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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.
License # Lic. Class Exp. Date
614611 C33 0'E
Date --' Signature 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.
N) 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 INSCORp Policy No. 1"100035900
(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,.l shall/forthwith comply with those provisions.
Date la?7 zed"a Applicant--.,'
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 inspectionpurposes.
Signature (Owner/Agee`) �� ✓' •�` Date � _ _ ,
BU,ILDiNIG PERMIT
03WPERMIT#
DATE VALUATION LOT w�,�� TRACT
JOB SITE
ADDRESS n-omcCLx lBmmom
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
LQ). GRILL
MCDrfM POOU &CPAs
78.034 C,ATA.` BARC'.&t ,0NA
P.O. BOX 1791.
TA Quagn. CA 922.13
LA QUiNTA CA 92253
(760)360.3585 CRL4 1945
USE OF PERMIT
P001 AWD/011 RPA
WATER. MATURS
VALUATION 10,000.00 LS
ERMATHD COS" C OF CONGMUC7 IDN
MIMI")
PERM7' PRE 8'07M bmv
MAN CHECK REM 101.111?0 39.316 1<7b.0S
CONSTRUCTION FZ IiJY-t30d�»d18-0i30 $11`�.OfJ
ELECTRICAL FEE- POOL 101. -000.420-000 W.00
T!Lt3MBINO ITT —POOL 101-000-419-000
OCT 2 3 2003
CITY OF L.R. t)'.tINTA
FINANC:�:.:�cPT.
fC°1709 AND PX" (C&
$265.05
LEss P. +Av5 f
- $0.00
!WAX,'iaE,R•11�i1~r FFY,S DUN, Now
RECEIPT
DATE /,
BY
DAT INA D
I INSPF019R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE —T
.INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & 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
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
?lumbing Top Out
Equipment Enclosure
Shower Pans
OX 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:,
Tit!t ot 4 a"
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
To: Greg Butler, Building & Safety Manager
BUILDING & SAFETY DEPARTMENT
(760)777-7012
FAX (760) 777-7011
To CDD: 9-19-2003
From: Oscar Orci, Planning Manager Due date: 9-26-2003
Status: IST Review
Building Plans Approval
(This is an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for the
following project:
Description: Water Feature at La Quinta Grill
Address or general location: 78-034 Calle Barcelona
Applicant Contact: Mike McIntyre 250-8346
The Community Development Department finds that:
❑ ...these Building Plans do not require Community Development Department
approval.
I
❑ ...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.
Oscar Orci, Planning Manager Date