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0111-009 (RC)U) F_ 04 U) W o =) c+) r- d u7 ' W o Z coo O_ o F- 0 ~ate U) Z CO LO N ON U °) as Ir Lo < W 0 J J mVU O tl Lo Z_ w 5 �O J 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 744548 B CIOD.1517T 014.31P2( 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). (k)I, as owner of the property, am exclusively contracting with licensed 6ontractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date 2. J ?- ei / 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 V fZR23T N, A111 U1 4.A,L Policy No. 34900012M011 (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. 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. Signature (Owner/Agent), �i `/ l f, eie �L�Date,/ Z •.! ,,o/� BUILDING PERMIT PERMIT# DATE VALUATION LOT 0111- 1 TRACT $409M.00 JOB SITE APN ADDRESS 799.440 COXiP><1PM CE:tWERDR, S7V 1 r� OWNER CONTRACTOR / DESIGNER / EN &NEER JAbln RAUL R.0YA.i...1v1•.,�#,Df"CF`9ANCY, WC. 79-440 COMRM RM CEi�i DRTVE 42.000 C.MC>.MTE COURT ##101 U Q'(.1NTA CA 922533 Pl.:i.M r:;£.',ii1�.t�+T CA( 92211r y�ta ! 4W f USE OF PERMIT COIRKERC'3A..LtMOMM 3200 SP T.1. ll NTAL (XVI VICK PER APP18:4:YVED P1,XN3 VALUATION 40,000.00 6 :0 1MUTED cob"11 OF CCd:)?2NS'RUM1017 40,YJ0. 111MM, i Fla F.iU$r1WIRY 0 ELEi TRICAL ITER; 101-00 0-420-000 Y.I:,UAA►BINO FYZ 101-000-41Q-000 g;3i.i10 ME;CRANIC.A.Is KE 101.000.421.000 �iG.aO ' Cf� t�+'1'1ttvC:'3ll7id.lrit'2i; 201^1 00-418-000 101-000-43:9-318 1314,11 qtDE'C*'1'3 2001 WYOFLAQUWA -LAK CW - .. T EES TIR-.1�.�`1W F$ilax i I'M AL Y -ER- 7 rX YEW DUX NOW 0329,61. RECEIPT DATE BY D T E �f �/ 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 1-16-02-- 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 �-' — BLOCKWALL APPROVAL Final 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 Futures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility. Notice (Perm) COMMENTS: � �/�/�— G�JL�I � :� - �- �� /n•�1�� y i WE i M Bin #�� '0 City of LQ Quinta- , Bu�74ing 8t Safety Division I P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777.7012 Building Permit Application and Tracking Sheet Permit 0111-b Project Address: 75l140, c° R wbq es ---i T- #'i Owner's Name::Q MEQ P AUL, A. P. Number: Address: -7 %''No ���rE Cer r6,- ; Legal Description: Contractor: Address: City, ST. Zip: 1 Telephone:hone:Qi Project Description: City. ST, Zip: . 1 = ti! AL'art t,(- . Telephone: State Lic. # : Citv Lic. #: Arch., Engr., Designer: Address: City, ST, Zip: 7— / 70 12/- Telephone:Construction Type:e: OccuP an v: State Lic... Project type one): Nev A d'n Alter Repair air Dcmo Name of Contact Person: Sq. Ft.:�, # Stories: # Units: Telephone # of Contact Person:: bq -7 Estimated Value of Project: oL Odd 49 gr— Wo APPLICANT: DO NOT WRITE BELOW THIS LINE lr*kWa el? 1485 WD # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets 2 .� L Plan Check submittedV��: i Item Amount Structural Cates. Reviewed, readv for corrections`7 Plan Check Deposit Truss Calcs. Called Contact PersonPlan Check Balance • Title 24 Calcs. 2 Plans picked up 1111q4 Construction • 3Y',, o Flood Iain plan Plans resubmitted I/ Wchanical Graing plan 2a' Review, ready for corrects/issue /2/� lectrical • -0 Z Sub ontactor List Called Contact Person -7>/Z„�� Plumbing Gra t Deed Plans picked up H.O.A. pproval Plans resubmitted Grading IN HOUSE:- Jrd Review, ready for corrections/issue Developer Impact Fee Planning Approval Called Contact Person A.I.P.P. Pub. Wks. Appr Date of permit issue 12 School Fees iq � S m AJ '11 Total Permit Fees V /C re(Z- 57a& S — elp COUNTY OF RIVERSIDE • HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH 4080 Lemon Street, 9th Floor P.O. Box 1280 RIVERSIDE, CA 92601-1280 TELEPHONE: (909) 955-8982 FAX: (909) 781-9653 INDIO TELEPHONE: (760) 