9909-226 (RC)LICENSED CONTRACTOR DECLARATION
hhereby 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 iri full force and effect.
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
-
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( 4 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).
( ) 1 am,exempt under Section B&P.C. for, this reason
ate Z 9,%1119 Signature of Owner Au
Y
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.
() 1 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).
( ) 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
workecs'Ecompensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 37b0 of the Labor
Code, I hall fo hwith comply with.those,provl ions.
late:
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
construction, and hereby authorize representatives of this City to enter upon
the/above-mentioned property for
linspection
purposes.
4nature (Owner/Agent) — /r 0 Date�'
r 7
BUILDING PERMIT PERMT#
DATE VALUATION &m.md.0" LOT TRACT
JOB SITE
ADDRESS 49-499 LUN.f�.ruR'4Va'E.K 1��.IV
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
499-499 EISENHOWER DR
LA 0131grA CA `�2253
USE OF PERMIT
[.:(Ahlii:lll IML icEMOORL
I4f'i!iOliKfil RMIS INO MN.l4M SPAL`'ti Cf-�OftMR-Ri LY CL MWANY 5]ORO) TO
NPW G.iREG IdC7RM11N +.."(.t'4.).lat;"',P1ON 4440P
VALUATION 30.000.00 Litt
fZ'1'EM'trYU0 COSH OF t°ON�►"TR31MON
PEi't14ii T I! RIC SUMMARY
PLAN CHECK 1-`A- )014)W-439-318 $269.43
MECI A01141CALTI.-111 lot _0001-4211 I -ow S«.M
sir
CTi e fP.IC'ElL CxS Lfe:( f30t3 {2()-tat $47.40
S TWCYNQ fk4$,Y1.f0WVEL? - CONDA 100• XXII-241-?Ui) 310.St.I
81.11-1-''I"O<tA1(,fC-)NS'ME[t;'t'Ii)NATJT.1NANCF1EC'K
LESS PRE-FIMI) FEES
so IN
TOTA1, PERM#.'it b"EW% DDIC NOW
/ 1
RECEIPT
DATE/� t/ /`
BY
�
DATE FINALED
INSPECTOR
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
Framing
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
POOLS - SPAS
g BLOCKWALL APPROVALS '
steel,,
Set Backs ,
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover,
Equipment Location
Underground Electric
_
Underground Plbg. Test
Final r
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: ; n
..
a^ , • �,..,.
`y -
"#
k
Final
Utility Notice (Gas)
-
ELECTRICAL APPROVALS v
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)
10/'29/99 08:08 FAX 760+771+4132 CONST BSL RESORT
5 s ,,j,�ITlf OF LA (�l INU
c,�� - BUILDING & SAFETY DEPARTMENT
a 777-7012
Ui SPECTION REQUEST LINE
777-71 s3
Owner K.EtESERT RESORTS INC
contra O WNEEL l BUILDER W/ WORK COMP
Permit Number 9909-226
O POST ON JOB IN CONSPICUOUS PLACE
r, INSPECTOR MUST -SIGN ALL APPLICABLE SPACES
JOB ADDRESS 49-499 EISENHOWER DRIVE
i RENOVATE EXISTING TENANT SPACE
(FORMERLY COMPANY STORE) TO NEW
TYPE OF INSPECTION ATE DIiTE INSP.
na
GROUND
PRE_-GUNITE
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
JOISTS 8 GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETE UNTIL ALL GROVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS 8 GAS TEST
HEATING & VENT- A/C
FIREPLACE
ROOF
BOND .BEAM
O.K. TO WRAP
GROUT - 0 4' 0 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABOVE
HAS BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE 8 GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
ol
PLUMBING
Fl NAL GAS TEST
HEATING — A/C
_
HOUSE NUMBERS
JOB COMPLETED
_
TEMP POWER
001
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING