0004-249 (DEMO)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
,hapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
of
License # Lic. Class Exp. Date
d3 r , dglJi�/F(
Date �-'���'+� Signature of Contractor`����`�'fa..�%!'i,?c�.>ft.
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.
STATE FUND 046-00.00D7229
(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, I shall forthwith comply with those provisions. /
Date: %% t3la Applicant-�hww y,-� /���� �{L
i .V r
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
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
co �truction, and hereby authorize representatives of this City to enter upon
t� above -mentioned property for inspection purposes.
/ /ip
Signature (Owner/Agent) 1< �c•e -tJ ibtil' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OW4-249 TRACT
04121/20C a21;3,Q343S x*
JOB SITE APN
ADDRESS
49v499 FI.F1b',."10WI 21?%'.ME —
OWNER CONTRACTOR / DESIGNER / EN INEER
1 SL DESERT RESORTS,19C
49-499 xW'idHOW.ER DME
IA Qt.]WA CA 92233
USE OF PERMIT
DEMOLI ON
ttJR- AU'i'tJdaYAW,19C,
71321 110-1WAY 111, SUITE
RANCHOIN E;ACWE CA 92270
(760)776.7579 Cti4 03864
MULLIUAN'S BAR AT LA QUINTA RITSORT & CLUB: REPADV ; INTERIOR
FINISHES
VAWATION
206000.00 l',
'.ES7.Th7ATXD COST OF C0Jg'RtTCiT0N
1'h'dW3r~' 1f'M S BAWARY
'VEMOU'PION FEE 101-000423.000 MI-100
J
S'UB=CC1TA.L CON b' fRUC'ti I -ON AND PLAN C. * CK
TABS PRE -PAID MES
RECEIPT I DATE
20,0W.00
r
^ '
L ♦
$45.00
ICU.00
S45AD
DATE FINALED I INSPECTOR
C,
0
7
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.
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate, Lines
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
Final
BLOCKWALL APPROVALS
Set Backs
Footings
Bond Beam
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underaround Electric
POOLS - SPAS
Final
I
I
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
Fncansulatinn
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Tema. Power Pole
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
I_f I t • (, U 1 .1. ' I yf , U 11 f 1 . f ,' i r•31-IL • U �
r
Bin.:p.::.:
City,of La
QuInta -
.
h
Building 9 Safety Division
ti P.O. Box 1 SO4 V'
-Pe
78-495 Calle Tampico J
La Qulnta, CA 92253
Building Permit Application and Tracking Sheet
Ffro�lectAddress: 49 499 Eisenhower.Dr,.LQ 92253
Owner's Name: KSL.Desert Resorts' Inca
A. P. Number:
Address:r 49 499 !Eisenhower Drive
Legal Description
City,ST, Zip: -La Quihta, CA 92253 • ,
Contra'
Telephone: ,760-777-4855
} �'
GJR Builders
Address:
PojecDescrition: Mulli an's.bar at La Quinta
City•ST,Zip: Rancho -Mirage; CA' 9227.0
'Resort & Club':-- Remove` interior finishes,
'
Telephone; 7767579~
including bar—& bar equipment, wood floorin
State Lic. # : '
'CityLict tr: N.`: k
bathroom fixtures and,.tile, custom) casework
Arch., Engr.. Designer: .N/A.
handrails, sound system etc. ' No ' structural
Address:
changes.
City. ST. Zip:
Telephone:
r.. $Construction
,:� k} Sn die ) 34. �'!'
Type: Occupancy
!L ••
State Lic,:
fb
Project type (circle one): New Addf n Alter Repair Dcrao
Name of Contact Person: 'Andrea Mock
S9 Ft' 3000
Stories: 1
H Units:'
Telephone b of Contact Person: 760-777-4855
Estimated Value ofProject: '$20, 000. "
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