0207-140 (RC)M
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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
.170 87 1 -w (79102/2(
Dated ` = r T Signature of Contractor 1: �-��--•""'
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.
Se.,) I have and will maintain workers' compensation insurance, as required by
ction 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 TAPT M1aUS RIAL R Policy No. 14 3
(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 thoseprovisions.
,✓Date:,t 21 '3 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.
r
Signature (Owner/Agent)_rr� r+'` i Date6'21,
BUILDING PERMIT PERMIT#
02,07-140
DATE f / VALUATION LOT TRACT
f $1 40kW.0
JOB SITE
ADDRESS 79-440 CORDO CENTHE.ff3.� #106
APN
(A -t020-
OWNER CONTRACTOR / DESIGNER / EN (NEER
79-44 0 CORPORAn, 7, CEATM,t DINE, 14520 ?•3AW TIMANEI
1A Q1WrA CA 9'1n1153- la'MI
CA 92335
(P09)427-4218
C"1 ILO
USE OF PERMIT
cc:IMMF cCr:[AL
102 .S. P'. `3`.1. 1A QUINTA i%HA#'t,[AA.CY f S- OC:E'LfgANCY
9
lr�
CONTRACT AMOUNT 1„1
� 0 ��02
LQUISTA
C1T� 0�
FINAN�EDE�•
•yam,; z
XSTAMAU D COV OF o
1.-TJF UI 1w'. Z 8I11rWARY
Ct"sl3'13fi11UCTION WE 101--000.418-000 ffi`i 50
`4
PLAIN CHECK M, 101-000439-318 16174.17
WIRCHAil+ICA1,XEE, 101-000.421.000 11*.3.04
ELECTRICAL ICAL FL -: 101-000-420-000 00.15
ViAMTHO EC 101-s;XV-419-000 $70,14
S'TR?. -NO AdOTION 10E - CtYUhl 100-000-241..000 WAD
AdAT 19 K."I AC PW - CM—OW 2.70-000-445-000 MOO
91M-'1 O'TM, C67NS: RU MOM A'11FD�`111LAsN (1).-TcI-sC�V1 C
$2,44.` 32
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.�L.:[ES 3 A3A',.:.`.'.[�.st'i;7.Ci .b' i. .':J•:,e7
,D0100
RECEIPT
DATE,,/
1./
BY _.DATE
FI A D
INSPECTOR
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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
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final g
BLOCKWALL APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Waste Lines - O
Gas Test
Electric Final
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:
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06/05/2002 14:46 7607777011
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LA QUINTA
PAGE 0l/0l
Biro 0
City of La Quinta
Pern* # P.O. Box 1504, 78-495 Caft Tampico
La QLdnra, CA 92253 - (760) 777-7012
OAO? - Building Permit Application and Tracking Sheet
70ject Addrcss:-7dr- "0 6*rOJOA� & p4rle- M. 7// wner's Nam
fXAdd=:
"106 PP—;"'
-
Address: Project Description;
I-Telephone&V1)*Z-f-
pt
Construction Type: Ocrupam
State Lic. eq'or 7 Project tvpe (circle one): New Add'n Repair Derno
Name of Contact Person, j?-aDr"r—r Is, Fu a Storics: 0 Unit
XTelephone of Contact Perso(->4 4-7 1-7 "Estimated Valuc of Proiect:
r,29"7-1 I - APPLICANT:, DO NOT WRITE BELOW THIS LINE
Plan Sets
Plan Check submitted
Item
Amount
Structural CoIcs.
Reviewed. ready for corrections
Plan Check Deposit
Truss C alts.
Called Contact Penon
Plan Check 11alanct
Title 24 Calm
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for corrections/issue
Electricx)
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI'l.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:.
