0308-293 (RC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provision's 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
464856 BMC 1.01',51f7.(
Date—�jSignature of Contractor +� ��� �� '4-A
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 isnot 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.
V1 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:
STATE FUND Policy No. 1411446-3003
(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 thoserovi iogs.
Date: �►pplicant �.�t>g. ,.
Warninga o 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
work is not commenced within 180 days from date of issuance of suc D
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 for inspection purposes.
'Signature (Owner/Agent) .:?tea Date 911 Al
BUILDING PERMIT PERMIT#
DATE VALUATION LOT--�� - TRACT
JOB SITE
ADDRESS 47-1.2(1 D Me PADidItiCS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
FtltdKER COI&AM'
1 U. RA COWI RU'Cfl ION
P.O. BO3C 7250
5065 >? VERON1k.
NL+'Ute'PORT BF.AOH CA 92658
p.f,Im SPRINGS Chi 92262
USE OF PERMIT
100)&oMC IALREMODEFL
COMMIKACIAL R.UEti9ODW. {'TRANS WE= HOUSING OFMC9 TI) 3500 SY,
'('YPF,VN SPRINKI,1tA OCCUlIA14T LOAD 44 CDC 20DI
VALUATION 48,af3a,R0 LS
XurIDIY3t1.Tm CO&T of C'ONGMUCl`IoN
40,4XV,00
PERMIT TJ EF 9UMMARY
PLAN CI•iEC"KFBE 101-000-439.318 2260.98
C(MSTRUCI'1014 FEE 101-000-418-000 $401,50
MECI-IA,Dn1IC:ALFEE 101.000.421.000 $83.00
ELECTRICAL IRE$ 101-000420-000 $05.00
PLUMBING FEE 101-000-419.000 $48.00
srILONG MOTION n1t - COMM 100-000-24 1 -000 $10.03
CC)IrTMUCTI0N AND PLAN C%rhM
_S -;8j S. a,;
IMS .PRI -PAID FEW
$0,00
S
TOTAL DPE10W FEES DUE 1i0 W
2 3-1003 ,.
P
SE
A
�E
C NC
DATE
BYDATE
FI D
INSPECMbA
—9.3 r; j
INSPECTION RECORD"
Sewer Lateral
Pool Cover
e
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL; -APPROVALS
Set Backs
Equipment Location
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Gas Piping -
Return Air
Steel
Waste Lines
Combustion Aid - -
Roos Deck
Plumbing Final
Exhaust -Fans-
O.K to Wrap
Shower Pans
F.A.U.
Framing
3 iS 3
Compressor. - - - - —
Insulation
- -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls '
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Sub Panels
Exterior Lath
-
Exterior Receptacles
nrwmil _ Int I ath
/n � 2
G.F.I.
Sewer Lateral
Pool Cover
-
Final -
Final
BLOCKWALL APPROVALS
- FOOLS - SPAS
Steel
Set Backs
Electric Bond - - -
Footings
Main Drain
Bond Beam
Approval to Cover
Appliances
Equipment Location
—
Underground Electric
Underground PI . Test
Final
Gas Piping -
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out jd
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
-
Sewer Connection
Encapsulation
Gas Piping
--
Gas Test
Appliances
—
[nal
®MMENT.�:�,,�
4*.W %/ �iG�
Final
Utility Notice (Gas)
,
�j0,h� /
�,jyp� D/G ,(►
ELECTRICAL APPROVALS
Temp. Power Pole
hiind Conduit
- -
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
-
Exterior Receptacles
G.F.I.
et
Smoke Detectors
Temp. Use of Power f
Final
Utility Notice (Perm)
QUINTA
OF I &S F DEPARTMENT
A,777-7 12
e- o f EQUEST LINE
FAN 777-7153
Owner KER COMPANY
Contractor ULTRA CONSTRUCTION
Permit Number 0308-293
POST ON JOB IN CONSPICUOUS, PLACE
INSPECTOR MUSTS
IGN ALL APPLICABLE SPACES
JOB ADDRESS 47-120. DUNE PALMS STE. C
COMMERCIAL REMODEL 2500 S.F. TYPR VN
SPRINKLER, CBC 2001 ---
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO,
TURN ON UTILITIES OR OCCUPY BUILDING
Tom Tisdale
Fire Chief
Proudly serving the
Unincorporated
Areas of Riverside
County and the
Cities Of -
Banning
A
Beaumont
A
Calimesa
A
Canyon Lake
A
Coachella
A
Desert Hot Springs
A
Indian Wells
A
Indio
A
Lake Elsinore
La Quints
0
Moreno Valley
A
Palm Desert
A
Perris
A
Rancho Mirage
8
San Jacinto
A
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 of Forestry and Fire Protection
210 West San Jacinto Avenue* ems, calgomla,925M * (909),940-6900 a Fax (909) 9AO-MO
December 16, 2003
City of La Quints
Building Department
Ret Fire and Life Safety Clearance
The Riverside County Fire Department is granting a fire and life safety clearance
for the following project located at 47120 Dune Palm rd. La Q.uinta suite C
Please give me a phone call if you should have any questions.
Respectfully
FRANK KAWASAKI
Chief Fire Department
By � Se
Terry oucy
Fire Safety Inspector
EMERGENCY SERVICES DIVISION • PLANNING SECTION • INDIO OFFICE
82-675 Highway 111, 2n° Fl., Indio, CA 92201 • (760) 863-88116 • Fax (760) 863-7072