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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
743025 B i 1113(1
1
,Date _ r6etignature of Contractor / 1.` ,
s
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 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 should become
subject to the workers' compensation provisions of Section -3.Z00
Code, I shall forthwith comply with those'provisions--'--.-- }
,,Date: ,— G -.-» i Applicant-
7� /%
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
fora 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, indemAify
& 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.
fSiiggnature (Owner/Agent) Date
BUILDING PERMIT PERMIT #"I 12- 169
DATE VALUATION S62A00.110 LOT TRACT \
23 AA
JOB SITE 78-080 CAL.LE ES 1 ADO APN 769-? 01-016
ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
Rrnn�n�t.i�c rrcyr•w.<rNrfrinrr nr ta�r�+,r.r.r�s%irc
b-114 A'd Ai1,1a %It . 11 A1'i 1, ibi 1.1 tW Al. -IYA.11�
?S-080 CALI..E 151' WO S1713,231 78•-080 CALL E E91'A.00 Si,E 201
LA Ql1LNTA. CA 922.5.3 1 tt4 Cr i,JINTA CA_ V2253
(7C,0)T7L-25053 CS1.0 54071
USE OF PERMIT
CO.'14id1.E1t(.:. M, 3t-EWDRI,
1'I-.ZOANSION OF 0aSTRI40PUBLIC LWRARa'
1't'+9.,13ri � 3EJPv
67,000.00 LS
RIAT.ED COS' 01" CO."dS°>rRUC+'`J IUCI T
PERMIT FEE ,r9'1.iM1VaAkY
I'i AN „1i,CK kms. 1�L-Ot3(� 4?S►�3.115' $3ii.i3
s.TINSTRIX,7f()W FFF 1171.4101?-418-fi► O baFa5o
PEE ,101-000 921.4900 ;5.00
I.I.ae; l2iLHLF'is �iG.i-t7t7ii-42 -Liijv $61.100
:ifi3(JiVt ItlOI'lC9tti!'iY,E - tlQritbGt .100-000-241NVV
I
1
q e;
S1j4-rf'TfAl.. f",ON,'" f UCTION AM)131,AN CHECK: x.22 n5
;,;VSs' ME- PA.i.LZ hEES 50.00
� . A ti
DEC 2 3 1998 h
DATE ABY DATE FINALED JINSPECTOR
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 Wail 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 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
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)
James M. Wright
Fire Chief
Proudly serving the
unincorporated
areas of Riverside
County and the
cities of:
Banning
Beaumont
Calimesa
a
Canyon Lake
40 -
Coachella Coachella
0
Desert Hot Springs
a,.
Indian Wells
4+
Indio
Lake Elsinore
La Quinta
Moreno Valley
Palm Desert
Perris
Rancho Mirage
9
San Jacinto
4
Temecula
Board of Supervisors
Bob Buster,
District 1
John Tavaglione,
District 2
Jim Venable,
District 3
Roy W ilson,
District 4
Tom Mullen,
District 5
RIVERSIDE COUNTY FIRE DEPARTMENT
In cooperation with the
California Department of Forestry and Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • FAX (909) 940-6910
April 28, 1999
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 group
B occupancy known as La Quinta Public Library located at 78-080 Calle Estada.
Respectfully,
FRANK KAWASAKI
Chief Fire Department Planner
B �a
Y
Walter Brandes
Fire Safety Specialist
F:\PEZWPDATA\LAOUIMA\PROJECTSIFINALSPUB LIB.WPD
EMERGENCY SERVICES DIVISION O PLANNING SECTION O INDIO OFFICE
82-675 Highway 111., 2nd FI., Indio, CA 92201 4, (760) 863-8886 9 Fax (760) 863-7072