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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty,? f 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
693077 13 (371ci Rf t
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). -
( ) 1, 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 Policy No.
Si.A,'R'3� FUND 1:R.)824 •01
(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
Warning: Failure to secure Workers''Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. i
i ;x
'Signature (Owner/Agent), - Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0201 _ 2.4 TRACT
' VI129/2 C t ,tw.(.0
JOB SITE A
ADDRESS 79.440 C 0. i 0JZATX' C$.N 6F -r, M'E
OWNER
f
CTOR /DESIGNER/ EN NEER
A
19.440 CK .R- TI RSM!, CENITA WAY
'77.5 70 33NUM-31M D LANE, ',41CMI -
LA.QLiWPA. CA 9225:3 •
]PAI.m.D&13 (!A,. 92211
(760)?60• 6153 GVRLX" 14395
USE OF PERMIT
C:C) � cifill YIS20ff, DEL
a
f;ClltA3,1tC2A1. t'3. • "13" ;CC]IPA$tC�• INSURANCE Ji1G1ICII;k''
JUJOTYPE �yLffd3 0 PER
1947 tIAi1PSIRMtil). fr gs � LL�,a'x.�r c CODE §304.5 FOR WOXIC 13FULTH Nei r %O. �f
CONTRACT AkUIC3t9NT U, l
T.eO'3M��.i.1�11R1.&.$7.Jd 4��iF'.L 4✓t' i,:�.7i.Q ��.4 A:.�I'O�n�.2.�:�1V
a'1.'7eG7S:���t.Yf.'
P UA:V S.'-R'1W,K Ffi, 701 -WO -439-318
COINSTis Crfw'.i1014 WE IW •4'100-419-000
Wt°.'RyAINICAL 11'-21 101-000-4-21-0 00
trd WTRJGAL. €est, 101-000-420-000 $37.50
PLUMBING FEE 101.000.419-000 91103.10
f25Y1r.+�'i'lC1A'PIoN Frt, 101-000-42:3.000 5fi%3Q
MS.HT<R-P,1PJDFW30
$0.00
yr.
� ri .,((��J�J•�
JAN
CPfYOFLAOUIV., ►
R
•DATE,—W _
By'
DATE FINALED
INSPECTOR
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
— _ _ G _
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
p Z
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
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:
Certificate of Occupancy
City of La Quinta
Building and Safety Department
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 79-440 CORPORATE CENTRE WAY SUITE #104
Use Classification: COMMERCIAL TENNANT IMPROVEMENT
Occupancy Group: B Type of Construction: VN
Owner of Building: J. PAUL
Building Official
Bldg. Permit No.: 0201-124
Land Use Zone: CR
Address: 79-440 CORPORATE CENTER WAY #102
City: LA QUINTA CA 92253
By: GARY SHOWALTER
Date: 2-13-2002
POST IN A CONSPICUOUS PLACE
FEB -13-2002 16:40
ORR BUILDERS 760 360 5591 P-01/02
CITY OF LA QUINTA
5
tILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-71IS3
J.
PwmIt Nun*or 0201-124
POST ON JOB IN CONSPICUOUS PLACE
—INSPECTOR MUST SIGN ALL APPLICABLE SPACES
79-440 CORPORATE CENTER WAY SOffM ocl i
JOB ADDRESS
COMMERCIAL TI - "W' OCCUPANCY - INSURANCE OFFICE
(OCCUPANT LOAD 9) TYPE V7q CONSTRUCTION,
INVESTIGATION FEE ASSESSRD PER 1997 UNIFORM
ADMINISTRATIVE CODE §304.$ FOR WORK BEGM VVIO PERMIT -
TYPE OF INSPECTION DATE INSP,
FOUNDATION & SETBACK
FOOTING STEEL
-GROUND PLUMBING
PRE-GUNITE
A
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUNDWORK
IV zv:fa
c
Do NOT OUR CONCRETE UNTIL ALL ABOVE HAS RM SIGNED
X'ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT -A/C
FIREPLACE
ROOF
O.K. TO WRAP
:GROUT 0 4' 0
IN;
VR
E POOL PRE PLASTER
:.'.'.POOL FENCE& GATE
SEWER, , SEPTIC TANK
FINALS
"41ECTRICAL
PLUMBING
kk FINAL GAS TEST
FT7 77
HEATING - A/C
NUMBERS
dicompLmo
TEMP POWER
ABOVE APPROVALS 00 NOT INCLUDE RIGHT TO