Review. ready for'corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Dale of Perm it issuc
School Fees
E-
Total Permit Fees
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To: Greg Butler, Building & Safety Manager To CDD:
From: Jerry Herman, Director of Community Development Due. date:' 712Z10;-
T
Status: I5'Gtf<�k
Building Plans Approval
(this is NOT an approval to issue a Building Permit)
The Community Development Department has reviewed the Building Plans for
the following project:
Description: /98;!
j erJAJ 1 f (�n Pi2auF/�IEE CAHARMAr-
q -1119 Go rLP`L`,r� C �_Al i2 E 2>/2) vE
Address or general location: i �
APN and/or legal description. 6 q 9- o'Z;D- 00 9
Applicant Contact: 54E /'� rrq c yeb
The Community Development Department finds that:
❑ ... these B ilding Plans do not require Community Development
De ent approval.
...these Building Plans are approved by the Community DeveI ent
Department.
❑ ...these Building Plans require corrections. Please forward a copy of the
attached corrections to the applicant. When the corrections are made
please return them to the Community Development Department for
review.
l9 °'z
Je
ermari , rector of Community Development Date
JUL-24-01;F I h'E P&EDi? •, , FAx� eta° i P. 1
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JUL-24-2082 WElD�l;09f 1tTEL NAME',. "�s=F'y't4�.w3"s'.�t �' F. 1
I -
RIVERSIDE COUNTY FIRE DEPARTMENT
FIRE PROTECTION
JOB CARD '
THIS INSPECTION RECORD MUST BE
AT JOB SITE WITH AN APPROVED
SET OF PLANS
p�1-lam
Owner l� �►r f�i�w,are.. "'' D'ate oZ
(_ocabon %•�(�O Caro��r�s� 'ia'.
Case No. 44Q -a 2- 3PK• I32
Sprinkler Company
Dgq4 AL,4qi,=r*,dQ
t Underground Static
Date
Inspector
! (200 PSI For 2 Hrs. Prior
to Inspection Time)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
Underground Flush
Date
'n %epr
�•
SS
t C C9—
at I
Overhead State
o-jDate
Inspector
(2
e)
F sem"
s
/--4 -0.3
_
Overhead Final
Date
Inspector
i
1 Fire Main Installer
I
Underground Static
(200 PSI For 2 Hrs, Prior to ln,
(Center Load Pipe Only, Joinp
Underground
Extinguishing System
Final
+j
Fire Alarm Installer
• i Final. .
Ri
Inspector
on Time)
Thrust Blocks Must Be Exposed).
Date Inspector
Date
Date
Inspector
Inspector
i
c"
Sprinkler Company C„d;,,14we„Q
�=
i Underground Static Date inspector
(200 PSI For 2 Hrs. Prior to Inspection Tlme)
(Center Load Pipe Only, Joints and Thrust Blocks Must Be Exposed).
Underground Flush. Date Ingpect4r
S T✓ .
SS l 3L
Overhead I Date Inspector
(2 efti fime)
1 Overhead Final Date Inspector
i
Fire Main Installer !
Underground Static
(200 PSI,For 2 Hrs. Prior to lrn
(Center Load Pipe Only, Joint's
Underground
Date Inspector
P tion Time)
and Thrust Blocks Must Be Exposed).
Extinguishing System instal
Final
Fre Alarm Installer
Final
Tank Installer
Date Inspector
Date
Date \
Inspector
Inspector
i Final Date Inspector
r
FINAL for OCCUPNCY P_SS
F -sr "O:�,
/—�
Inspector Date
DO NOT OCCUPY THIS STRUCTURE UNTIL
i AFtER FINAL INSPECTION.
i 264.159 (Rev 10/97)
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 folio wing.-
BUILDING
ing.
BUILDING ADDRESS: 79-440 CORPORATE CENTRE DR #106
Use Classification: COMMERCIAL (LA QUINTA PHARMACY)
Occupancy Group: B Type of Construction: VN
Owner of Building: JAMES PAUL
Building Official
Bldg. Permit No.: 0207-140
Land Use Zone: CR
Address: 79-440 CORPORATE CENTRE DRIVE
City: LA QUINTA, CA., 92253
By: DANIEL P. CRAWFORD JR.
Date: 1/8/03
POST IN A CONSPICUOUS PLACE