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0303-314 (MECH)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 689956 0-43 02QD -C 061.4012( tdate _ '� l 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: ( ) 1, 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). ( ) 1, 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. { ' 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 STATE COMPIRSATI Policy No. 16711 no.03 (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 ;Fie Labor Code I sh*,forthwith comply with those,provisions. Da te: t)i 111! ,3Applicant 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 dbove-mentioned property for inAectioyn�,ppurposes. t,Fignature (Owner/Agents �~ !�"��� Date .5 PERMIT # BUILDING PERMIT -314 DATE VALUATION-,� �' 3 LOT TRACT ±� ADDRESS50 JOB SITE , D ~78-15 AWNSi?A)LA I OA ND " APN OWNER CONTRACTOR/DESIGNER /EN (NEER VMdOe MnfAYD SMC 164611 MOJAVE D121iED 522 SKAYNM M�.�J' 'iiIC:4'CJI'��iTIL L CA 92392 YN p,3°CJ°t S CA 91405 - (818)373.7584• C BL9 4511 USE OF PERMIT 1aCHANTICAL RE247017E (2) MOSTINGAC UNITS AND 1NST,e3U.(2)1di'�..0 k1C'UN1TS.' its, ONSTRUCT BUILDING DUCT WORK. 2004 C. -MC AIC •- COMMERCIAL "tyJ -"D STS : M� W f'0;irT OF t.0N5'Xl`RUCTI OR 16„46'l sa NOMTF�i Irl. SUWA4RY PIAN CHFICI; F1'E9 103-000-439-318 $11700 ' CO7NS`1c Rtltr'1` 01,1 FEE 101-000-418-000 $130.00 U9 I3ANIC.AL,1cRE 101-000-42-1-000 0 11.10109 . ZI.4'",fr C`ldlM., FRX 101-000-420 000 - $69.00 STRO4+CI ?ti+ O IOC REE, - COMM 100.000�,241-000 13.46 :185.46 LW5 Pmt PA` D %E til oo ° D PMV911 IVIES P'l NOW $40A6 OCT -14 2003 T. CITY OF "LAQUINTA FIMANC En DEPT. " RECEIPT �� DATE BY DATE FINAL p_ / 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 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 APPROVALS Final POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: . X b3a3�31� Building _�� nuc Address �1 G' T a Wit 4 -N QUA& P.O. BOX 1504 APPLICATION ONLY L/ ^A 78-495 CALLE TAMPICO r0tJ Del LA QUINTA, CALIFORNIA 92253 Owner rlerw 1 f� 1' 2— BUILDING: TYPPE'CONST. IV OCC. GRP. f2— A.P. Number _ 1 I Q 12-4- 0040 Legal Description i -OT 717► 7K r 75 p�15£PT Gw�P5, N )? iilp • %� ' J IJ� Project Description . ( e Mailin Address Address I & y6 / l�6J-A V i� DR. Loi � � 65& v)y��o)�zv) L� /� ZIP C� q Tel. 11 Z� `2, ontractor� , To ) p Address i LT. 6a2 &7F Sr36 j. OjQ i Zip Tel. 818373709 �. k � I Ali' tiff State Lic.City & Classif. q 15- 6 Lic. # �S Arch., Engr., J Designer AIA rei `I 5L, /vj A h% )5715T HVA6 rr:; 0; Sq. Ft.,,f /"� No. No. Dw. Size 10q f . Stories Units New O Add ❑ Alter O Repair O Demolition ❑ Address160 IF, F / /'� Tel L, pr m61 F— Y, y 15 Q /I U�J I -r A5TA 1' Cii�C�1piAJZip�ICai>G� ���t# C�-225 N /9 C, u1�17-"s: 1�EV S �� LOC5, A U ' � t I 8 J LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under Provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my license is in full force and effect. �y x}1 05 ��` � SIGNATURE DATE OWNER -BUILDER fromt DECLARATION I hereby affirm that 1 am exempt from the Contractor's License Law for the following reason: (Sec. 7031.5,Business and Professions Code: any .city or county which requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its Issuance also squires the applicant for such permit to file a signed statement that he Is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Estimated Valuati �© /IJP!/') l/,(/(/ PERMIT AMOUNT Telephone 4 of Contact Person:["Estimated Value of Project: APPLICANT: DO NOT WRITE BELOW THIS LINE at Submittal Req'd Recd TRACKING PERMIT FEES Plan Sets ,'' Plan Check submitted Item Amount Structural Calcs. ' Reviewed. ready for corrections Plan Check Deposit Truss Calcs. Called Contact Person Plan Check Balance Energy Calcs. Plans picked up Construction 4111, Flood plain plan Plans resubmitted Mechanical • Grading plan 2nd Review. ready for Corr Ions/issue Electrical • Subcontactor List Called Contact Person Plumbing Grant Deed Plans picked up S.111.1. • H.O.A. Approval Plans resubmitted Grading fN' 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 Wim- v� fZZ1,13--See Ga r 'ss/ �y-• Total Permit Fees Q 3/P7 sit' cr-` ,3lz01Jz ,ac -E y`9�63 a/a? �o "a eue ylglo3 'er. �3 U )P -V- Tom Tisdale Fire Chief Proudly serving the Unincorporated Areas of Riverside County and the Cities of - Banning Beaumont Calimesa Canyon Lake Coachella Desert Hot Springs Indian Wells Indio Lake Elsinore La Quinta Moreno Valley Palm Desert 4. Perris 4. Rancho Mirage 4. San Jacinto 4. Temecula Board of Supervisors Bob Buster, District I John Tavaglione, District 2 Jim Venable, District 3 Roy Wilson, District 4 Marion Ashley, District 5 RIVERSIDE COUNTY FIRE DEPARTMENT In cooperation with the California Department of Forestry and Fire Protection 210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • Fax (909) 940-6910 f July 08, 2004 City of La Quinta Building Department Re: Fire and Life Safety Clearance The Riverside County Fire Department is granting a fire and life safety clearance for the following project Verizon, located at.78.150 La Fonda:.st,.La°Quints. Please call if you should have and Questions. Respectfully FRANK KAWASAKI Chief Fire Department By to tso Terry A�ocy Fire Safety Inspector EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE 82-675 Highway 111, 24 FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072