0105-121 (MISC)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 Date
Date 6 Signature of Contractoro,,�J,/ T
UILDER DECLARATION
I hereby affirm under penalty of perjury that,.[/am exempt from the Contractor's
License Law for the following reason: i
( ) 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.
ST k AUL MIR :t mAE
(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 prov{M—ons of%Section 3700 of the Labor
Code, I shall forthwith comply with those provisiorism--_--_• -
Date: "�! ��� Applicant--, ". rr •. >�
Warning: Failure to secure Workers'�Compensation coverage is unlawful and
shall subject an employer to crimink'penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize _representatives of this City to enter upon
the above -mentioned property.•for IInspec'tion purposes.
Signature. (Owner/Agent). Z=-•.....•-- Date �''�- �t
..-. M-•..•..•tea"'-'"'...-..,.,• . r
BUILDING PERMIT PERMIT #
DATE f VALUATION LOT 5i� 11�;g, TRACT
/�
JOB SITE "'
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN INEER
,X< .Q"t.61MAHOTEILKS.L
HR0 01UM 0 1TF.17�.�.-ECO C
49-4,99 =M-IMMA DR.
]sO. OX.1 496 r .
LA QVMTA. CA 9225.3
TWAR, ULA C.P. 92593
(909)694.4114 CBL#
USE OF PERMIT
'1fXrYflr$.NN11'90 IGCUL S71!'TE PFR. atPPrtiit,7 EZ) PLA14N ONLY
d;.'0.Tf 0? 'C'ORRMU TI'ON
45:
�.>XST(KAMr0
SO.rf IM1a`A`JJLR �8 {l�/.U.R44
CIONVYWCVOR MIR; a 01 9-0001)
S`3'Rt;)NO MOTION VeK - COMI•9 1 Of)-OW-241-000 PAS
r
J6-Tcrk1, COY4 '`.Cf014.1qD aLA9i`..JF
1ZSZ PRE, -PAW Fr
vo
J I J U L - 9 2001T
i CiTY OF LA OUINTA
FINANCE DEPT
;
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
A')
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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
Final
Final
POOLS - SPAS
BLOC.KWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
''"
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS.
GaiTest
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
I Gas Test
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)
Jul-09-02 12:50pm From-BROOKSTONE
� CI �0 LA QUINTA
OF I BUffP_DIN �Ir.- ETY DEPARTMENT
I d -7012
- SP 6 N REQUEST UNE
-� " -71S3
Iwner A H TEL KSL
permit Number 0105-121
POST ON' JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
OB ADDRESS 49-499 EISENHOWER DRIVE
UNMANNED CELL SITE PER APPROVED
PLANS ONLY
TYPE OF INSPECTION
DATE
INSP.
OUNDATION & SETBACK
OOTING STEEL
IAIN GROUND SYSTEM
ROUND PLUMBING
-RE-GUNITE
-O NOT POUR CONCRETE UNTIL ALL ABOVE HAS SEEN
SIGNED
ONCRETE SLAB
DISTS & GIRDERS
LECTRICAL GROUND WORK
O NOT POUR CONCRETE UNTIE. ALL ABOVE HAS BEEN
SIGNED
OUGH ELECTRIC
OUGH PLUMBING
OUGH GAS & GAS TEST
EATING & VENT - A(C
REPLACE
OOF
OND BEAM
_K_ TO WRAP
ROUT ❑ 4' ❑ 8'
TAMING 013 44,NoF
t5p —cot
-7rl
ISULATION
:tE-ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
nvu/A! I INTGl2IfiQ
KTERIOR LATH
DOL PRE PLASTER
DOL FENCE & GATE
FINALS
LECTRICAL
�uMBINa •
NAL GAS TEST
EATING - A/C
DUSE NUMBERS
)8,50MPLETED
=MP POWER
9096944113 T-943 P.002/002 F-579
VCl _ F LA QUINTA
BUILD SAFETY DEPARTMENT
FP
3 777-7012
I � IN �TION REQUEST LINE
777-7152
HOTEL KSL
Permit Number VJLV /-1V /
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-499 EISENHOWER DR
SUPPLEMENTAL TO PERMIT 0105-121 TO
REFLECT ELECTRICAL FEES
TYPE OF INSPECTION
DATE
INSP.
FOUNDATION & SETBACK
FOOTING STEEL
7 - V, a
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN
SIGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN
MGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING op
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
i
i
Bin
City of La Quinta
Building 8i Safety. Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet =
Permit #
/ r ��
I
Project Address: 7 .� �g E�S�NGvYi�
Owner's Name: t
A. P. Number:
Address:
Legal Description:
City, ST, Zip:
Contractor: �- /
Tele h one:
P
Address:
Project Description: - oT�t s r
City, ST, Zip:
Al
��tro.atvn.
Telephone:
hone:
✓� Ci.e
State Lic. # :
Arch., Engr., Designer: HSA
City Lic. #:
\`P
Address: 60/.2O i�•r�t /Nib �A �✓/'����
S
City, ST, Zip: 5�i`� O
�i4 _ ���
VI (-
%STelePhone: '��O
StateLic. #: C -- 9 7 97 '•'
Name of Contact Person: - O)N/,) LE&O FZA4A '
Construction T e: Occup
Pnc Y
ancy: YP
Project type (circle one): Add' n Alter Repair. Dem
mo
o
Sq. Ft.: S� # Sto ' Units:
Telephone # of Contaci Person: `j
9 F/3 c 3 f i
Estimated Value of Proj
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERIIIIT FEES
Plan Sets
Plan Check submitted
�8
Item
Amount,
Structural Calcs.
Reviewed, read corrections
Plan Check Deposit
-15--
ss Calcs.
ijitl 24 Calcs.
Grant Deed
&c ool es
ubcbntactor ist
Planning 1pproval
i
\
Called Coon act Pers n
Plans pAed up
Pal n�vesubn fled /J
2 lRevie ,ready fo j a�orrections/is a
Ca11edAContact Person
sPians picked u
/
Plan Check lance
onstruction�
Mechanical
Electrical
tPlumbin /
O , 50
Pub. W s. Appr
Plans resubmitted
Grading
H.O.A. Approval
'"' Review, ready for conrec 'ons/issue
Developer Impact Fee
�---
Called Contact Person
A,I,P,P.
Date of permit issue
Total Permit Fees