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0303-303 (BLCK)H N W Osco W � it ~o Z CID O O H ( J D LU LU h a.. rn Z LICENSED CONTRACTOR DECLARATION hereby 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 in full force and effect. r - License # Lic. Class Exp. Date 640934 D I: +•i C11t1 i Signature of QoQyactor j)'I"r`"Ji OWNER -BUILDER DECLARATION 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), O 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. have and will maintain workers' compensation insurance, as required by Settion 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: Cartier k1.ATIGNA L ONIUM F Policy No. 70913P9 (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 t t. if I should become subject tote workers' compenpation`provisions of Se ion 3700 of the Labor Code; qq Sjaa tfnwith comply With thoset p vgIns. ! ! , �ate:1 S U Applicant! 1 Y 913.)(.: Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in. Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application.. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued, as a result.of this applicaton agrees to,, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2.. Any permit issued as a result of this application becomes null -and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and. State laws relating to the building construction, and hereby authorize reprgsentatives of this City to enter upon the above mentio,ndd_pro . rty for in�p`I io ion 'poses. 1 / , r �gnature (Ow n', "` Date BUILDING PERMIT PERM[M3_.1W13 DATE VALUATION V,4,500.00 LOT 164 TRACT :3002,14 JOB SITE ADDRESS 04419 CI11�iGSEA COURT APN OWNER CONTRACTOR/DESIGNER/EN (NEER SHE HOMES SHA HOMEb. S2e1"25y0�A�'IMIRb7. p (� 1ql�j.$¢1 91-Z��t_�'0A//TVI'N.'.-_ CJF.. 62 ; /A� �� l�, Q•[TLl�i'.1'A. CA i22il 1AM l^'1C1.M, CA, 92883 (941�D1�33•ft��G# 5S76 USE OF PERMIT OENER AL BUILDING 61x'1', WALL 149,00 LP UsTn" 'Et:RD Cogr OF G~O:t`t°r".d'[,'.UMON vON:TRUC!TION FFZ 101-004-418=OLy© 63.D0 teD APR 0 3 2003 CITY OF LA QUINTA FINANCE DEPT. (M -TOTAL COprMUCTIOU AHD K" CHECK I.E 2 PRE -PAM 1-M3 TGY].'A . xERt1 IT FEES MMOW :.3I' .90 $15-3,00 $9100 %3f.?il .� RECEIPT I DATE/ � * :� I BY fw ,�'` I �FIN�It�� � I IN OR l 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. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Unes Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 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 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: 4DMainiero, Smith and Associates, Inc-. Planning / Civil Engineering / Land Surveying 777 East Tahquitz Canyon Way, Suite 301 / Palm Springs. California 92262-6784 Telephone (760) 320-98:11 / FAX (760) 323-7893 - e-mail info@mairiierosmith.com - www.mainierosmith.com May 7, 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 122 — 126 and lots 16.4 - 166 are as follows: Very truly urs, Steven J Van, L.S. 6500 SJV:tt cc: - Hector Guzman, Engineering Department Mike Groessl, Shea Homes LAND �% Pad Elevations v � Lot # Address Plan Field Difference 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 +0.02 164 60419 Chelsea Ct 427.80 427.84 +0.04 165 60397 Chelsea Ct 428.30 423.33 *0.03 166 60375 Chelsea Ct 428.50 428:52 +0.02 Very truly urs, Steven J Van, L.S. 6500 SJV:tt cc: - Hector Guzman, Engineering Department Mike Groessl, Shea Homes LAND �% STMJ.VM �0\ v � REG. EXP ` yk r+� N0.6500 OFC W