0208-141 (RC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of_the..Business.and—.
C14 LU Professionals Code, and my License is in full force and effect.
M License # Lic. Class,, ' ` Exp. Date
LU r �5 si7 r ,,/ . .. _. f�! 3112^
Z /Date �' Signature of Contractor �` A
I
ID �.- ._!'"" 3! '`� 'a , �•.- "..
r -H OWNER -BUILDER DECL'ARATIOPr
Ha ~ I hereby affirm under penalty of perjury that I a'm exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
ce) () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
d Q WORKER'S COMPENSATION DECLARATION
p 2 Z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is _issued.
performance
Q U W 1 have and will maintain workers' compensation insurance, as required by
O UQ Section 3700 of the Labor Code, for the performance of the work for which this
li rn permit is issued. My workers' compensation insurance carrier & policy_ no. are:
z Canier STS Tri pj)4I) Policy.NO✓"`f42`824-0.2
C)
J (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--"
3 subject to the workers' compensation pfovisi✓o s•of•Section,3700 of the-Ldbor
Code, I shall forthwith comply -with those ovisions„ •"'"-
Date: _ U. ril Applicant_.:2'77
'7/''
Warning: Failure to secure -Workers Compen\sation-enrage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensatign, damages as provided for in Section 3706
of the Labor Code, interest and alto tney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this applicatio and state that the above information is
• correct. I agree to comply;w'ih all City, and State laws relating to the building
construction, and hereby,/ authorize representatives of this City toenterupon
the above-mentioned property for inspection purposes.
{�5ignature (Owner/Agent)-_ ---=""rte Date 'y- 4''f
BUILDING PERMIT PERMIT#
0203-147t
DATE 2s Q VALUATION sFp = LOT TRACT
lbs ri+vc+
~z
*,F
P L.JOB
SITE
#109At
OWNER
CONTRACTOR DEftNER/EN INEER
J. PAM
MR. B1J71 'OERS
79.440 C0r`%1'Q1�=' CENT DR,
L,' 7I-
LSA QUNTA CA 92253
P.AL:F.d11�1a�Ia T r . ^.
USEOF PERMIT
C10100(gil$f:mr, REMODEL
206'I S.1. 't'MANT IMPROVM f " M: t MA.10
re0)1TMCT Ah9(. VNT Ino
WMA -M) COST X r Ct7xer ortumoN
Cs'ONTi fR.UCTION FEE 101.000.418•-000 $271.50
/91,AN MiEUIC PEZ 10 t -E300-439.•31 R $2.7trL67
MUCHi1NTCAL11SE, e01-000-421=0100 826.00
FLUM111ablo FREI x 101-000.419.000:
c.TRCYNG MOT1014 FtE • bOWA 10D -(XX) -2A1-000.' $3.88
tAn '!'IIIA
CITY OF LA QUINTA
FINANCE DEPT
�li1z,-1�C?IAT CColy`9'3'RtT 'I1C)2 PLA1-TC.f;'L9XK
T0T,411, ,PnM' F..9. ',i DUE PdS.►W = -S614121*5
RECEIPT
DATE
BY�
DATE FINALED
INSPECTOR
_e
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing 02
t;'�
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 2 o
Final
_
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines �'./ j — p
_ 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 G)_/ O
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)
(2-7
COMMENTS:
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Banning
.;.
Beaumont
.;.
Cahmesa
.;.
Canyon Lake
4.
Coachella
Desert Hot Springs
Indian Wells
Indio
Lake Elsinore
4.
La Quetta
.;.
Moreno Valley
44
Palm Desert
.;.
Perris
.;.
Rancho Mirage
e. -
San Jacinto
4.
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
oao a - )
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 est San Jacinto Avenue • Perris, California 92570 • 909 940-6900 • Fax 909 940-6910
August 5, 2002
Orr Builders
77-570 Springfield Lane, Ste. D
Palm Desert, CA 92211
Re: Non -Structural Building TA Plan Review
LAQ-02-BP-154 / Yes I Can
RECEIVED
AUG 0 5 20024/
ORR BUILDERS
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) The building sprinkler monitoring system must be extended to provide an interior notification device
within the tenant space. Plans must be submitted to the Fire Department for review, along with a
plan check/inspection fee.
3) 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.
4) Install portable fire extinguishers per NFPA, Pamphlet #10, but not less than 2A1 OBC 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.
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
Walter Brandes
Fire Safety Specialist
H:UPEZW POATALLAOUINTA%PROJECTSTN_IM PRIALA"2-BP-156.d..
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
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