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LICENSED CONTRACTOR DECLARATION
I 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 ffect.
License # Lic. Class Exp. Date
r 1534 j 6/: 410.3
bate � .Signature of 6ontrasto�
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
S&flon 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 2+iATIO14A1: UMON 7 Policy No: 7183300
(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 a ree .that if I should become
subject to the Workers' compensatioh.provisions ectioa 3700 of the Labor
r ---rte
Code; �. ' al(f h ith comply these ovislons.
ate::-� 4i Applicant t<.1
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 INS 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 buildinlL
construction, and hereby authorize repro entatives of this City to enter,upon
the above-mentioned properthor-i see n purposes. d""'
Signature (Owner/Agent)^-'" Date
PERMIT #
BUILDING PERMIT
DATE _ VALUATION & iD6,�f� M LOT 166 TRACT
ADDRESS 60-:375 C—W.LSE cA CU �r JORSITE
APN
OWNER
CONTRACTOR/DESIGNER/EN INEER
SHEA LA QWNTA,
$ UKA Ho las
60-313 TitTa.00YPAI:ISV AY
81.260 t.MME 62
LAQUfNTA, CA 9225
TFC CA 92883
(QO4)8 33-6996 03T A 6876
USE E OF PERMIT
ff&0 L F'.*AMMY DVM— i.UJG
..ta awe r
WALLF, P001, EPA OR DR-I'VEWAY APPROACH
CUMM CONSTRUCTION 21398,00 SF
PORCHIPATIO 376.00 SF
(JARAGOC,ARPOR.T 733M SF
ENTIMi'i'E D COSr OF CO-N6'.E',rr'ITCUOR
206AW.00
PERWfY, kT SutVDAaRY
CONSTRUCTION TI i0a-(nJQ-41>�C!(10 �1,Iil4.Rit
PlI Id CHECK FEE 141-000-4'39.318 X313.S;�
UPCHANIC,AL FEE 101.000-421.000 $75,00
ELECTRICAL V99 101-000-420-000 $133.53
P1,UMf IWO FEE 101.000.419-000 S149.00
STR.ONO MOTIO21 FEL - RE31D IM -000-2411-000
ORtADiWO I! ER 101.000.423.000
DEV ELOPFR IAAP.L+CT FXE $2,403.00
ART IN PUBLIC PLACES - RESIC 270 -000.445 -COO 81 -6. -sl
Iai. B -TOTAL L03+i'°LI'D.`k2T.1'C'L10PT AND PT d X CY-WICK:
$4,640.55
t-? LE 33 PR P.A@ F M
T1O.UO
MeNQW
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RECEIPT
DATE,
Y
D FIN
INSP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
4zDucts
Slab Grade
Return Air — —
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
m
F.A.U.
Framing JW 71 AALI-A15
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
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 I Palm Springs, California 92262-6784
Telephone (760) 320-9811 / FAX (760) 323-7893 • e-mail info@mainierosmith.com www.mainierosmith.com
May 7, 2003
Department of Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Qtiinta, 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 –
1.26 and 'lots 16.4 -166 are as follows:
Very truly urs,
Steven J Van,. L.S. 6500
SJV:tt
STEVEN'J.VAN,
v
REG. -
cc: - Hector Guzman, Engineering Department J+J, N0'o
Mike Groessl, Shea Homes 0F CAS
U
Pad Elevations
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
Britflebush
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 Ct428:3v"
1
428.33
+0.03
166
60375
Chelsea Ct
428.50 1428.52
+0.02
Very truly urs,
Steven J Van,. L.S. 6500
SJV:tt
STEVEN'J.VAN,
v
REG. -
cc: - Hector Guzman, Engineering Department J+J, N0'o
Mike Groessl, Shea Homes 0F CAS
U