0401-334 (OFC)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
777699 B O7 W/2(
r
Date E 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
f l 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 1ADFRT'Y MUTU.A6.7 Policy No. i+ �',F+.u?+M00472302Ti
(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 pr visions.
Date: �• Applicant W'
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminal enalties 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.
Signature (Owner/Agent) > " _^ Date1
BUILDING PERMIT PERMIT#
DATE 12M VALUATION $63'009 X10 LOT 186 TRACT 30357
JOB SITE
ADDRESS ---y.' S ;�tiri(�fja.�,� APN
OWNER , CONTRACTOR / DESIGNER / EN (NEER
TOUT, BROW' 81NC IDIDU BROTF U A TC
73121 FREDWARING4100 73.121 :I-W—T)
PADA MOMT CA 92260 P1AJ,A9 P: E? ST,RT Cly. 92,260
(760)6`74-3699' CB1.10 3832
USE OF PERMIT
aTONiil -CART W .A311DOS' N *RFA'W/20rX20' C., KHOPY & DPLA8'N
I13`iRRCEPTOR, APPROVED PER MUP 2003436 2001 CODES.
3PRI1dKd.I;xP..EfD. CANOPY 400,00 3F
F�'i`.Q"�"2) COST OF C4?I'�SI'�2Crur-rON X00000
PLEA? CHECK MY 101.000.439-316 $29.2f,
CON STMUC 10N FEE 101-000-418-000 $4.5.00
ID1,CTMBRIQ FRE 101-000,419-000 $40,50
STROMO UOTION FEE • Ct7WA 100-000-241. -000
UFFB05 2004
CITY OF LA QUINTA
FINANCE DEPT.
13(16=TIOTAT, C,'ONYIT,' UC.PllOrd' AIM I.AkT Ct ,CCG $115.25
1XS3 PRE -PATI) AME 5 $0,00
Cg:AL :4±'L%L9I' F rti 1� NOW
RECEIPT DATE BYE O+ DAT qL I PECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _
Forms & Footings
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
Final
BLOCKWALL AOOR&A&
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)11
00,
ELECTRICAL #..�PRO ALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Tom Tisdale
Fire Chief
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
January 14, 2004
Brindle Development
13428 Maxella Avenue, #625
Marina Del Ray, CA 90292
Proudly serving the
unincorporated
Re: Non -Structural Building Plan Review /
♦$D-3 qJ
areas of Riverside
LAQ-03-MSC-092 /Mountain View CC Pcy`?L0�1-p
County and the
Temporary Cart Barn & Office ;
Cities of:
Fire Department personnel have reviewed and approved the plans you submitted for the above
Banning
referenced project. Please be advised the following conditions apply as a part of the conditions for the
4•
issuance of a building permit.
Beaumont
ti•
1) The Fire Department is required to set a minimum fire flow for the remodel or construction of all
Calimesa
`•
commercial buildings using the procedure established in the 2001 CFC. A fire flow of 1500 gpm for
Canyon Lake
a 2 -hour duration at 20 psi residual operating pressure must be available before any combustible
4-
material is placed on the job site.
Coachella
❖
2) The required fire flow shall be available from a Super hydrant(s) (6" x 4" x 21/2" x 21/2") located not
Desert Hot Springs
less than 25' or more than 165' from any portion of the building(s) as measured along approved
4•
vehicular travel ways.
Indian Wells
�'•
3) Modular Building - Install Knox Key Lock box, Model 3200, mounted per recommended standard of
Indo
4.
the Knox Company. If the building/facility is protected with a fire alarm system or burglar alarm
Lake Elsinore
system, the lock boxes will require "tamper" monitoring.
•;•
La Quinta
4) Install portable fire extinguishers per Title'l9, but not less than 2A1 OBC in rating. Contact certified
❖
extinguisher company for proper placement of equipment.
Moreno Valley
41•
5) If assigned by the City, approved building address shall be placed in such a position as to be plainly
Paha Desert
visible and legible from the street and rear access if applicable. Building address numbers shall be
a minimum of 12" for building(s) up to 25' in height, and 24" in height for building(s) exceeding 25' in
Perris
40
height. All addressing must be legible and of a contrasting color with the background.
Rancho Mirage
.;.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
San Jacinto
❖
All questions regarding the meaning of these conditions should be referred to the Fire Department
Temecula
Planning & Engineering staff at (760) 863-8886.
Sincerely,
Board of Supervisors
Bob Buster
FRANK KAWASAKI
District 1
Chief Fire Department Planner
John Tavaglione,
District 2
Tim Venable,
By
District 3
Walter Brandes
Roy Wilson,Fire
Safety Specialist
District 4
CCc:>C-c:-of=L-a-Quinta--.Building Dept.
KVEZM DataUA 0wft%PRQIEcrs%&idtp P(.VAcT4Y sc:ou(bydac
Manion Ashley
District 5
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2"d FI., Indio, CA 92201 • (760) 8634MM • Fax (760) 863-7072