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0209-002 (RC)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Ohapter 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 7657086 B HX A 112( Date { ` Signature of Contractors �_ _`_,�; j;• ('" `� OWNER -BUILDER DECLARATION O 1 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 i 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 NATIONAL. FDR? 1143, Policy No. WC2491SOA27 (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 provisionA.s of Section 3700 of the Labor Code, I shall forthwith comply with those provis`i.ons. Date: ( i 7 Applicant tf) _.--w VA � 1 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? 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 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 Finalll��!!� — _ _ Final -� _ POOLS - SPAS BLOCKWAL APPROVALS 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 _ Waste Lines . G 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 COMMENTS: nl— Final r-,/�R ( � I D _ Utility Notice (Gas) ELECTRICAL APPROVAL 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) - Craig Anthony Fire Chief RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 2 an Jacinto Avenue • Perris, California 92570 -e • Fax 909 910 Proudly serving the October 15, 2004 Unincorporated Areas of Riverside County and the Cities of: City Of La Quinta Bant»ng Building Department Beaumont 4. Cahmesa Re: Imaging Center & Clinic .;. Canyon Lake 4. Coachella The Riverside County Fire Department is granting a fire and life safety clearance 4. with the following address, 79-440 Corporate Drive, La Quinta. Please call if you should Desert Hot Springs have any questions. .;. Indian Wells 4. Indio Lake Elsinore 4. La Quinta FRANK KAWASAKI 4. Moreno Valley Chief Fire Department Planner .;. Palm Desert _ Perris By 0 Teyrry�DeSucy Rancho Mirage Fire Systems Inspector 4. San Jacinto 4. Temecula Board of Supervisors Bob Buster, District 1 John Tavaglione, District 2 TD/j I Jim Venable, District 3 Roy Wilson, District 4 Marion Ashley, a District 5 EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 2nd Fl., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072 ti � 5 V - � 4S OF T1 To: Greg Butler, Building & Safety Manager From: Jerry Herman, Director of Community Development No To CDD:. �-a0-" Due date: '� - a 3 Status:�e-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: Vlk , 2, 5/ Description: D T Fat.4_t TlJ Address or general location: 71- ��y L ,• l L:d APN and/or legal description: Applicant Contact: The Community Development Department finds that: ❑ ... these Building Plans do not require Community Development Department approval. [D' ...these Building Plans are approved by the Community Development Department. D IV ❑ ..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. JergWman,birector of Community Development C/ �" /2 3 o' - Date 411,G 23 ' I NVT,; RFD Bir # -75 3 YY? City of La Quinta eml Building &r Safety Division _ P.O. Box 1504, 78-495 Calle Tampico La Quinta, CA 92253 - (760) 777-7012 Building Permit Application and Tracking Sheet Permit # 0, ' �� Project Address: r. L[� .D (�6• Owner's Name: 44 VVI L-- A. P. Number: �j CIL U Address: � _. �, � ( Legal Description: Contractor: ' CJ"-, Citi•. ST. Zip: -�- Telephone: '-, Address ,K - i t (�� ULA �2 Project Description: - �Q� Cita. ST. Zip: Lao x(223 Telephone: ' P I State Lic. # : (,C9-4(,C9City Lic. #: Arch.. Engr., Designer: U�� Address: bly, 1F' / Cite, ST, Zip: C ✓� a1Q4 Telephone: State Ltc.#: Name of Contact Person: , , �� Construction Type: e Oc uPanev . Project h ecir le one):: Ne%% Add'n Alter Repair Dernot Sq. Ft.:.Ik 1 3 # Stories: # Units: Telephone # of Contact Person:qL*C)> Estimated Value of Project: -X- APPLICANT: DO NOT WRITE BELOW THIS LINE # Submittal Req'd Rec'd TRACKING PERMIT FEES Plan Sets % Plan Check submitted ��Cf Item Amount Structural Calcs. Reviewed, read) for corrections4Z 9 13 Plan Check Deposit Truss Calcs. Called Contact Person r q' 3 Plan Check Balance Title 24 Calcs. Plans picked up Construction Flood plain plan Plans resubmitted Mechanical Grading plan 2nd Review. ready for corrections/issue Electrical Subcontactor List Called Contact Person Plumbing Grant Deed Pians picked up SAI.I. 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 Date of permit issue School Fees Total Permit Fees 333- 2 lq zl-h GSA• - c�a-� N-A4L9AA a