9804-193 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
HChapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 U) W P,•ofnssionnls Code, and my License is in full force and effect.
ch License # - Lic. Class Exp. Date
I LLJ - 743867 B ��. !99
r` CC /
o Z r— ate Signature of Contractor ,;
(.o
Ji.—
C I OWNER -BUILDER DETZARATIOND�
W W I hereby affirm under penalty of perjury that I/am exempt from the Contractor's
U)
License Law for the following reason:
Z ( ) I, as owner of the property, or 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
O N Date Signature of Owner
rn
CL Q WORKER'S COMPENSATION DECLARATION
p z 1 hereby affirm under penalty of perjury one of the following declarations:
r O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �!- • compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q perfoPr nance of the work for which this permit is issued.
Q U ,6(+'`) I have and will maintain workers' compensation insurance, as required by
OU Section 3700 of the Labor Code, for the performance of the work for which this
2rn -_ permit is issued. My workers' compensation insurance carrier & policy no. are:
It Z Carter Policy No.
ob O STNI'E FUND 1424452
J
(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
3 subject to the workers' compensation provisions of Section 3 00 � e Labor
Code, I shall forthwith comply with thos �pr svisi ns.
Date: Applicant
r
Warning: Failure to secure Wo>ers'.Compensation coves a is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compent"Sation, 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
j • correct. I agree to comply with all City, and State laws relating to the building
constructio'n, and hereby authorize representatives of this City to enter upon
`;;� the, above-mentioned property for inspection,purp�oseeA-.--Z-.,Z
' atur (Owner/Agent) JJ--'� —�" Date
)q�BUILDING PERMIT PERMIT �KOa-193 CONTROL#
1,
DATE J�- Y§8 VALUATION $� (19.00 LOT TRACT 7 613
1 .L
JOB SITE
ADDRESS -
SS 7 .120 CALLE MADO UNIT .104
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
MARV1N 14OMP.S
WORLD DE VELOPMENT,1NC
5.1-370 AVL B.ERMUDA.S
PO BOY 1.3287
LA QUiN'lA. CA 922..53
P.A1.M DESERT CA 92255
(760)772-1919 CBL# 5028
USE OF PERMIT
BUILDING
ADD ONF WALL AND 4 ELEC!` PULOS
VALUAP.ILIN 100.40 LS
EST.1jV1A1TED COST OF CONS'1•)11UC11ON
.100.00
PERMIT EEE SUMMARY
PLAN QW -CK. ITTF 10.1-000039-318
CONSTRUCTION ME 10.1 -000 -418 -OW 1i15.0A
.
EI CPRiCAL FEE 101-000-420-000
STRONG tvItOTION FM - 60MN 100-000-241-000 $.54
LJma, 11 113 TOTAL CONSTRQt7rION AND PLAN CHECK
$41.75
LESS PRE -PAID FEES
�IAY 011998 TOTAL P1?i:R1tTIT FEES DUE NOW
$ 41.75
OF
—A
RECEIPT
e
DATE i
. l d
BY
DA A D
�
INSPECTOR
INSPECTION RECORD
-= v
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 �7= _
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
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 Pale
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
E
t
Final
Utilty Notice (Perm)
COMMENTS:
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COU�,,,T�y ON RIVERSIDE
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kpri130, 1998
RIVERSIDE COUNTY FIRE DEPARTMENT
177 cooperatiO77 with the
California Department of t Orestry ar7d Fire Protection
210 West San Jacinto Avenue • Perris, California 92570 • (909) 940-6900 • FAX (909) 940-6510
James M. Wright
Fire Chief
World Development
P.O. Box 13287
Palm Desert, CA 92255
Proudly serving the
Ann: Craig Petersen
unincorporated
areas of Riverside
Re: Suites 103 & 104
County and the
cities of:
TENANT IMPROVEMENT PLAN CHECK
Beaumont
You have been issued a release for a tenant improvement on an existing building. THIS IS NOT AN
Calimesa
OCCUPANCY PERMIT. Prior to opening your business, you must contact the Fire Department
+
Planning & Engineering office to schedule an appointment for a Fire Safety Inspection. You must be
Canyon Lake
present at time of inspection.
Coachella
It is prohibited to use/process or store any materials in this occupancy that would classify it as an "H"
Desert Hot Springs
a
occupancy per Chapter 3 of the 1994 Uniform Building Code.
Indian Wells
Repair work and/or maintenance using open flame equipment, welding or the use of Class I,II, or III -A
Indio
A
liquids is prohibited.
Lake Elsinore
a
La Quinta
If 1 or more heads are added to the fire sprinkler system, plans must be submitted to the Fire Department
.01
for review along with a plan check/inspection fee. All areas must be covered by fire sprinklers.
Moreno Valley
Palm Desert
An modification of the Fire Sprinkler system must be done by a licensed sprinkler company,with plans
approved by the Fire Department.
Perris
4
Rancho Mirage
In a sprinklered building you must maintain an 18 inch clearance from bottom of sprinkler head to any
s
shelving or stacked merchandise.
San Jacinto
w
Temecula
FIRE EXTINGUISHERS:
A minimum 2AI013C Fire Extinguisher, (State Fire Marshal Approved) must be mounted in a visible
location within 75' walking distance from any point in your building or suite.- Fire extinguishers can be
Board of Supervisors
installed by a licensed extinguisher company with a State Fire Marshal service tag attached to the
extinguisher, or purchased from a retail store with a sales receipt attached. Extinguisher must be serviced
Bob Buster,
District 1
yearly by a licensed fire extinguisher company.
•
John Tavistrict rict 2
D
District
Electrical Panel box: All breakers must be labeled and a clearance of 36 inches must be maintained
around the panel at all times.
Jim Venable,
District 3
Roy Wilson,
EMERGENCY SERVICES DIVISION
District 4
PLANNING SECTION
INDIO OrI71 E
Tom Mullen,
43-209 Oasis St., 2nd Ft. Indio, CA 92201
District 5
(760) 863-8886 FAN (760)863-7072
To: World Development April 30, 1998
Approved building address shall be placed in such a position a to be plainly visible and legible from the
street. Said numbers shall contrast with their background.
A durable sign stating "This door to remain unlocked during business hours" shall be placed on or
adjacent to the front exit doors. The sign shall be in letters not less than one inch high on a contrasting
background.
Please contact the Fire Department Planning & Engineering Staff for final inspection prior to occupancy.
Applicant/installer shall be responsible to contact the Fire Department to schedule inspections. A
reinspection fee will be required if more than one (1) inspection is necessary. Requests for inspections
are to be made at least 24 hours in advance and may be arranged by calling (760) 863-8886.
All questions regarding the meaning of this condition should be referred to the Fire Department Planning &
Engineering staff at (760) 863-8886.
WB/jp
Sincerely,
RAY REGIS
Chief Fire Department Planner
By
Walter H. Brandes
Fire Safety Specialist
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