0306-112 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
:3 ch License # Lic. Class Exp. Date
r— QL
r- 656128
fl -
oZ r- Date ' - D Signature of Contractor t; "_�•- �' `'�� .r ay �'
CD O
J U CD, OWNER -BUILDER DECLARATION
W W I hereby affirm under* penalty of perjury that I am exempt from the Contractor's
~ a License Law for the following reason:
Z_ ( ) 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).
C'') () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
0)
d Q WORKER'S COMPENSATION DECLARATION
o Cc I hereby affirm under penalty of perjury one of the following declarations:
Lo O () 1 have and will maintain a certificate of consent to self -insure for workers'
X UJ �= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q U "'..itl- "have and will maintain workers' compensation insurance, as required by
O U Q SeCtion 3700 of the Labor Code, for the performance of the work for which this
Il rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
1t Z
co Z Carrier 9T.A-M. G'OMPI!'ti+ SATI Policy No. 00-6110-200
�a
J (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
3 subject to the workers' compensation provisions of Section 370,0 of the Labor
Code, I shall forthwith comply with thosprprovisions. t1i
Date: ',_2"j," 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.
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 fpr inspection purposes., i
Signature (Owner/Agent) 4f Date IK
UILDING PERMIT. PERMIT#
J
f
2
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
i'Z.t]SP,�YC}3vf3i
141 tV 62
66.1 U<i 1�4 xNYMP
Tffl R.'d ,LI CA 92683
CA,. 92236
00335
USE OF PERMIT
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�1',' !. A 1,11k+q A
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Frf:`01 SPA, 8Sf"' OXI,. LINE (ANS"s x!.21 SF 1995) r x 1..1r: Y 0A.it1: k NT,
1%r'!3?.i y S.'M' rT.AN(til+r:.RD, Af i4k Y&-1DAR1UEW1 kHAU, iir: CJS]' rum'; A1 -S`
:R,r w?1.A3 F R WP12CT iOPa
1tx. i*JAL;, i,! U 1 IY
PGOI.A.7iDlOgSF¢. 17,1'"J.00 LS ,
Zag°'It'x�l. V.�WAT IM COST CI F';i2,1 9.1 tirG"Il't1ON
�,.Al 3 CHECK FEE ).W0 =f�91Q�-4139.31 S $122181 ,
♦
J 00
H1K`11!1rU-.141Q(1L "AP, __1 POOL 101 000-421-f= t1lito
FISE - P;:: 3f.. $0.03
i'...IUMSRa3 FEE - P(Otal, 19) -000-4 a 9-00D
8'131;'s-•'T.cYrAl., C"ONi ;IR.1tMIGN AND pl ikN, CNXICK
X407,1 i
JUN 12 2003
C OF LA IUINTA :
nap?
RECEIPT DATE
BY
DA FI Q
INS R
! ✓
I 1
T.
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
OX 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
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
s
Set Backs
lectric Bond
Footings
Main
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
Mainiero, Smith and Associates, Inc.
Pldnning / Civil Engineering / Land Surveying '
777 East Tahquitz Canyon Way.. Suite 301 / Palm Springs. California 92262-6784
Telephone (760) 320-9811 / FAX (760) 323-7893 • e-mail info@niainierosniiih.com • www.mainierosmith.com
May 13, 2003
Department of Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Form Certification
Tract No. 30023-2
Construction Sequence 1-E
Gentlemen:
This letter is to verify that the following building forms have been checked for elevation and
horizontal location 'by Mainiero, Smith and Associates, Inc. and found to be in substantial
conformance with the approved Precise Grading Plans. Finished floor elevations for lots 121 -
126 and lots 157 - 166 are as follows:
Lot #
Address
Plan
Field
Difference
121
81-687 Brittlebush Lane
431.80
431.78
-0.02
122 •
81699 Brittlebush Ln
430.80
430.75
-0.05
123,
81711 Brittlebush Ln
429.70
429.62
-0.08
124
81723 Brittlebush Ln
429.00
428.98
-0.02
125
81735 Brittlebush Ln
428.30
428.27
-0.03
126 '
81747 Brittlebush Ln
427.60
427.62
+0.02
157
81-858 Brittlebush Lane
434.90
434.92
+0.02
158
60431 Lavender Court
431.70
431.72
+0.02
159
60-407 Lavender Court
432.20
432.23
+-0.03
160
60-387 Lavender Court
432.50
432.51
+0.01
161
60-392 Lavender Court
-432.50
1432.51
+0.0-1
162
60-414 Lavender Court
432.20
432.20
+0.00
163
60-438 Lavender Court
431.70
431.70
+0.00 .
164,
60419 Chelsea Ct
427.80
427.84
+0.04
1,65-
60397 Chelsea Ct
428.30
428.33
+0.03
166-
60375 Chelsea Ct
428.50
1428.52
+0.02
Very trul yours,
Steven J Va , L.S: 6500
SJV:tt
cc: Hector Guzman, Engineering Department
Mike Groessl, Shea Homes
OND SU�L
STEVENJ.VAN F�
v
REG. EXP °3
fJ NO. G500