0303-295 (BLCK)LICENSED CONTRACTOR DECLARATION
"uj 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
C` CV W Professionals Code, and my License is in full force and effect.
O =) ch License # Lic. Class Exp. Date
dLLJ 640934"l)
40934 /Wo/J3
o Z r --Date, Signatur . of Contractor �� �`-
co O.�
J U (:) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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).
co () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
OC
CL Q WORKER'S COMPENSATION DECLARATION
o 2
Cc I hereby affirm under penalty of perjury one of the following declarations:•`'
O () 1 have and will maintain a certificate of consent to' self -insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q L) ( )° I have and will maintain workers' compensation insurance, as required by
O C) Q S ction 3700 of the Labor Code, for the performance of the work for which this
LO Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier NATIONAL UNION Y' Policy No. 702:1379
Cb 5
� O
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'subi.ect to the
workers' compensation laws of%California, and agree that ifI should become
subject , o the workers' compen°sation prrov isi
CodeIhafUort
ons off'Section.3700 of the Labor
lt hwith comply with thns. ose ppVp,0Yp % 1
Applicants i a..41`k=-'z.��"�
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
pro '/erty_for inspection purposes.�( t d
Signature (Ownerr/A'gentjf+V � 1"Y)
Date
BUILDING PERMIT-�. PERMIT
y1"
DATE VALUATION S }40(),0,D LOT 126 TRACT 30023
• � 3
* /. -3JOB
SITE
ADDRESS 81•-747 73Rt'1r fLEBCAWS 1 LSF 1VE
APN
OWNER
CONTRACTOR/DESIGNER/EN &NEER
SHFA HO fS
MU A HO2wtl+;S
01.260 le SUE 62
81-260 ANtMKM 62
LA.QUINTA CA 92253
'THERMAL
CA 92983
(90x',833.6996
t:I3Z# 6876
USE OF PERMIT
C:#YNEMAT BUILDtA1G
9h Jldr b' URI :Z�N WAL.L, UXci.'U N YJ 1'irg. 11ILK 1.:UL) & 1i11tUV LIU JILANS
'Eis1.II4!IAnTKU COW OF CO,IiT.4".I.IRUCT,YON
$ 6-41W.00
DEMI' V u�'S &a'OJ'�f�i 1ARY
CONSTRUCTION ME 101-000-418,007 $33.00
APR 0 3 2003
CITY OF LA OUINTA
FINANCE DEPT -
EPT.SUIE
SUE 40TAL
40TAL i:'M"lt3?'€3'C.nON AND PLAN" CIZCK
$33.00
LESS PRE -PAtDFFEC,N
50,00
wax, PEkmrr irns Due mow
RECEIPT
DATE
BY
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
POOLS - SPAS
BLOCKWALL APPROVALS
steel -
Set Backs
Electric Bond
Footings 5 . D3
Main Drain
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
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)
Mainiero, Smith and Associates; Inc.
Planning / 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@mainiero§mith.com www rnainierosmitlixom
May 7, 2003 0 -TA
Department of Building"and Safety , MAY 3 REC'n
CITY OF LA Q.UINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Form Certification
Tract No. 30023-2
Construction Ss^::ence 1-F .
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 127 -
135 and lots 167 - 171 are as follows:
Very truly y rs, OND
S
o
L S�ENJ.VAN �
v
Steven J Va , L.S. 6500_ REG .EXP
SJ V °tt NO.6500 �Q
cc: Hector Guzman, Engineering Department FOF CAI��
Mike Groessl, •Shea Homes
Pad Elevations
Lot #
Address
Plan
Field"
Difference
127
81759 Brittlebush Ln
426.90
426.87
-0.03
128
81771 Brittlebush Ln
426.20
426.18'
-0.02
129
81783 Brittlebush Ln
425.40
.425.39
130
81795 Brittlebush Ln
424.70
`424.70•
+0.00
131
81807 Brittlebush Ln
424.10
424.12
+0.02
132
81819.Brittlebush Ln
423.40
423.41
:+0.01
133
81831 Brittlebu'sh Ln
422:60
422.61.
+0.01 .
134
60356 Sweetshade Ln
423.20
423.20
+0.00
135
60334 Sweetshade Ln
423.70
423:72
+.0'.02
167.
60380 Chelsea Ct
428:50
428.53
+0.03
168
_
60402 Chelsea Ct
428.,10 428.12
_
+0.02
169
60424 Chelsea Ct
427.30
427.29
-0.01
170
60351 Sweetshade Ln
423.50
423.51
+0.01
171
60329 Sweetshade Ln
'424:10
' 424.18
+0.08
Very truly y rs, OND
S
o
L S�ENJ.VAN �
v
Steven J Va , L.S. 6500_ REG .EXP
SJ V °tt NO.6500 �Q
cc: Hector Guzman, Engineering Department FOF CAI��
Mike Groessl, •Shea Homes