0206-002 (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 #Licc.Class Exp. Date
7
99537 B c 9/3111013
DateSignature 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.
,. ) 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 STATE FURD 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 „p�rovisio�ns-of Section 3700 of the Labor
Code, I shall forthwith comply with those;provision ! a
x"Date:•R / ApplicantW10
Warning: Failure to secure Workers' .Compensation coverage is unlawful and
shall subject an employer to criminal''penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his;. ,
application.
1. Each, person upon whose behalf this application is made & each person at
Whose request and for whose benefit work is performed under or pursuant to
,any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for,insp/erccttiion purposes.
--"Signature (Owner/Agent) Date iLv
fh✓C
BUILDING PERMIT PERMIT#
02061-
DATE VALUATION LOT TRACT .
SMAM
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
0KF,-FSJ;-Vk14LA QIXANIM LLC
so 0)11 (_YJ1rrR&C01TNG DIC,
71 _094. TA UTA.i T
;558 # 7 YQRC 1I S1. n.FJ".9'
�,i��,3MC0li$.iIiAGE CA. 92270
Tivil 11.11M.J0Rt.V. 'WA 92530
USE OF PERMIT
CC>MMERCL` ,
l
S'1'ORA.C?Y; RACKS. AND 0O1viOC. LA:S R iii APt%C2.£iVItV PLeANS,
I!',kaLLiATION 4g,p f„40 W
cogl,OF S.We'A lyn'9,V'1,r.7I�,aJ.`Y
•�v� gyf�y,�p
=�id9A" SRJL'i1G1V4
CC: NS` RUCTI N FEE 101 _000-1119-000 $'482.60
vi`i:'RONG MOT1014 YEF - COMM 100.000.741.000 SO54S
,r
E
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1ks J':F cT
CITY OF LAQUINTA -
FINANCEDEP'P. I
RECEIPT
DATE •; sF
B ( "
I INSPE
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 9 _7
BLOCKWALL A PROV LS
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:
I 7w,5/23/2002 15:45
Bin N
I � I
Permit #
ALJ oo
Project Addmssi-t A. P. Numbcr:
7607777011
Contractor: -jt' -rev "50
Address: -V S S
City. ST. Zip:
Telephone:
State L'ie: 0:
Arch.. Engr,. Dl signer: V
Address:) j • � A -Ad
City, ST. Zip: S
Telephone: SIP?—
State Lic,
Name of Conta t Person:
Telephone it of Contacl Person:
a Submittal
Plan Sets;
Ssructuril Calcs.
Truss Caics.
Title 24 4alcs.
Flood pltlin plan
GradingIan
Subtonloclor List
Grant Died
H.O.A. kpproval
IN HOUSE:-
Plannin® Approval
Pub. W kp. Appr
School Hees
LA QUINTA
City Of La QUinta
Building or Safety Division
P:O. Box 1504, 78-495 Calle Tampko
La Quinces, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
Owner's Nam 4-
Cin, Lit. a:
PAGE 02/03
Address: -)F 1 �t27 s. 'Dvpoi•rf— �t���
City. ST. Zip:` Oft o Cib- `l •� _ i
clephone: Oq • 31 18 11
PMieet nracriniinn- ,{- C-VF�aboSe Jt ,AE of L1oXK
N
X63 M91
5 Flo& 7
y j
Construction Type: v Occupancy
Project type (circle one):cit Add'n 41ter Rcpoir Demo
Sq. Ft.: II stories.
TU -1 - 01 -&?j . la a I
Estimated Value or Proieet; 000
APPLICANT: DO NOT WRITE BELOW THIS LINE
Rcc'd
TRACKING
PERMIT FJEES
Plan Check submitted
&
Item
Amount
Resitwtd. iow
6 WaPlan
check Deposit
Called Contact Person
i 17
1/1*
Plan Check Balance
•
Plans picked up
Construction
Plans resubmitted
Mechanical
11' Review. read• for carr ctions/issue
Electrical
Called Contael Person
Plumbing
Plans picked up
S.M.I. - C
•
Plans resubmitted
Grading
'" RevIt-. read' for correctionstissut
Developer Impact Fee
Called Contac Person
A.I.P.P.
77��
Dale or Dcr . i$2ut 4-flL-11.
3
+ Fla w-er- VPIL-vi .
Total Permit Fees
r
YOUNG ENGINEERING SERVICES.
Engineering Architecture•Surveying• Building & Safety Services
Letter of Transmittal
To: City of La Quinta
Attn: Ed / Greg
Tel No.:
We are forwarding:
No. of Copies
1
Date: 6-11-02
Project: PC #0206-002 (ls` check)
78-680 H VY 111
W.O..
Tract No.:
X By Messenger By Mail Your Pickup
Description:
Plans
Structural calculations
Comments: Structural content is approvable.
This Material Sent for:
Your Files
Your Review
Checking
Other
By: Eric A. Frenzel
Phone # 760-342-9214
X Per Your Request
Approval
At the request of:
47-159 Youngs Lane, Indio, CA 92201 (760) 342-9214
Bronz Young
JUL 192002 9:'15RM
Tom Tisdale
Fire Chief
Proudly serving the
utio=porated
areas of Riverside
County and the
Cities of
Baan ing
4
Beaumont
Calimasa
Canyonum
m
Coadmills
Desert Hot Sprins
Indian Wells
Indio
0
Lake Elsinore
0
La Quiffs
Mm,rno Valley
Palm Deseit
O
Penis
e'
Rancho Mirage ,
San Jacinto
Temecula
lloar9 of supra iaare
Bob Buster,
D1sWat 1
John Tongliono,
Distrix 2
Jim Venablq
Dibvia 3
Ray Wilson,
DIswlct, 4
Tom Mullen,
Dlsmia 7
June 17, 2002
K L CHARLES & ASSOCIATES (562) 864-8784 p.2
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Foresfty and Fire Protection
an Jacinto venue • Forri, callrornia ROD Fox (9M 940-010
K L, Charles S Associates
12631 Best Imperial Highway, Bldg B, Ste 111
Sang Fe Springs, CA 80670.4759
Re: Highway Pile/Rack Storage Plan Review
LAO-02-BL.DO.102 t Stapies #1324
Fire Department personnel have reviewed and approved the high pileirack storage analysis report.
submitted for the above relbrenced project. Please be advised the following conditions apply as a part
of the conditions for the Issuance of a permit.
1) Submit fire sprinkler system plana designed In conformance with the approved high plied storage
analysis report.
2) Store perwrinel shall limit and maintain the storage heights on racks as determined In the analysis
report: Personnel shall also monitor and maintain the proper clearance of rack flue spaces on a
regular b*Ws.
3) Store personnel shall maintain the unobstructed minimum 44 -inch aisle widths and accestas.to
egress doors on a continuous basis.
4) Ira tall portable Ire extinguishers per NFPA, Pamphlet *10, but not lose than 2A200C•In rating.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 663.6608,
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
13y
Walter Brandes
Fire Safety Specialist
ttwswrw�T+nwas.rrau+Faec rs�s►ooJeuao-0aeLow wcsi�
EMERGENCY 39RVICES DMSION • PLANNING 50011ON .INDIO OFFICE
82-075 Highway 111, 2r-° FL, Indlo, CA 92201 • (760) 853.8889 • Fax (760) 863-7072