0310-333 (RC)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
Date r /Id I 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:
( ) 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..
( ) 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 STAVE 1 OID Policy No. 46:fd1 ON0120
(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 wit, those provis'ons.-
/Date:/2 /rApplicant .� �% 4 f., .- — �Y , •i "�^..
. P' -
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 oof this City to enter upon
/Signature
property for inspection purposes.
f
`Signature (Owner/Ag"'en � ✓/.�' !�.�r""'Date/77 "V
BUILDING PERMIT_ PERMIT#0310-333
DATE VALUATION atA LOT TRACT
JOB SITE
ADDRESS 47-050 Ste'. MAIM 420.1
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
LA QU1 N1_r1k DFWM10PFRS;1: LC
.AFFPR'eU CCaNN'M t,JC:"1TON' CO. INC.
77.900 AMILT.E OFUR, V.A. � s
PALM 17F5,'N,1.2.T CA 512260
PALM MOW C.'E1 92111
C?60)345-2626 CMTJ) 5089
TOM SCF' ERER & ASSOCIATZO
USE OF PERMIT
` CCt71 EVIERCIA•Lbi1 ODE
1067 S.' PAI..lU3 CANYON`I3,RIVE
TENANT IMPROV'EPlLr14T-Oir.";UlTi420I- LITE €.1,N, 1,1411•, 850 ,-q.ft. '
"B" OCC. TYPE V -N CONSIT, LOCATED 1N PARC1-14 ST -JELL 13LDO,
2001 CODE& titRE'V•OC.ABLIte Ip:ASEN9EW- i .AICiR:L;EM'91 T..
VALUATION ION 6,7225, 00 LS '
r';3t�31r'.4 air CC�1�3'�'%d17'Ct`�l�72�C1ti
. ;.
PIM ,W.. FEESEMMMARY
PLAN C73,pcK
CONSTRUCTIO'14It`LIu:.: '1031.00041.13-000 $90.U0
MECHANICAL YFE : 101-000-421-0,00 .. 42b.,00
ELE TWCA1,XPE,. 3:.01-000-2.0-000
FdtBINGFEEyV1440-4 ��...
DEL 09 2003
.CITY OF LA QUINTA
FINANCE DEPT..
T 3• i�T.�li� CQ 33lT iTG'1�i �V . PIAN Cy�p�;[1�.�C�Y�
�'Z6yyp,e:/ni�: t%��6
Y'd y�+.l'�� S.
. .f.�Gr'rSS i-.i.zep�� .C.67.J:.S .
$0.00
DUENOW
5.00
RECEIPT
DATE
BY
DATE FINAL
INSPECT
C
INSPECTION RECORD
OPERATION
DATE
I 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
OX to Wrap
F.A.U.
Framing ,G
O
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
t-
Ib o
Final
Final _
BLOCKWALL APPROV S
Steel
POOLS - SPAS
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
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:
"
_
Tom Tisdale
.Fire Chief
Proudly serving the
y Unincorporated
Areas of Riverside
County and the
Cities of -
Banning
Beaumont
Calimesa
Canyon Lake
Ae
Coachella
•:1
Desert Hot Springs
4•
Indian Wells
Indio
Lake Elsinore
La Quinta
o�
Moreno Valley
Palm Desert
4 -
Penis Perris
4.
Rancho Mirage
•S
San Jacinto
4•
Temecula
Board of Supervisors
Bob Buster,
District 1
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 ofForestry and Fire Protection
21 est San Jacinto Avenue* • Pema, California 925704; (909) 940-6900 • Fax (909) 0
Apri121, 2004
City Of La Quinta
Building Department
Re: Fire and Life Safety Clearance
LAQ-03-TI-089
Elite Lending
The Riverside County Fire D ment is granting a fire an a for the
Following address located t 47050 -Washington street ste=4101;4102,420 a Quinta.
Please call if you should h an-uestions. - _
FRANK KAWASAKI
Chief Fire Department Planner
eA
By
Terry De oucy
Fire Safety Specialist
DE/j1
EMERGENCY SERVICES DMSION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2n° FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072