Frenzel
Phone # 342-9214
47-159 Youngs Lane
Indio, CA 92201
(760) 342-9214
Bronz Young
I
1 V
� T4'•C
°��x
To: Greg Butler, Building & Safety Manager
QAYL
CITY Off' !-A Of IINTA
JUN 2 7 RECD
BUILDIN(i 1—Y
From: Jerry Herman, Director of Community Development
To CDD: G 2-610 Z
Due date:
Status: S� 'Yo4i✓ o.-
/?EViS =7-, r-_•
Building Plans Approval
(this is NOT an approval to issue a Building Permit)
The Community Development Department.has reviewed the Building Plans for
the following project:
Description: /� o� E L%Ex�,�r✓sro,� o wE L t,S �iR2 G� i,d 5�2 32.5.
Address or general location: 7 e 6 3 o W1 63 /f�,�y / //
APN and/or legal description:
Applicant Contact: .)s/ C/K 171a Rive -- V J' - % 0/* 1//
The Community Development Department finds that:
❑ ... these Building Plans do not require Community Development,
Department approval.
...these Building Plans are approved by the Community Development
Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
rmaq, Director of Community Development
Date
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
Beaumont '
4.
Calimesa
Canyon Lake
1 4.
Coachella
4.
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
La Quinta
4.
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Bush,
- District 1
John Tavaglione,
District 2
Tim 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 • Penis, California 925 • 909 940-6900 • Fax 909 940-6910
August 9, 2002
Carlson Associates, Inc.
120 Montgomery Street, #900
San Francisco, CA 94194
Re: Non -Structural Building T/I Plan Review
LAQ-02-BP-158 / Wells Fargo Bank
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project. Please be advised the following conditions apply as a part of the conditions for the
issuance of a building permit.
1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a plan/inspection fee. The approved plans, with Fire Department
Job card must be at the job site for all inspections.
2), Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A10BC in rating.
Contact certified extinguisher company for proper placement of equipment..
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Requests for inspections are to be made at least 24 hours in advance and may be arranged by calling
(760) 863-8886.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
M:%PEZWPOATAHAOUINTA%PROJECTSITN IMPMLA042-aPA 58.doe
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072