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C� 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 - 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).,9 '
() I am exempt under Section , B&P.C. for.=thisreason/
Date i `-y i Signature of Owner �ir P rt't �"•
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.
(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 shouldifiecome
subject to the workers' compensation provisions of Section 3700 of,the Labor
Code, I shall forthwith comply with those provisions: ;.�"
Date: 1 ''�- '''1 Applicant ./
/ • / ' f -�
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:f
Signature (Owner/Agent) !'��. ��' - Date
f
PERMIT#
BUILDING PERMITw7�;
DATE .al g zx VALUATION . LOT TRACT
JOB SITE
ADDRESS 51-4.W.55 DY .W C:J,.UB MAIM'.
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
M—AIN OWUL
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52- 105 AMTOAREMMMA
.LAQUIiTI-A 922,53
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USE OF PERMIT
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RECEIPT
DATE
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BY
_
DATE.FINAL D
INSPE
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a
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
POOLS - SPAS
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
Electric Final.
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX 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:
Certificate of Occupancy
4 -- f T4af
INcoroanm��
asst
OFT9� Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 51-455 Desert Club Drive
Use classification: Commercial Office Building Permit No.: 0401-076
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Occupancy Group: B Type of Construction: VN Land Use Zone: VC
Change of Use — Residential to Commercial
Owner of Building:. Oneil Address: 51-455 Desert Club Drive
City, ST, ZIP: La Quinta, CA, 92253
By: Daniel P. Crawford Jr.
Date: 1 /12/03
Building Official
POST IN A CONSPICUOUS PLACE
JUL-26-04 MON 11:41 AM RIV, CO, FIRE P&E INDIO
Tom Tisdale
Fire Chief
Proudly serving the
Urtinourpotaled
Areas of Riverside
County and the
C1tiUN of:
Banning
13eauulonl
s
Calitncsn
r.
Canyon Lake
Coachella
v
I)Lsert HEu Sprin&c
rr
Indian Wells
i
bldio
i•
Lake Elsinore
La Quinttt
Moreno Valley
C•
Palin Desell
ti•
Perris
Rancho Mirage
San JacinEO
Temecula
Board of'Supervisors
Bob Basta,
Districl 1
John Tavaglione,
District 2
Jim Venable.
Uisirki I
Roy wilstm.
r) ism cT 4
Marion Ashlcy-
r)iso'ict 5
FAX H.. 1 760 863 7072
P. 1
IF
RIVERSIDE COUNTY FIIZE DI✓PARTMENT
In cooperation with the
California Department of Forest ry and Fire Protection
1 OWest San Jacinto Avenue . Perrls, alifornia 92570 • (9W) M-6900 • Fax 69 0
June 26, 2004
City Of La Quinta
Building Department
Re: Bob Edwards Construction
The Riverside County Fire Department is granting a fire and life safety clearance for the
Following address located at 51455 Desert Club .3t., La Quinta. Please call if you should
have any questions.
TD/jl
FRANK KAWASAKI
Chief Fire Department Planner
BY
Terry De y
Fire Systems Inspector
Y P
EMERGENCY SikVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2nd FI., Indio, CA 92201 - (760) 863-WM6 • Fax (760) 863.7072