0304-013 (SFD)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.
G =) C) License # Lic. Class. Exp. Date
R Ir
oZ ti Rates Iv, L '' Signature of Contractor 1 i
OCID-
J U C) OWNER -BUILDER DECLARATION
Ha r—I hereby affirm under penalty of perjury that I am exempt from the Contractor's
I) 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).
cr) () I am exempt under Section , B&P.C. for this reason
4n
N Date Signature of Owner
ON
CD
d Q WORKER'S COMPENSATION DECLARATION
< cc I hereby affirm under penalty of perjury one of the following declarations:
n p• O 1 have and will maintain a certificate of consent to self -insure for workers'
K W LL compensation, as provided for by Section 3700 of the Labor Code, for the
J Q performance of the work for which.this permit is issued.
I have and will maintain workers' compensation insurance, as required by
j U Q Sgction 3700 of the Labor Code, for the performance of the work for which this
L F- permit is issued. M workers' compensation insurance carrier & policy no. are:
It Z Carrier NATIONAL UNION 7 Policy No. 70353099
ono Q
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 3700 of the Labor
Code, I shall -forthwith comply with those provisions.
Date: l 1 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 for.inspection, purposes.
Signature (Owner/Agent)„!: Date
BUILDING PERMIT PERM�ct,s
DATE VALUATION LOT +�-yf TRACT 30�021i'.
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APN 1.111&4_:,
OWNER
CONTRACTOR / DESIGNER! ENGINEER
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60- { 1 1 •P.i� ^�j�� 1 S .l�i?�W.1J,A Y�.�.l.
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131 -2 0 .f-41�E14 \1.L. 6f.•
IAQ( 11.114. CA
TBITINYLL CA ..833
-909>oSi -8996 : }:. # 687
USE OF PERMIT
ltir FJUAHIP:C�WE11.,PeC1
u " !;."t_t 1 444 1. PEAR 04.wc F 11. I r$43127, NO 0i9 "" 7 f,
31Y'.AI&Sti K.)04 aPA OR DRIVEWAY APf'ItOACtf. :1401
f '
CORITAf CTI(V 4769.01U :131,F
pol,vZ(;Kt PA,VO W7.40 5111
OAR A.0VC'.&.R110RT 1119,00 3F
HNI:MWNF.W C.109'' M r;t?NS'i'RIleF c,11`t
�� 44,9 4,60
I;i. XN C11HRT::
IJY 1!UZ0iCAL PSE 101--900-421-000
F.LEC V'11:i(: ti. M7 P, 101-000-420• 000.• Si4 ,Sir
PIWOMWN(l 7P.F 101 -N!041
STROMC, MOTION is 'F ph ;IO 'I i:) _000-1-4 i -000
ORAL'tlFl0 FFIE 1011 -00q)-4 V-a1pL i .atir
D1P,iQL01'XR YMPACT FTPF,
.&PT 11.4 RUYILIC P1a.ACIIul W.i'5II'. 2*70-000 443-M gi�Zs
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00V1 'tRLC':f'10N 111grr PLAI%,� CHFXX
:AL lnTK1R_kffX FESS DUE NOW
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Ll
RECEIPT
�J1T�— '-- `� `
BY
DI D
INSP
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts d:K _1/1Z
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 Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
P®OLS - 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
1A 710
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
X
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 A 4f
Temp. Use of Power 61 X)5r_y7
Final
Utility Notice (Perm)
COMMENTS:
IDMainiero, Smith and Associates, Inc.
Planning / Civil Engineering / Land Survejdng
777 East Tahqui'tz Canyon Way, Suite 301 / 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 Quinta, CA 92253
Re: Form Certification
Tract No. 30023-2
.:Construction Sequence 1-F
Gentlemen:
V
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 trulyy rs, 5�,0 SNC S
�� SIEVENJ.VAN
Steven J Va , L.S: 6500 BEG. D(P 4 '%°
SJV:tt J►� N0.6500 C
cc: Hector Guzman, Engineering Department OF C
.Mike Groessl,. Shea Homes
>at
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
-0.01,
130
81795 Brittlebush Ln
424.70
424.70
1 +0.00
131
81807 Brittlebush Ln
424.10
424.12
+0.02-
132
81819 Brittlebush Ln
423.40
423.41
+0.01
133
81831. Brittlebush 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
1 +0.02
167
.60380 Chelsea Ct
428.50
428:53
168
60402 Chelsea Ct
428A0
428.12
1 +0.02
169
60424 Chelsea Ct
427.30
427.29
-0.01
170 1
60351 Sweetshade Ln
423.50
423.51
+0.01
171 1
60329 Sweetshade .Ln
424.10
424.18
+0.08
Very trulyy rs, 5�,0 SNC S
�� SIEVENJ.VAN
Steven J Va , L.S: 6500 BEG. D(P 4 '%°
SJV:tt J►� N0.6500 C
cc: Hector Guzman, Engineering Department OF C
.Mike Groessl,. Shea Homes
>at