0304-083, 0304-086 (CONR)CO
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LICENSED CONTRACTOR DECLARATION 0
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
43.50:33 33 C9 C5� mc,/ � 0V2V2(
Date /''t' ' Signature of Contractor,,' -� /--ter-'
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 STATE PlYND ' Policy No. 134239:1-f)3
(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 prgvisions ofSection 3700 of the Labor
Code, I,shall forthwith comply with -th''ose provisio :r►s!�'
Date: Gi" i�i Applicant—
Warning:
pplicant_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.
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 propert/yfor in�pectian-purposes.
Signature (Owner/Agent)' : f f �+�" Date.
BUILDING PERMIT PERMRN
/
DATE % .- VALUATION LOT OYA-W3 TRACT
L� $292,494,00JOB
SITE
APN
ADDRESS 46-;3f02 2)UNF. P. AI,114S ROAD
649-"" 13
OWNER
CONTRACTOR / DESIGNER / EN (NEER
I.A QDr N'1:A C0140.0T r-110VAH'S VI.0 WES
I S'TOUft INC.
,W267 MONT'1'1',F:Y AV-ENTH. -0
57370 Zig P, 110 YM. ' #201
PALM DRSERT CIA 92.260
TUCCA VfiT.UY CA 92284
(.760j3-5-1369 1 tMT-4 =3
USE OF PERMIT
1+OUM,AT'ION
N)UNDATIGN C'I'MLY PFRbAIT, - 45'7& SQ.AT. ASSEMBLY 8L—Da. 4376
SQ,FT, A38EMBLY RUILD1140 (LA QUINTA Ct?IJzi1t. AIAT[0714 OF
JEHOVAH'S WITNE..SSn), NO WORK AUTHORIZED BEYOND SL.AJ3 LEV'EI..
"AJC -- COMME?RCLAL 4,736,00 3F
CON3TRACT AABCPJN7' 275,&18.00 LS
ESTI" colvr OF CON1101I rVC011 V
792,494.00
PERAW FEY, sUMT*URY
C014TRUCTION FEZ 1(11400(3-418.0001 111,31 oo
PLAN C I -➢I=. Cid 'FZ,?, I o i -000-139-318 10761,16
FEE, DEPOSIT 101-000-439-318 _V159.00
ELECTRICAL. FEF 101-000-420-000 $162.62
PLUM81110 FEE 101.000.419-000 $133,30
OFLAIANO "Z 101-000-423-000 173.00 .
DEVELOPER I-MRA.CT FEE 58,..".42 ,
_LRT IN PUBLIC PLAXES - COMI 270-000-445-000
- . UCTION AM Pl '\,N• CHEM
$11,926.17
IMS PER -PAM F1051
-$750.00
r
AQP
MAfff Ia'F.;_K NOW
C17 9� of LA PT.
FINANCE [DEPT.
RECEIPT
DA
BY _].DATE
FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings44
Ducts
Slab Grade 00rgReturn
Air
Steel
Combustion Air
Roof Deck
Exhaust. Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.0,
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Wain Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines om
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
Utility Notice (Perm)
COMMENTS:
May 1852003
Building and Safety Dept.
City of La Quints
78-495 Calle Tampico
La Quinta, CA 92253
Re! Kingdom Hall Bldg #2
Dear Sir or Madam:
ENGINEERING -
0
R P 0 R A 1 f D
I have reviewed the structural components of the above referenced project. I am
satisfied that this structure complies with the structural design as shown on the approved
plans. Please call meif you have any questions.
Sincerely,
Michael D. Hacker, P.E.
68.487 Highway 111 • Sulte 43 • Cathedral City, CA 92234 • Q60i 202-1;800 • Fax (760) 202-8267
enghieer0hockerengineering.com
LICENSED CONTRACTOR DECLARAIYION `
I �ereby Arm 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
�
ww
Date Signature of Contra
ctop`/
OWNER-BUI
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
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:
Cartier �".:1 AT L' :FUND Policy No. k14203.07
(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 prFri
ITS of Sect!%3790 of the Labor
Code; Lsfiall f hwith comply with Jho dons. ?i jry
Date: Applicant _r° .. d
Warning: Failure to secure Wofkerh Oompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost.of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building:and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property'ibr fn$pection purposes.
Signature (Owner/Agent) �r ` 1 ^^Datei
BUILDING_ PERMIT
DATE � t✓ .Ci VALUATION $J1V. . LOT
JOB SITE ADDRESS �: '! D -T- .�. i?JLLPA i �1•?�I�,D
OWNER
LA Lc%AM;A C:'.3.` 0.OF JF.;.6'K.ytF./!I!,'! ++IY I'. M
44, 26 J TAIDIWIT/,%I;Y AVh'.!i1:'W_ "f
USE OF PERMIT
PERMIT #
'eLfa 2
CONTRACTOR/DESIGNER/
TRACT
&i5*_01h1k1-013
Vol�'l i. t_►1`Yiil }�' �'4.1`� t 1I S 'I14r lYUCCA 'VXLL11Y CA 92184
4YLLaJ iY'A. aYJ/V W�.S !. !i♦h'J l:,f.[�!A!,! 1i 1./!(,LJ!l�al. ia': ?/La�V1".l �'�t. ! r
Yy -W, SUPP?..Q AU NTAI, TO PERMIT 0304-093.
:0if.'12:WYVVY 90Iv1f:s-:SiAR
M4<IVIA111) -1101i FEE, 01, 00,Q-411 -000
S'!'R0Nf:y MOT1014 FFf; • Ci MM 100.000 -:?41-000
APR 3 0 1003
CITY OF LA QUINTA I
FINANCE DEPT
:1ClB- iJ1:h[
C<AT
T�gsq WIZE RIS $0100
RECEIPT I DATE - BYtI DJRN14LED� I 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 ;j'- / .o117
Exhaust Fans
OX to Wrap
F.A:U.
Framing
Compressor
Insulation , p 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
V 3 157
Final
Final
BLOCKWALL A PROVALS
(POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PRV. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines o3 A7,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer.Lateral
Pool Cover
Sewer"Connection . B
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 B
Utility Notice (Perm) , d 7j
COMMENTS:
Certificate of Occupancy
Titye 4 4 Q"
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: 46-302 DUNE PALMS ROAD
Use classification: ASSEMBLY BUILDING
Occupancy Group: A-3
Type of Construction: VN
Owner of Building: LA QUINTA CONG. OF JEHOVAS WITNESS
—,s,
Building Official
IN A
Building Permit No.: 0304-086
Land Use Zone: RL
Address: 44-267 MONTEREY AVE. "C"
City, ST, ZIP: PALM DESERT, CA 92260
By: STEVE TRAXEL
Date: 07-01:-2003