0208-139 (BLDG)LICENSED CONTRACTOR DECLARATION
1 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
483630 A 1 ra;131/2(
D_.Signature of Contractor�rrt �' - �Z,t ifi "�•"
w
OWNER -BUILDER DECLARATION~�� f11e�
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 S�rA`rg P1xop, Policy No. 044- i1UNIT 00.1930
(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, Ins ail forthwith comply with, provisions.
Date:'I•• 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.
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. •rr ,.
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 perm,t•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 applicatibn. 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 propeoy..Jor inspection purposes.
Signature (Owner/Agent) �t `� + t e F m �i� Date • L 1
�. ,
PERMITk
i-BUILDING PERMIT
DATE `z , VALUATION AALOT ` ' TRACT
JOB SITE
ADDRESS (AM DRIVEAPN
653-1-01.
OWNER
CONTRACTOR / DESIGNER / EN INEER
LA:101.el,xm
f9LAND VAMEY Sr'OW4SMUCT1014C7 r0,140i
44-4� ?N1-;UM—M bit
SWVFR 4v?x
(90W)875,2112 0113LO 65(Yr
USE OF PERMIT
M41 r .
COMMERCIA•L,-AT.1 UNMANNED CE*LL4 U'fFhf.lA1!`HUIIXIIEN } 40
"nt7,t '<. -d si4"G`.E�i�ltly i?; 'F - I f:L''1d `t3�1lCxi�?AI� '4Stt 220
`J`QPT. to :Penh a 0,409.019. �
PORCH&A'TIO 220,00 SE
tvCY3vf' RAC,`i' AMOUNT 62,074.00 i.S
�.°0�°�Jl� OF CONwT�`�.i`�Cyw�.'ION �'
..
� 4ra,(3W,t
^ry�� YY��yypp��,,tt pp r,• 17,,1 p({- pES'�MATUD
.Z"1`i.fV.i.Y.3, is 31.L• C15..�. ,Y .::.. .... .. .. ' .�....
YS
C:f)NSTIKICTIO1 PEE 101-000-418.000 VU00
PLAN CHLI .K.1V9
MECHANICAL PE'E 101-..000421-000 040.0
ZLKC TRICA), I 101-000-420-000 '001.00
S113ONO IMOTION FEE. � COMM 100-000241-000 st;o
i .
ORALFMf1TE '.ot-JCd`r23-600 $13.01)
.ART IN PUBl:I.0 PL ACI,S - COM? 2,70-000-445-000 $325.00
SU R-.i'OTALCON'911RUMdlY,.wr�¢¢'��•].A66f���ffl1yq3nr�����t✓Tq"i E
$1,268.41
4.P
IX)TAU, 11MWr Y031)10E. IOW
SEP 2 4 2002
QUINTA '
CITYFINANCE
DEPT.
RECEIPT
DATE l
BY�-- r
DATE F ALED
3
INSPECTOR
INSPECTION RECORD
s , 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
— a
�,�
Compressor
Insulation
(
L
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
4
27,
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:
d 3 • �Gl�
` c,J `�•_�� �/
lrp
r
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)
� LA QUINTA
�UILDI S FETY DEPARTMENT
QV�t�P -7012
Fd CTION REQUEST LINE'
— > 777-7153
Owner ✓ LA OI11 N'I'A H(I'1liL K1L
Contractor INLAND VALLEY CONSTRUCTION CO, INC
0208-139
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
49-499 EISENHOWER DR
JOB ADDRESS
- ATT UNMANNED CELL EQUIPMENT
BUILDING. 240 SQXT. S-2 OCCUPANCY, TYPE V-N
CONSTRUCTION W/ 220 SQXT. TRELLIS.
SUPPLEMENTAL TO Permit # 0209-019.
TYPE OF INSPECTION
DATE
INSP.
TEMPORARY POWER
SETBACKS
U/G PLUMBING / WASTE
U/G ELECTRICAL / GROUNDING
FOOTINGS / STEEL
CONCRETE SLAB
O
DO NOT POUR CONCRETE UNTIL ABOVE SIGNED
ROOF NAIL/ PRE -ROOF
OKAY TO WRAP
ING COMBINATION
, .62_
UGH ELECTRIC
ROUGH PLUMBING
ROUGH MECHANICAL
INSULATION
COVER NO WORK UNTIL
ABOVE SIGNED
INTERIOR GYP. BD. DRYWALL
EXTERIOR LATH
�='--
GAS TEST
SEPTIC ABANDONMENT
SEWER CONNECTION
SEPTIC / GREASE INTERCEPTOR
MASONRY INSPECTIONS
FOOTINGS / STEEL
BOND BEAM
POOL / SPA / WATER FEATURE INSPECTIONS
PRE-GUNITE / SETBACKS
U/G PLUMBING
U/G GAS
U/G ELECTRICAL
PRE -PLASTER ALARMS / BARRIERS
FINAL INSPECTIONS
TEMP. USE OF PERMANENT POWER
ELECTRICAL
PLUMBING
CIC WORKS DEPARTMENT
COMMUNITY DEVELOPMENT DEPT.
FINAL / JOB COMPLETED
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
y
Certificate of Occupanc_
t-
i ty •_ o f La Q uin to 4
Bu�ld�ng and Safety Department 7 ' F,yQF�
This Certificate; issuedb.pursuant to ;t/ie requirements of Section 109 of - the Uniform Building Code, _
t,. . - _ - -
certifying thkat; `at'the time of issuance, this `structure ,was in compliance' with the various ordinances'
of the City regulating building construction. or use. Forthe fo/%wing:
BUILDING ADDRESS: �49-499 EISENHOWER DRIVE,
' Use Classification: COMMERCIALCELL INSTALLATION Bldg:' Permit. No ;0208-139
Occupancy Group: rS-2 Type•'of Construction, VN. Land Use,Zone: TOURIST'"
k - COMMERCIAL ,
1 -
Owner of Building: LA QUINTA HOTEL;,KSL Address: 49-499 EISENHOWER DRIVE '� r
City: LA QUINTA,.CA.' 92253 ` s
By: KIRK`KIRKLAND r '
Date: MARCH 18, 2003 ,
- 'Building Official
r _