0205-129 (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 Divisioq*-of-th"e Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class %% Exp. Date
69301/7 H t -.. ovo zoo
Date47—A-r,1. Signatu
OWNER -BUILDER DECLIARATION
I hereby affirm under penalty of perjury.tliel 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 7
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 rggg7,, Xq1NDPolicy No.
(This section need not be completed if,tt
() I certify that in the performance of
I shall not employ any person in any I
workers' compensation �aws of Califor
Subject to the workers' compensation-)
Code, I shall forthwith comply::with Dios
Date:ra Applicant -�
'Permit valuation is for $100.00 or less).
le work for which this permit is issued,
inner so as to become subject to the
a, and agree that if I should become
)visiohs"of Section 3700 of the Labor
provisions:-
Warning:
rovisions-
C
Warning: Failure to secure Wofkers' Ciffipensation cover�gei; uhlawful and
. �f
shall subject an employer to+c� f, jr mmal,penalties and civil fines up to $100,000, in
addition to the cost of comp ensation, damages as provided for in Section.3706
of the Labor Code, interest Ad 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);'Z' j "'a' .'� r Date 4-.,—1 �.
BUILDING PERM_ 17 PERMIT#
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/VALUATION R LOT TRACT
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ADDRESS 7:�-449 €`�Rr0"{`� 8;` W1.% _ DRIVE4f I
OWNER
CONTRACTOR / DESIGNER / EN (NEER
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77-5I0 PyRIVELD A,AN+y SUM u
LA QUIN TA CA 92253
PAT -)b4 DESERT CA �Y2218,
d7014If"63a WIN 1395
USE OF PERMIT
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PRUMI'iIF, SUMAlt"v
(MS7rP-_M1N feivil air. ---W6-418-000 $2"50
H AN CE ftX -M 1,01-aw- 9-318 -261.59
hffiCHWICAL P i.d)�-fi#3t? j12-IiJif$l .SA
PU.ITIVIDE 10 -boo- 119 -off s .c
___STR:{'SNG M10`D`iO1.�'. - CO M W -CM -241-000 $6.30
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IS.>WIXMUT CONSTRUCTION AND PLAN (NUCK
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D9irE NALED
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 Wail Firewall
Exterior Lath
Drywall - Int. Lath
�O
Final
Final r �2
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
'inal
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
COMMENTS:
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)
Tom Tisdale
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
Cities of:
Farming
Bedumont
Calimesa
Canyon Lake
Coachella
Desert Hot Springs
Indian Wells
❖
Indio
.❖
Lalkke Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
San Jacinto
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy Wilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPAR:YMENT
In cooperation tivith the
C alif�rrnia L)e�crrttvent of Tbrestry and Fire Protection
210 West San Jacinto Avenue & Perris, California 92570 • (909) 9 . Fax 909 940-69 0.
May 13, 2002
Orr Builders
77-570 Springfield Lane, Ste. D
Palm Desert, CA 92211
Re: Non -Structural Building T/I Plan Review
02 -BLDG -123 / Knight Chiropractic
Fire Department personnel have completed a review of the plans you submitted for the above
referenced'project. Please be advised the following conditions or corrections must be completed and
approved by the Riverside County Fire Department before a building permit can be issued.
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 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.
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
H1PEMPOATA\LAOUIMAPROJECTSUN IMPRV%02-8L0G•I23.doc
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 21d FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072