0312-262 (MISC)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 effect.
License # Lic. Class I Exp. Date
Date Signature of Contractor
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). r
O I arrvexempt under Section B&P:C. for this reason J
Date/;K_ 1 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
Section 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 'S 3U13 L1. Tr Policy No.
(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
subject to the workers' compensation provision's of Section 3700 of the Labor
Code¢_Idall4ofthwith comply with those provisions a --tr
Date %1 i pplicant,"/ -t f 4.
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 ins ection purposes.
Signature Owner/A ent) -t ( 9 L..
Date
i
BUILDING PERMIT PERMIT#
DATE - VALUATION LOT TRACT
�SiO 29909
�•�
i
JOB SITE`
ADDRESS 6(k SATA ROSA PLAZA
- •.
OWNER
CONTRACTOR/1' INFER
SAITIVA ROSA.PLA7—A.0 r` - CiAN E%iC.9WN
U'WAI`M -BUILDER
PO BOJ 1503
LA QUINA C.A. 92253
�) CbL83
USE OF PERMIT
Z-,UPPLXMD4TAL, TO PERMIT 0301.113 TO REFLECT CHANUe OF
COM'r)r ACTOR '; O OWNER SUIUD9R,
ESTMAI® Cc» OF CONST7CON
PERM, pFRF S M MCL
3UPPI.�'Ar11.°NTA1, PEPA1T F9r1- IM -000-423-000 $4.60
]PI kN' OTIF-f`I
$4.150
LE33 P.►27 -PAM YS
01(xC
TO"1'AL P:I;RWT TI;YS IDTTE ISSM
RECEIPT
DATE "?
BY - ,• '
DATeFI ALED
INSPECTOR
4/
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
.O �,', ,
Exhaust Fans
O.K. to Wrap
— T
F.A.U.
Framing
_ 2. 1, p14
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
5 -014
Drywall - Int. Lath
�?
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS
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
COMMENTS:
/Z -t9•o3 ST.
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole `
Underground Conduit
;lough Wiring
Low Voltage Wiring
Fbdures
ain Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �Q
erffica-te� `of Occu :ac r#=�
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of }" F Building & Safety.Departrri;entr
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-Thin, Cbrtif cate7is.,is"sued"'pursuanf_to.'the requirecnents-of, ecfion".109 of�the California Building'"
Code,- certifying: that; ."at '-the``time of issuance, this,' structure was in ` complianceY with the
provisions of ,the .Building Code�aod the--various-ordinances of= the 'Ci re ulafifi building,
tY g' g._.
construction and/or use. 3
BUILDING ADDRESS: 50-600 SANTA" ROSH<P
LAZA LLC B-17" ,U-1 {
Use-clas5ifi_cation: SINGLEfAMILY:AT.TACHED- - y T Building PermiVNo.: fl312-262
.Occupancy Group: R-3 ' Type of Construction: W. N
Land: Use Zone: VC
Owner of Buildind-SANTA ROSA PLAZA'LLC Address ' P.Oe BOX 1503 '
City,:ST,,ZIP: LA`QUINTA.
' t _ CA 92253
T
By: STEVE.TRAXEL '
_ s Date: 8-17-2004
Building' Official
` POSTIN A CONSPICUOUS PLACE
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This Ceitifieate~is issued.;pursuant�to. the#requirements of.Section1.109;of fhe California Building
r(Co'de certifying: tha : at =the #irne'. of : issuance, ,this' structure,' was in compliance with the t
.. varous ordinances of.-theCtegprovisions .of ihe,Buil,ding Code,.and-the lating building
constuction and/or use.
BUILDING ADDRESS 50=600 SANTA ROSA PLAZA LLCB-47 U-2`
Use.ciassification. SfNGLE- FAMILY'ATTACHED: Building Permit No.: 0312-262 ,
;Occupancy Group: R=3 Y Type-of'Constr'uct_on: Vy=N' L nd°'U Zon
- a Se e' VC°
Owner of 9Bulldin SANTA ROSA PLAZA LLC •., ;; :, ,. � � _ � `
Address: P.O
BOX f603 -
Ci
503-Ciy
ST ZIP: LA QUINTA. CA 92253~.