863-7000 FAX: (760) 863-7013 PERMIT APPLICATION FOR SMALL QUANTITY MEDICAL WASTE GENERATORS Name of Facility fG� -1A -FA Address �- Type of Facility t�AL E)F Phone Number -- Fee Schedule: Date .11--7-6-0j Small Quantity Generator Permit Fee Limited. Quantity Hauling Exemption (if applicable, a separate application is to be filled out for the Exemption to be issued): • first four persons transporting medical waste ($25.00) • each additional person beyond the first four ($5.00) • nine or more persons transporting waste ($50.00) n Prepared by: TOTAL: I ZZ $25.00 PLEASE COMPLETE PAGE TWO (on reverse side) C= For Environmental Health Department use only: Date: o j `Check # �' ��` S Amount Q V O-K;'T-41r� Q 3 ? 3s- © ��-► avo w IO 'd 9b SI 100Z 6Z AnN ObOZ-298-09Z:xe3 30I330 iaM39 - U -W RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West an Jacinto Avenue . Perris, California Fax (909Y94=1 0 31, 2001 Tom Tisdale Adanac Development Company Fire Chief 1700 Industrial Ave. Norco, CA 92860 Proudly serving the unincorporated Re: Non -Structural Building TA Plan Review areas of Riverside LAO -0I -BLDG -0721 Dr. Albert Rodriguez County and the Cities of: Fire Department personnel have completed a review of the plans you submitted for the above referenced Banning project. Please be advised the following conditions apply as a part of the conditions for the issuance of a •� building permit. Beaumont ee 1) Fire sprinkler system plans for the tenant improvement area must be submitted to the Fire Calimesa Department for review, along with a planlnspection fee. The approved plans, with Fire Department ❖ Job card must be at the job site for all inspections. Canyon Lake 44 2) Provide either a separate Knox Key Lock box, Models 4400, 3200 or 1300, mounted per Coachella recommended standard of the Knox Company or provide key(s) for inclusion in the general building Desert Hots Springs g Knox Box. If the buildingtiacility is protected with a fire alarm system or sprinkler monitoring system, "tamper 40pr' the lock boxes will require monitoring. Special forms are available from this office for the Indian Wells ordering of the Knox Box, this form must be authorized and signed by this office for the correctly 0 coded system to be purchased. Indio .+ 3) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A1 OBC in rating. Lake Elsinore Contact certified extinguisher company for proper placement of equipment. 0 La Quinta 4) 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 Moreno Valley strip centers, businesses shall post the business name and suite number on back doors as well as the •S Palm Desert front. All addressing must be legible and of a contrasting color with the background. ee Penis 5) A durable sign stating "This door to remain unlocked during business hours" shall be placed on ❖ or adjacent to the front exit door. The sign shall be in letters not less than one inch high on a Rancho Mirage contrasting background. 0 San Jacinto Please contact the Fire Department Planning & Engineering staff for final inspection prior to occupancy. eti Temecula Requests for inspections are to be made at least 24 hours in advance and may be arranged by calling (760) 863-8886. Board of Supervisors All questions regarding the meaning of these conditions should be referred to the Fire Department Bob Buster, Planning & Engineering staff at (760) 863-8886. District 1 Sincerely, John Tavaglione, District 2 FRANK KAWASAKI Jim Venable, Fire Department Planner District 3 �Chief By Roy Wilson, District 4 Walter Brandes Fire Safety Specialist Tom Mullen, District 5 HiPE2WDATA""NTA%PROJECTSWLDO_PCUAO-01-BLD"72.Ax EMERGENCY SERVICES DIVISION - PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2"a FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072