0401-258 (RPL)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
�i`�29U1 133 I2/31/a'
/ t Sign �t�e 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.
( t) 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:
Cartier STME FUND Policy No. M-1TOi""-200s
(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.:
Date: % ...{ f I ;Applicant!
r ✓ t "
r
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/Agentj.� t �='�— ' r Date 1
BUILDING PERMIT y �" PERMIT#,--
DATE VALUATION �9 *� LOT" TRACT
�,...4.1R
JOB SITE
APN
ADDRESS X�w .d'AYR=0,'i. V. !',,&SC J
,OWNER
CONTRACTOR / DESIGNER / EN (NEER
POWER FNANCE
DAVM'1,..A1)rj1N( '1nk H
P10-. BOX 13.1
41.780INWAG a D
LAgYNTA Cis. 92253
1:ixR M.41<it3ilkiES CA. 9220)
C160YtIDS-7528 CRL* 3 724
A
USE OF PERMIT
PC?Ox.ANDIOR ISPA
POOUfSAA, OttAi°,.6(dSMARRIER1,S SHALL HE W.PLACE.AT PRE•PLA,5TIM �
1143PIXcITIC N. EQUIPMENT 99CLOSURE NOT INCLUMD
POOL .A)+1'1 OR SRA 12.000s .00 1.x.9
ESTMAW1. J CC?fiT Wr 010HIS7C UC` o lq
12,M).00
PLAN CREC'1: FEIR '401-000.439.318 $$7.75
CONSTROC ZION RZ 101-000-418-000 $135.00
MECHA141CALFEE POOL 101.000.41-000 $24.00
ELUTfRICfit. .. POOL 101-000-420-000 $45M
PlIUMBINO FEE ,. PCtol, 101-C 00.419.000 $27.00
D OPAL C1'JC,0r10W.A= I)I_ • W C'H'F,
X318.7:')
3 IM9 PPX---P.A.M MMS
$0100
JAN 2 2 2004 ry, p+p��yT7�}
14aaar.!'.S:a�Y76d•iJSs.f� 01
:A7S.Qs1�
CITY OF LA QUINTA
tF1;3ANCE DEPT
RECEIPT
DATE
V
BY
DA FINA
INSPEC
N
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
ol
Set Backs
Electric Bond
UrT
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
Z-jC
C..as Piping
Gas Test
Appliances
Final
- Q
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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CID S
CONSTRUCTION
Residential/ Commercial
1-16-04
MEMO
Ed Ranndle via fax and mail
City -of L-a-Quinta-- = -
Building Department
78495 Calle Tampico
La Quinta, CA 92253
Re: Jazzy J's Cafe and Catering Permit #0310
78065 Main Street, Suite C100
To whom it may concern:
The business owners Dan Williams and J' Marie Atkins of Jazzy J's Cafe and Catering
have requested CDS temporarily stop the job.
Effective 1-15-04, our contractor's license (767086), workers comp, general liability,
builder's risk insurance are suspended for this project until further notice.
This letter is to inform you that no inspections may occur after 1-15-04 and no work may
be performed on suite' C 100.
We will notify the City in writing when the Owner gives CDS a "notice to proceed" or
another general contractor is selected to complete the project.
Best regards,
�f 1n
Bnan`Ewing" ;
President .:
78,401'Hwy..111, Suite F2
Lo Quints, CA 92253 cc: Dan Williams, J' Marie Atkins, Wells Marvin, Dean Holm, Jorge Rivero, via fax only
Tel. (760) 771-3593
Fax (760) 771-4093 :-
E-mail: info@Abuilders.com
wwwAsbuilders.com
A s 8 license #767086 The Hallmark of Integrity and Innovation in Building