0312-079 (RC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W: Professionals Code, and my License is in full force and effect.
O n tM License # Lic. Class Exp. Date
LLJ
r` CJ rn
464856 B RIC r 10/31/2(
oZ f-- Ate Signature of Cor�--�--
co O
J U CID OWNER -BUILDER DECLARATION
LU LU rl- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ co License Law for the following reason:
Z ( ) 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).
MO I am exempt under Section B&P.C. for this. reason
N
Date Signature of Owner
O�
d Q WORKER'S COMPENSATION DECLARATION
Z
I hereby affirm under penalty of perjury one of the following declarations:
H O O 1 have and will maintain a certificate of consent to self -insure for workers'
W compensation, as provided for by Section 3700 of the Labor Code, for the
Qperformance of the work for which this permit is issued.
n Q ( ) I have and will maintain workers' compensation insurance, as required by
U Q Section 3700 of the Labor Code, for the performance of the work for which this
L' H permit is issued. My workers' compensation insurance carrier & policy no. are:
C ZCarrier Cb 5 'TATE FUND Policy No. 1615446-2063
�a
g (This section need not be completed if the permit valuation is for $1.00:00 or less).
( ) I certify that in the performance.of the work for which this permit is issued,.
shall not employ any person in any manner so as to becom subject to the
workers' compensation laws of California, and agree that if I bhould become
3,subject to the workers' compensaion`
tprovis'ons of Section 00 of the Labor
Code, 1 shall forthwith comply with those provi' ions.
Date: Applicant ",,
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.
-r
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'[ have read this application and state that theabove information is
• correct. I agree* to comply with all City, and StaEe 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) _,J C. Date
BUILDING PERMIT PERMITN
D . E f VALUATION LOT 03120312� 0 J� TRACT
$45 }''��
100
JOB SITE
ADDRESS 47-'[20 DUIN'E PALMS ROAD SUITE A
APN
- CANNED
OWNER
CONTRACTOR ! DESIGNER / EN (NEER
BART ill[ &T.R
'ULTRA CORGI T RUC' IT,01-7
T' -ALM,, SPI t alb CA 92262
( C)0)320.2113 CBI..# TBD
USE OF PERMIT
CON%O tCIAL RMAODEL
COUMF,RC.IAL REMODEL (RF..PJ.TOR. OFInCE TI) 2988 SY, "B"
OCCUPANCY, TYPFVN SPRIN KLERED, OCCUPANT t,,t7AD 29, 2001 C%C°
VALUATION 4$,000.00 L:t
F.14T[1 ,TF.I) COSEC OF CON UMUCITON
451000.00
:PERArYt T :ems: AVIARY
i`•ONS'IRUCTICJI•l KZ 101.000.418 -MM $3 2100
PLAN CkIRCK (Eli; .101-000-4.39-318 x{308.70
MECHANICAL FSB 101.000-X131-000 31.913il
FSt..W R.IC Lim 101-000-4:20-000 $74.766
PL(lMOrt10 FZi ' ' 101.000.4'19-000 $48,00
STRONG MOTION FII • COMM 140-00-241-000 $9.45
SUB-TC)TAL CON,TMTYC 014 AM .PLAN MAW*
$9,12.4 ;
LESS P.RF-PAID 11~Y?9
D Air F11'1M3'1'.:it°L�S :PJ1i3'E ATOW
12.4j.
DEC 0 9 2003
CITY OF LA QUINTA
RECE ? r BY �y` DA INP
L..
OR
VI
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
I.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
441
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 APPROVA S
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
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
P 7V
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
"Indegwund Conduit "
Rough Wiring/l
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power y 0
Final
Utility Notice (Penn)
COMMENTS: /J
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City of La Quin --t3&tt AI�Pvto,
Building. SSafety DW
P.O. Box 1504, 78.495 e Tampico
La Quina, CA 92253 - ) 777-7012
Building Permit Applica n and Tracking Sheet 9-26,�
It
Permit #
Project Address: q IZZO 06 PAa "q A
Owner' !Snogowgiz, A&jwg6
A. P. Number:
Legal Description:
Address: PACA eAX) YOiJ DO
City. ST. Zt PAt Sh?i�JSSXeA qZZd'1:_,?
Contractor. VL-rk& 0AQ-,X6k_,erQA:)
Address: -j OA 6
FTelephonc: -j'7,?-_55,Vo
jectDe+ption:
City, ST, Zip: 40
zz
'w"
eti
Telephone: 4E)5 -F373
State Lic. # : q6 (175 6 —6
City Lic. #:
Arch., Engr, Designer. -
Address:
City, ST, Zip:
Telephone:'
MI.
-t - � - . I
Construction Type- Occupancy:'
State Lic. N:I
Project" (circle one): New Ad c�r) Repair Demo
d'n Alta
Name of Contact Person: -1; P
04 1 Cacer
Ft:
# Stories:
# Units-
Telephone # of Contact Person:
Ysti"t Value of Project: -iq�joo
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req -d
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Chtck submitted
Item
Amount
Structural Coles.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balsoci
Energy Calix.
Plans picked up
Constructioa
Flood plain pion
Plans resubmitted
Mechanical
Grading plan
2" Review, ready for correcti
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAI.I. 0
NAA. Approval
Plans resubmitted
Grading
IN HOUSE.-
Review. ready for correctibustissue
Developer Impact Fee
Planning Approval
Called,Coutact Person
A.I.P.P.
Pub. Wks Appr
Date of permit issue
Scbool Fees
'1AS&A,
+L
4,Tot*1PermitF
'
ees
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities of-
Banning
f
Banning
Beaumont
Calinesa
0
Canyon Lake
4
Coachella
Desert Hot Springs
O
Indian Wells
O
Indio
O
Lake Elsinore
O
1 Quinta
b
Moreno Valley
0
Palm Desert
O
Perris
Rancho Mirage
4
San Jacinto
4
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District2
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 Vied San Jacinto Avenue . Perris, California Fax
February 9, 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 address located at 47-120 Dune Palms road 'Ste #A La Quinta. Please call if you
should have any questions.
TDfjI
FRANK KAWASAKI
Chief Fire Department Planner
�-e7/v D7 __.et'Tene cy
Fire Systems Inspector
EMERGENCY SERVICES DIVISION •PLANNING SECTION • INDIO OFFICE
82-675.HIghway 1i1,.2nd Fl., Indio, CA 92201 • (760) 863-8886 a Fax (760) 863-7072
Certificate of Occupancy
Toaf 4 4 a"
Building &Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
>x 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
h construction and/or use.
BUILDING ADDRESS: 47-120 Dune Palms Road Suite A
Use classification: Commercial. Realtor Office TI
Occupancy Group: B
Owner of Building: Bart Rinker
Building Official
Type of Construction: VN Sprinkled
If; I_1
Building Permit No.: 0312-079
Land Use Zone: CR
Address:
City, ST, ZIP:
By: Daniel P. Crawford Jr..
Date: 2/11/04