0307-180 (CSCS)U)
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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
692234 D H7C'. (17/'31 /2(
Date t 'f 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.
(\)" 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 STI!`1'ts: FILMIJ Policy No. 044-020014.119
(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 shall forthwith comply with those provisions.
.
Date: (/ ! Applicant t�
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, indemni
& hold harmless the City of La Quinta, its officers, agents and employees. D
2. Any permit issued as a result of this application becomes null and void i
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.
Signature (Owner/Agent) !�' Date �� �•
1
'BUILDING. PERMIT. PERMIT�N�7-x
DATE 'VALUATION LOT TRACT
Plat -12 F3iaK4.
JOB SITE
ADDRESS 7&030 (31A .MB"CI~'LONA
APN
777.1.2531)01,
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I—A QL'T& ,-.k G1'tD..i:. LUC
C & 0 CO23StIRUC31014
'78-034 CAL Z DARC"1=LONt IA
96514016H WCONL tf l f l ►
LA QTTI 4TA CA 92253
tJ.l LAI;T 91786
(909)982-.9863 CK 0 3539
USE OF PERMIT
COMWRC'.fAL,
£;L)IW.�I. 3,369 �Q,d�i: 08�C.E .4�UC1,01?d(.i Bd'.lA+Ic�Wd T01LET11vO0AhS..cSq
OCCUI'AlI M TYPE VW SPM4,UARM BLD0 PHY4,11CALLY ATTACHED. -To
SLDGS W/ PE'f MIT 0302.011 &007-181
$I'TtTf! KL:I R 3069.40 SF
AIC — RE31D ZUsITIAL Vil"m SI+'
CON` ILALCT A14OUNT 1124,934,10 tZ,
As '.1A�►..61h`:LED C.'d3W OP iC:P?N',0,M1 Cr10JN
iERC1+.Ic'1: FIZ SIITlV>i!lUU ft.'RY'
C.`01gSTRUCTION FEE 101-000-418-000 $986A
Pl,..AN CHECK FEE V94.09
;
FEE DEPOSIT 101-000-439-318 -$1.;306,00
'
t.%ECHANICA1, .1 P=? 101-000-421-000
ELECTRICAL PRE 1*01.000-420.0 0 $140.99
P1.,•UMBINO FEE 01-000-41219-000 $177.50
-
(f`FROAIGMOTION FEZ -.COM 1100.000.241 -WO na1,p9
ORADVOU FTZ 101-000-=423-000 1il5.fiA
DEVE1,0PER NPACT Rai37,c,01,23
.(tRT 1N P'UBL 1C PLACES • COM) 2702.000.445.-000 $99a:B0
C",O3n1011 U'CTI(. N AID PIAT f"H R
$10,787.10
e� a W1.13,24 P'R ,-FA to FE -17.3
411500.00
15 2003. T0T,1•Y .PM?1d rn1X8 UR Novi
3" 1207110
JUL .
CITY OF LA QUINTA
FINANCE DEPT. -
a
RECEIPT
DATE BY
'J'
DATE FIN�J
INSPECTOR
-7 1 i" A.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs — Q
Underground Ducts
Forms & Footings
Ducts
Slab GradeIt
Return Air
Steel k
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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:
T_ire
A
l(�-r�ti3
9
uril 24 02 10:02a TURPIN CONSTRUCTION 7777613 p.2
°O IPOTENT�AL FUPFZE
OFFICE BLDG.
C9
/'45'X35'5X SQ. FT.
c vlq EX!:
cp
301
1660
0
R 145.00'
L 420.99.0 r.
0
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00
0 0
0
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0 PLAZA LOCATfON-'f
0
=16
0
0 R
0 1 5. DEN9E TREE6
2
L=
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RAST om
20' '-50 so.
0
0P OPOSED-B
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6D 5 -2700 SQ.
O
0
0
Z7
EXISTING RESIDENCE
.0
0 0 U-1%:=1800
-Q.FT.- - - -
% (TO BE REMODELED FOR OFFI(
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CITE( OF`,LA QUINTA
BUILDING & SAFETY DEPARTMENT
CF��OF TNY �Y
1 777 7012
INSPECTION REQUEST LINE
fi • 777-7153
Owner ? -LA'-QUINTA GRILL, LLC
ContractorC & G CONSTRUCTION
Permit Number 0302-011
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 78-034 CALLE BARCELONA
COMMERCIAL REMODEL - REMODEL
EXISTING RESIDENCE (R-3) TO OFFICE
OCCUPANCY, TYPE V -
TYPE OF INSPECTION I DATE I INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL - Gt
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. (DRYWALL)
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G AS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT /.L -
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED J 7
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
�= -CI`rY'F LA QUINTA
BUILRJWI; & AFETY DEPARTMENT
x,777-7012
---�wllau TION, iEQUEST LINE
I -.ba
001 777-7153
Owner!LA-QUINTA GRILL LLC
Contractor C & G CONSTRUCTION
Permit Number 0307-180
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRE-SS-030_CALLE-BARCEL-ONA�
COMM. 3,369 SQ.FT. OFFICE BUILDING W/ M&W TOILETROOM
"B" OCCUPANCY, TYPE VN SPRINKLERED, BLDG PHYSICALLY
ATTACHED TO BLDGS W/ PERMIT 0302-011 & 0307-181
TYPE OF INSPECTION DATE INSP.
TEMPORARY POWER
SETBACKS —4
U/G PLUMBING / WASTE
U/G ELECTRICAL/ GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL / PRE -ROOF,_ 2'7 o� .
OKAY TO WRAP - -I
FRAMING COMBINATION
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION i
COVER NO WORK UNTIL ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL G
EXTERIOR LATH
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC /GREASE INTERCEPTOR
MASONRYI
FOOTINGS /
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE /SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
MECHANICAL
PUBLIC WORKS DEPARTMENT2- -
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED '. /i� ;?
ABOVE. APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING