0106-151 (RC)U)
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LICENSED CONTRJ DECLARATION
I hereby affirm under penalty of perj m licensed under provisions of
Chapter 9 (commencing with Section 7l of Division 3 of the Business and
Professionals Code, and my License is in tull force and effect.
License # Lic. Class Exp. Date
Date
693077 B (i 414 a/2i
—. Signature of Contractor
--OWNER4UILDER 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.
(e,,) 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 Policy No.
«�''I'.r�s,'$'.1, FUND - 12,4282$
(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.
bate: ' Applicant
Warning: Failure to secure Workers' Compensation coverageisunlawful 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 cf 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.
11 Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT .1 ,
DATE �� { VALUATION LOT 0106-151 TRACT
JOB SITE APN
ADDRESS
-440 C:K°I.R-P0 M IT QRN'+1" IC .lri1:?M 3&4 C,. fA9.-02Q-0W
OWNER CONTRACTOR /DESIGNER / EN INEER
55-52,5 f':cCiriiRY 1�sLLO 77-570 Rte. (Ji=J_ LANE, SUM
CA. 92253' PALM 1,}L'SERT CA 92211
(160)360.6632 CBLO 1395
USE OF PERMIT
Ue+ NA,3'1T IMPR£Ilf i M26,14T PEP 14.PfaP..f. 090 }'%.NNS
It'Ulw'41'10ATKI114 ME AGOSE33F.D PER 1997 UNIFORM, lxiDMIX- f'.1".I RATYV'
�.:OFJV. §3K5 FOR WIC RK Y3FA114 W''ITKOUT OU11,D111 0 PUMIT.
VALVIViow
�%0i%). fro 1,S
PM-MtrF-,ICE 1b1oAI:Y
1' AN ('I3E,01%,SCE 101 -000-439,1318
E:(JldSTRU C T iUN PFE 101-000-084000 lrzzP.
MECHA0IC'.A L rc, B 101-000-421-000 Saw I
RAJ%S.".'.I'ReC,9tYM REF, 1R31►C {i-�F f1...C1?7 �tt�.£t0
STR0,114 t :Md3`:'.ION PEE- • COMM 100-00��T-"
=�
Df
JUN 13 2001
Y]. MALPEUMFUNDUENOW
RECEIPT DATE el f' ��' f BY DATE FINALED INSPECTOR
v
;i4m),00
$316.81
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
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace, P.L.
Grills
Fireplace T.O.
Fans & Controls
arty Wall Insulation
Party Wall Firewall
Condensate Lines
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
COMMENTS:
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)
I=,
8 TPECT
SAFETY DE
77.7;7012
IOA AEQUE
777-7153
JAWS FAUTs4ri�iKCE DfP1
Owner _ _
ContraCtof
OR II UILDERS ,
Pwmit Nun14el- 03106-151 __-_--
Fos-, OR J013 IN eamigiPl- UO JS PLACE
!NSPECTOR MUST SIGN ALL APPLICARL.E SPA,C:ES.
"ADDRESS ^�.µ.s.� `0R--FORA'TIE CENN'T tE L - RIVE
MaTIROVENIENT PER APPROVED PLANS
50111=
.
TYPE OF INSPECTION DAM
R'n4"aP.
FOUNDATION & SETBACK
MOUGH, ELECTRIC
FOOTTNQG MEL
—
!IA jol 01Kv m!) SYVEM
PRE-GLIN1TE
J�7 N0'o P0UR CONCRETE UNTIL ALL ABOVE WAS BEEN
}
SIGNED
GUNCReTE SLAB
.iC)18'15 b t3IRDeRS� _
T!_EC,T'RIGAL aD MK?RK—
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CCNCitE?F UNT:. AL;. AgnVE NA,S SZE-:
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City of La Quinta
Developers Project Approval Form
9
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: 79-440 CORPORATE WAY (TI -OFFICE, J PAUL BLD)
Applicant Contact: ROBERT RICCIARDI-760-346-2223
Application / Circulation Date: 6/12/200
Date
Community Development Department
/A.--q-
N
Christine Di Iorio, Plannir4 Manager
Public Works Department
C' v
_eDg
Date
Steve Speer, Senior Engineer Date
Building and Safety Department
Greg Butler, Building and Safety Department Manager
Health Department
Fire Department
Schools Fees Paid
Date
Date
Date
Date
9