0003-317 (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
/ 339503 C20 C36 B 03131/30(
GDate"- �/ ""GSignature 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
(� 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 Policy No.
&NENIPT
(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: 2- - 'Applicant ., x
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.
/Signature (Owner/Agent) r,' Date
4 1' BUILDING PERMIT PERMIT 00413-317
D?TE VALUATION $8,000,00 LOT TRACT
JOB SITE
ADDRESS 511-355 'WASHINGTON Si"RE FT #2H
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOHN BOOTH
COAST DEWLOPMENT/AT,M90 & 14EATff
7961 LOOKOUT
7895 ANNAi DALE .AVE ,
PALM DESERT CA 92260
DESERT H(XI' SPRfNG: CA 92240
f 7ci0i32'�-05b8 f_ fail 6042
USE OF PERMIT
COMAIER.CI.AI, REMODEL
TENANT UVIPROVFS ENT - CON -VERT EXISTING SPACE INTO Sr iD H/ICH
SROV (SUB DEPOT)
VALUATtON 81000.00 113
OTINA EDCOST OF CONSTRUL riON
8,001).00
PERMIT FEE SUNfMAicY
PLAN CHECK 1E 101.000-439-31.8 $64.31
1(0�'1.-000y-41111-0Fl/0�0
7C��O;;NS)TWC'gT��IO�^N[^pl!�EE pS94.00
Li'l�i!"HANI1'ALi FEE toll 421-000 12 1.
4AXCTRICAL FEE t{11]. -000 -420 -OW
PLUNTSINC FEE 101-0()0-419-000 $31.50
STRONG PdOt'ION FEE - COM 100-0001,241-0006 .$1,68
. PLAID
MAR 3 0 2000
MTI( OF LA QUI
T'
Slv"M-WC.A.L CONS'TRUCHON AND PLAN MiHCIK
$244,211
LESS PRE-P.MD FEES
TOTAL PERMI f FEES DUE l` NOW
$244.28
RECEIPT
DATE
/By ^.
DATE FINALED
INSPECTOR
,G
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Undergrounq Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing G _ C,
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines O U
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)
RIVERSIDE ME CALIFORNIA DEPARTMENT OF FORESTRY INDIO P&E
909-955-4777 . Fax 909-955-4886 RIVERSIDE COUNTY FIRE DEPARTMENT 760-863-8886 Fax 760-863-7072
4080 Lemon Street, 2nd Floor 82-675 Highway 11.1, 2nd Floor
HEADQUARTERS
P.O. Box 1549 - � Indio, CA 92201 ,
Riverside, CA 92502-1549 210 WEST SAN JACINTO
PERRIS, CA 925.70
INSPECTION LOG
COMPLIANCE ORDER'Page %of %
PERMIT/CASE # Notice No:
FACILITY NAME Date:
ADDRESS 85s' City, 41A Phone:
The items listed below are in violation/requirements of one or more of the following:
UNIFORM FIRE CODE UNIFORM BUILDING CODE:
RIVERSIDE COUNTY FIRE ORDINANCE ' CALIF. HEALTH & SAFETY CODE (TITLE. )
OTHER ` &7A i3
�n.li�E _hey-y�IJ�O�.-� '7+ie,.�, ' : n SMn »3 • -
l
Measures shall be taken` to correct listed'-violations/requirements. A reinspection will ' be conducted on or about
19
FAILURE TO OMP MAY
RESULT IN LEGAL ACTION OR SIGNIFICANT. DELAYS OF APPROVALS.
Received B' f • Titles _'
Fire Inspecto s , ,21S Radio I.D. 7
FOR FURTHER INFORMATION PLEASE CALL
Phone
RCO 26.11A (Rev 11/99) "
t•
,
l
Measures shall be taken` to correct listed'-violations/requirements. A reinspection will ' be conducted on or about
19
FAILURE TO OMP MAY
RESULT IN LEGAL ACTION OR SIGNIFICANT. DELAYS OF APPROVALS.
Received B' f • Titles _'
Fire Inspecto s , ,21S Radio I.D. 7
FOR FURTHER INFORMATION PLEASE CALL
Phone
RCO 26.11A (Rev 11/99) "
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COUOF•RIVERSIDE HEALTH SERVICES AGENCY
typ,RTMENT
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OF ENVIRONMENTAL HEALTH
'.ENVIRONMENTAL HEALTH SERVICES
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SUPPLEMENTAL REPORT TO.SAN. FORM # DATE
SUBJECT PERMIT NO,
ADDRESS /A)6 -G f L
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INSPECTOR
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REMARKS: I P lM. o `�: J O ` O ifP �. �. (m C C �I r ?moi, `c ` b n.• 'z. � rc P -
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DEH-SAN-118 (Rev 2/88) w, ,' Distribution: WHITE—Office; CANARY—Owner; PINK ice
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This Certificate issued pursuant `to the.arequaements of Section X09=of the Uniform Bui/ding Code,
certifying -that, at the`.time-,of issuance, this structure .was°in compliance with the various ordinances
•� a.t
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r - ' �.*�" •; � Y'�ti. .. , .y.- may.
Y of the, City regu/sting bui/ding+construction or`'use.
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-'BUILDING ADDRESS i`fi''� �:� WASFiIIVGTO N:'ST;�STE .-N
.-
Use Classification: COMMERCIAL', *11. 'SUB DEPOT
Bldg,'�Permit No.: 0003-317 `
~
Occupancy- Group: B r'Type of Construction:
- VN': LandlUse. Zone: COMMERCIAL
Owner of Building: JOHN. BOOTH �'• `
Address: 7964:16OKOUT
•
City: PALM; DESERT, CA., 92260
.DANIEL
By: P. CRAWFORD JR. '
-
Date: 6/2.1/2000
Building Official
} n POST -IN A CONSPICUOUS PLACE
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