0103-209 (SIGN)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,,Chapter/�i,(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 f `Exp. Date
t•5,,,.%F�S:I��ti �, �.;23';E�Cl: " � ,��C39;�3f1�'�"C
r Dai vt;\7� '? Q�ignature of Contractor'"
d
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).
O I am exempt under Section B&P..C. for this reason
Date Signature of Owner
k,
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-ins&e for workers'
compensation, as provided for by Section 3700 of the Later 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 v4r� for which this
permit is --issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is fordl00.00 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 /tKat if 0should become
subject to the workers' compensation provisions of S ctlon 3�Id0 of the Labor
Code, I shall forthwith comply withhoswprovisions.
-'bate: 1� . 9 ! s P 7 ¢ Applicant-
Warning:
pplicant 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.
r
Signature (Owner%Agent)"ti - '_4 1� Date PI
' BUILDING PERMIT PERMIT# D
:
DATE VALUATION LOT 0103.2..09 . Z
MOM
JOB SITE
ADDRESS
.MAR
OWNER
CONTRACTOR / DESIGNE /EN IN ER 1
�'Er}3,�E� �Pa.I'� CARE
ft
��
�
78-82.2'.TIM
� to T.-HoLTff�:i� � Y a DEPT
LA, QUIMA. CA 92233
1-4, QMTA'► C.A 92251-
CSIA 2180
USE OF PERMIT
ORWRAL
Ilei Oi:.rt1` E EXIVZNG 310N PER .&PPRt.8VED MA:M .
VA1, UATICtxi cn.0�1 tn9
W.UNUTE°' C°t. FY OF Q:0IV'NT.R'UC:IX0.K
8W.00
CON,31*1RL9t:TION FEE 101-00 0-418-000 NXIDD
,1,1kW i UC&L Tfuz 101-000-420-000 $1.5.00
)PIAN C.RCQ9 = 101-000.439•�316 $13,65
S'T};.ONQ MID MN FRE . COM&I 100400-2111 -000
h+
BTIR-'I'C1TAL C(3NS a;i�.'�3't'`�' OYS ANT) PLAM Cis..€ M
$50.15
LESS M -PAID FM
V0.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
t
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 r�_(% _
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
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:
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PK43C 1-9 H �. AREA LOT AREA
a.. a,— r
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ALLDLTaola IMP N.Wy •(M,7U v) 2204 O'sly 230•'A.a1..a 1/laoo
M I.M r t
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20-4.8
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220 v 20-4.8 low
w ts/ s t as
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.w sr .%, teo4
1'•• 7 ..200 Sr 20.#14 31 li-L1/7'11000
1 /HAS[ 2 w �.r r Liu OIL tW i:0"000 M b.t14f1 yji1uo/0`
w CsIJN.1■Iq t■.S■I v # t1.s0O V 94 sr LI -•#.6 1000
M I.tM v ...ItidNt r.a 1aV y ,00 K 37.4u sr 221••1.3/1000
TACO a[2l. , IMI 2:010 K 31,2#4 it ;'1-12.�/taoo
1 147.3 v 30.243 x M-0 #/loos
ra i;iw v »:w
M r ar 30.0•i//t1000
l:e000ee v 30:70773 K t�:`i/ wo
PHASE3 M ~mow 30313 w /12000v 30:�v 33-a:i//11o�00
la t6:= v IMP 7.600 sr .. _ . 33.311 v 31••1.■/1001
M sJ.t v rA11's-- R[I
-8.1000 v _ 20. ata sr ,Sr.a/t000
t� tlarr+i b.M r N
3..003 ar W.1//OOl
• N t.M v A!m2.711 1 $1 30-2.♦,11000
umall[ ♦ to. no Y A
• N a►� Y (0411# N I4Y rLt
Pc7R19 A -T _
^CLOTNL3TIA
Y[ R `- N � PECTIO•N- FEE OF
�.nYl[la att« awteeL WILL $VE', $30
IreNGY•. Ilel[l [/ORTO•[.R C�IAR
GED IF THE APPROVED
PLANS AID JOB CARD ARE NOT
` THE S•t�T ON
F
INSPETI N- OR A SCHEDULED
rt ••. � 9 �.\`\mss
.A cs , 'Y{r N P6 •�„ 'l •�,. �+ ,♦`
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Ebb
no
-TY OF LA OUIN 1A
Monument ' BUILDING & SAFETY DEPT-
FOR CONSTRUCTiON
AI'Pm VEU Y IMMUNITY DEVELOPMENT DEPART ci t
C 'a ey
BY DATE .7 3/
EXHIBIT -554.223 SF. PROORANIED RM. AREA
ARfw WITH EXPANSION
CASE NO. 3043 PAUINIC rWVIOW
s.5/1000 STALLS PM*IM .
WITH MANSION
-INCLVOES THE THEATRL FOOTPRINT ONLY .
ANO DOC$ NOT INCLl1OE THE MEMA1419E
-
` �#�r ONE ELEVEN -LA QU I N TA
I _OYE RALL twr 'lta.pav M.s1av
HIGHWAY III & WASHINGTON STREET
_�_ _ _ LA OC1 I NTA , CALIFORNIA
200 _ A C06MENCIAL rROJUT LY:
A, �aelb•an.tiw 4N rt'�[...1 - - —WASH I NGTON/ADAIAS
PARTNERSHIP
.r -, _ ....r.16 Yr tr 1242 • wtr 6.2.1 4__444.._ n
-4wrr... 1-.+., w. nr•-+• •-RANCHO MIRAGE, CALIFORNIA
Irrh r 6i Nett 11 M I.rw IMlir.
• MICHAEL SHOVL IN
4
ARCHITECTS -;`s`
1
aMN�L.tOIO'wl` • 1M 3M -A[•711# ^;_.
R
•�
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•
-:D/F MONUMENT INTERIOR ILLUMINATED SlGW'-'**'
I - r . . r-4
8' LONG
..
. . . .
BOLTS
VIEW & #4 AREBARJHRQUQHT:.-�-
MAIN STEEL FRAME DETAILS
& FLUORESCENT LAMP DETAILS
8' (+
MAIN STEEL FRAME DETAIL
TOTAL El
'4.FO()T
4 FLUORESCENT LAMP
1 1/2" X 1 1/2" - 1/8" STEEL TUBING
20 VOLT BALLAST - MAX 20 AMP
I - r . . r-4