0201-196 (RC)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
45)035, B � J 01../'31/"2(./
Date f' "'� f Signature of Contractor' Y .. _%
r Cf X 7
'.
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:
Carder raRMPT Policy No
(This section need not be completed if the permit valuation is for $100.00 or less).
(yr)> 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, andJagree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor.
Code, I shall fofthwith comply with
thosepro'
visions
'- `�!
,�Date/ pp
Warning: Failure to secure Workers' Compensation coverage is unla I and
shall subject an employer to criminal penalties and civil fines up to $1.00,000, 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 -oh 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) ! Date
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT TRACT
JOB SITE /0 APN
ADDRESS `
79-44150 C OR PORAIN MZ M11< _ -
OWNER
CONTRACTOR/ / EN (NEER
JA10S R & MRARON 1,M Y?fiXT '.,
AT, T,*TI r`iC0,1IkUCON
79.44'0 C'ORTO1CSE bEIi.W.i
51-538dYETMAIMpMY1Z
i A Q1Xtt+]'m CA 92M
L.A. <,pJ1T'rA CA 4:112:53
k -?1G0)7 11 X43€13 crosl 1463
USE OF PERMIT ,
COMNIUMIMAT,,
T1e,1b,%N ' IMPROV FAMT, %* O C:UP tNCY k;110ANEMRINCt f�'tF,AM OfTIC ES.
;,:il;.;,�.W. (6�1<I/3FT;Cixfi�Li? 3 a3'1xRUL OLD. �.�:r 141 _? " 1I� i•� `)./'J � ,.
CONTRACT A.4atM41' SO;Ir000 us
ER 1W.MM, COST OF C 0,145MUC"11011
N),000.00
F.TaW1~ FTS! NUMNIARV.
PLAN 0 EC"K FEE 101.000.435-318 &:249:43
CC:INS`i R JCTION a' cif . 101-4)00-418 000 $+414.1511
&]M9'i1 ITICfill, MY?, 101-000-421-000 5411.50
Lr1..0`C:'11' IC.R.i,3XE, 101- 420-000 OVA
PLLM41Nr3t PUN $35,00
r:
_ ,e'r)
14 1002 YPEUR !1.4'$• ro ET KDUE if ow
I-
cmror. LAQUIRTA
P!�}�Kf!nwyT"
RECEIPT
DATE / �:
BY ��4^
DTE FINA
INSPECTO
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
- a °Z
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall insulation
Condensate Lines
Party Wall 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
— 2 a G' /�
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 (Peart)
COMMENTS:
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of
Banning
4.
Beaumont
Cahmesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
Indio
.;.
Lake Elsinore
ti•
La Quinta
Moreno Valley
4.
Palm Desert
Penis
Rancho Mirage
4.
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Tim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
---21-OWest San acii to venue ems, California 70 • ) 6900 . Fax (909) 940-6910
January 25, 2002
Watson & Watson, Engineering
79-440 Corporate Center, Suite H
La Quinta, CA 92253
Re: Non -Structural Building TA Plan Review
LAQ-02-BLDG-103 / Watson & Watson -Eng;
Fire Department personnel have reviewed and approved the plans you submitted for the above
referenced project. Please be advised the. following conditions apply as a part of the conditions for the
issuance of a building permit.
1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire
Department for review, along with a plan/inspection fee. The approved plans, with Fire Department
Job card must be at the job site for all inspections.
2) Provide either a separate Knox Key Lock box, Model 4400, 3200 or 1300, mounted per
recommended standard of the Knox Company or provide key(s) for inclusion in the general building
Knox Box. If the building/facility is protected with a fire alarm or burglar alarm system, the lock box
will require "tamper" monitoring. Special forms are available from this office for the ordering of the
Knox Box. This form must be authorized and signed by this office for the correctly coded system to
be purchased.
3) All egress doors shall comply with CBC Sec. 1003.3.1.8 for proper door hardware.
4) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A10BC in rating.
Contact certified extinguisher company for proper placement of equipment.
5) Approved building address shall be placed in such a position as to be plainly visible and legible from
the street and rear access if applicable. Minimum of 6" lettering is required for suite identification. In
strip centers, businesses shall post the business name and suite number on back doors as well as
the front. All addressing must be legible and of a contrasting color with the background.
Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy.
Requests for inspections are to be made at least 24. hours in advance and may be arranged by calling
(760) 863-8886.
All questions regarding the meaning of these conditions should be referred to the Fire Department
Planning & Engineering staff at (760) 863-8886.
Sincerely,
FRANK KAWASAKI
Chief Fire Department Planner
By
Walter Brandes
Fire Safety Specialist
H:1PEZWPDATAH/WUINTATR0JECMTN IMPRVUA"2-8L011107.dN
-EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82.675 Highway 111. 2^d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072