9906-192 (RC)r� 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.
A License #t Lic. Class Exp. Date
�f05J (�i 1 05/31/2011
D atec® Signature of Contractor
0_1�'"��
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that,l 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
Sec ion 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. .
- . 'P+'ItM10ik'i COMP IN
(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 sha I fortWith comply wiWhose prgyisi
&42!T) VApplicant 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 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 inspection purposes.
tSignature (Owner/Agent) % ~% �% '�Z Date 4 :2
s
PERMIT #
BUILDING PERMIT
DATE (W2,.15/19�)VALUATION �� � 1• 0 LOT TRACT
JOB SITE
ADDRESS 79-742 HIi".i�IWA-V All SUITE C
OWNER
CONTRACTOR // DESIGNER / ENGINEER
UAL PROPERTY ASSOC.
fLC fJlJy1AryTS A1S2,
1,7066 N.E WPDXf BLVD.
1'7 22.1. S1:+.XI ARK C,1 K(%E SU.[ 113 L
COSM MESA. CA 92027
IRNINE CA 92714
{v
(949)27.44955 f:HLA
USE OF PERMIT
Ct'.��i NIMCIAL R01#10.DEL
TENANT I' iLPROVI:Misiv l" - AIR71:OUGIf CF.UR.AR
4
Y . 1
'VALUATIOI j 15,0011M LS
gMY i111111,C�.i.A .� 9sal'`€ S3.A'. 0�...Vi�),)+h .6i 6J%l�j�C4��.i
.k..At�ti 1/•RtV
,p
�7 EF; 8illYRxYAt1RY
PLAN CHECK lrE6
tX)NS'.1'EJJC7' ON FEE
IVIECHNNICM, YEE, .101.-000-421.-000
ELECT Ii.f%;.4I. FEE, 101,000-410-M SiS.4t1
LESS1'.15.1'.-.1�.t1.Yn`I'k7 1• S
$0.00
TOTAL P&:Ri41s11'JI" FEES d)Llla;NOW
$297.30 .
'o
RECEIPT
DATE
BY J(�
DATE FINALED
INSPECTOR
1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
F.A.U.
Compressor
-�
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole.
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures'
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Giles of:
Banning
Beaumont
d
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
A
Indio
4
Lake Elsinore
La Quinta
4
Moreno Valley
Palm Desert
4 �
Perris
Rancho Mirage
o-
San Jacinto
4
Temecula
Board of Supervisors
Bob Buster,
District t
John Tavagllone,
District 2
Jim Venable,
District 3
Roy WII$M,
District 4
Tom Mullen,
Districts
3:35 PM RIV, CO, FIRE P&E INDIO FAX N0, 1 760 863 7072 9.gU49-T/ Lf Z
RIVERSIDE COUNTY FIRE DEPARTMENT'
In cooperation with the
California Department of Forestry and fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940.6800 •5AX (908) 841}6910
July 26, 1999
City of La Quinta
Building Department
Re: Fire and Life Safety Clearance
C6 -1y OF I_A 10-J'UINTA
JUL 2 6 RECD
r'
SIJILDdivu AN SAFSTy
The Riverside County Fire Department is granting a fire and life safety clearance for the group
M occupancy known as Air Touch Cellular located at 78-742 Highway 111, Ste. C.
release_tq.wpd
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
EMERGENCY SERVICES DMSION 4 PLANNING SECTION 4 INDIOOFFICE
82-G75 Kghway 111, 2nd Fl., Indio, CA 92201 0 (760) 8634886 0 Fax (780) 863-7072
P