0009-074 (RC)LICENSED CONTRACTOR: DECLARATION
I f eby affirm under penalty of perjury that I am licensed under provisions of
kChapter 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
ate M AA a° Signature of Contractors
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
Lipehse 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 withslicensed
contractors to..construct the project (Sec. 7044, Business & Professionals
Code).
() I am exempt Under Section B&P.C. for this reason
Date Sianature of Owner '-
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the fcffowing declarations:
r ( ) I have and will maintain.a,,certificate of consent to self-insure'for workers'
pe comnsation, as provided for by Section 3700 of the Labor `Code, for the
performance of the work for which this permit is issued. ? .
(.>,11 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).
O 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 9s 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 those provisions: I
Date: & , / ^ Applicant" / f' d r)1.Yi�
`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.
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
perms ;;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:=):.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.
t.Signature (Owner/Agent). ,!t�1��' Date rye
/IV �..
-BUILDING PERMIT PERMIT" ;
Y
DATE (( " VALUATION LOT �_'y TRACT
E @`Saw
JOB SITE S
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
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55-92V .5�L.YCL.JI.��iY�'Y1) -,
f.`A 92253
LAQVIWA CA 9225-3
USE OF PERMIT
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N��'I`�:S'1'1�3�i't')O�,1€�'pF J'A�7ulp:F.i�lG D PEFt 19"
Gt3D §304.3 FOR I3y00K.. Ry414, N Wt'1`ilOUT I3LYYit01140 PRRMIT
7'PALUJ9lTION '.. . KNNOX LS
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1'1 w t _q "K 41799. 101.000-439.318 S 5"i,lit
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C 0*0T1'?.ur.T1/..1W FEW 201-000-418.000
i'�I�FLS�'I�IC'!'C1C}1~? �;;�..� 4CY8�QG+Lt-�o-2:?"•rb :� ��fl�.:50
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kiFS#.14(Jr J, COk3 3'i.E+}IT .. SON SAND PLMT rur '.Ys°.
$1 j506. f 8 .
1 M-PS+.1s'11S
$0100
RECEIPT
DATE
�
BY
.na fjt
DATE FINA LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
..
Vnderground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans .
O.K. to Wrap
1
F.A.U.-.
Framing ""
Insulation
7-
Compressor
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
/ L?- O
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
Elebtric 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)
^v'y' •1: L<_ this, I rUl'1 Lei ULIIIllii
U
f
City La
of Quints -
Bulldin¢ u Safety Dlvlslon '
P,A. Soz 1504 ,
78.495 Calle'Tamplco r "
8'
La Qulka, CA 92253
Quilding'Permit A placation and Tracking Sheets .�
Project Address: 49 499 Eisenhower Dr. -L
Owner's Nante: KSL Desert- Resorts:;... Inc.
A. P. Number:
-Address: 49 499 Eisenhower Drive
Legal Description:
City,ST, Zip<: La Quinta, CA 92253
Co o Owtier/Bui� der
Telephore: 760-777-4855
a a. .....:> ::
i%
Address: 49 499 Eisenhower Drive
Prolact Description: Tenant Improvement of space
Cih.ST, Zip: La Quinta, CA 92253 ` ' <"
on the Plaza at La Quinta Resort & Club.
Telephone;
u 777-4855
?'f 5ia„�� ia'IR i'""'i r'• a:
Build partition.wall
p s for offices, revise
CityLic, a: 4
lighting. New carpet -furniture -etc. '
,Arch.• Engr.. Designer:' Flatow. Moore. Shaffer McCabe
_
Address:,809 Copper Ave NW "
city. ST: Zip:, ' Albuquerque,' NM •87102
' -
Telephone:' 5,05-766-6610
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Conetructlon e: `
Occupancy:
'
_ .
State Lic. +y:
:t;:EJ:, fsra>.i'>Nt;Sa'�f
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Project tyre (circle one): New Add'n Alter' Repair . Demo s
Name or Contact Person:. Andrea Merrill —Mock,
S9• Pt•
M Stories:
N Units:
Telephone a of Contact Person: •.760 . 777=4855
Estimated Value of Project: ' $80 000...
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