STEVE TRi4XEt
Date: -8-17i-2004741-1
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Build'ingROff cial`
'} POST IN'A`CONSPICUOUSrPLACEnouI
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�;, This Certificate `is issued-pursuant-'to.,the• requirements of Sect on J09"of the Californ aY Bu�ld�ng `
Code, certifying_,.tha4 -at: the time of issuance.,'- this structure. -was- in compliance _ with ;the."
provisions -of the Buildingf Code :and theYvarious ordinances of- the: `City r,`egu%acing building
construction and/or use. a
SOILDING ADDRESS, -600 SANTA ROSA`PLAZA LLC B=17 °.11.-3
Use classification: SINGLE FAMILY -ATTACHED .:4 Buildin°g'Permf No:: 0312-262
' � c
- Occupancy Group R=3 ' `. T, .—cf.'Constructlon: V lNr ,,Land -Use Zone: VC
.Owner Of Building: SANTA ROSA,PLAZA.LLC z _ Address-. P.O:..'BOX 1603 -
ng:
City, ST; ZIP LA-QUINTA�CA;92253„ y
By:'STEVE TRAXEL
�: �,.., !b'i't..• ;. D
ate: 8-17-2004
:Building Official.,-
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} . ' POST IN A CONSPICUOUS PLACE
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oF - Bci�ld�n & 4Saf t :D m - Mrd
This Certificate-'-Is issued-pursuan' Uto. the-requirements of, Section 'l09 of=the,. California•Building +
Code, certi n that � :" at the -time of `:issuance this 'structure was in com 1►ance with the -
fY 9 p. " {
- visions. of lhe� Building Code and; the 'various" ordinances-:of the�;Ci °
p g ty' regulating building
construction and%r, use. ..
BUILDINGrADDRESS- 50=600.,rSANTA.'ROSH PLAZA LLC -•B-17 1J4ri
U1 a classification-SINGLE`,FAMILY ATTACHED . y.:> ' "Building'Permit :No :.0312-262
Occu anc Grow R3
p y , p: - Typeof Construdon: V' -N - and Use Zone-, VC
Ownerof Building:,SANTA ROSA PLAZN'L` LC x �. ' ° J ` Address: -P.O.-BOX 1503r " =r
'Cit;`ST, ZIP' LA.QUINTA: CA 92253,
=� By :STEVE YTRAXEL
• •a •date: 8=1 T-200`4
rt Building Official' *r.,
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POST.IN A.CONSPIC000S PLACE
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TC:erfifica te. of Occupancy .
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GoF9,'Buffd�ng & Safe
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iThis wCertificate is, issued. pursuant to the requirements of Section: X09' of the California Building
Code, 9
certi �n that, ==at the 'time` of. issuance, this. structure was 'in compliance with the
fyi
.provisions of: the, Building Code and:. the:. various ..ordinances" of the ,City regulating building
construction and/or use.
BUILDING ADDRESS: 50-600 SANTA ROSA-PLAZA LLC 'B 17 U-5
Use-classification .SINGLE FAMILY- ATTACHED = Building Permit No.. 0312462
Occupancy Group: R-3 Type of Construction: V -N rt Land Use Zone: VC
Owner of:Building:• SANTA.ROSA-PLAZA•LLC s -Address: P.O.. BOX 1503''
f - City, ST,-ZIP: LA QUINTA,;CA 92253 ;
• ,,' _ .: x
-,By; -STEVE rTRAXEL
_ zr a ,:}' y' • Date..!147-200.4 ,
Building Official.:;' t
t�POST.IN=A.CONSPIC000S PLACE 1 '
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3 i�s..k� Certificap.OF; ;,:'B ild Saks v -De a, r"n t= -4This, ettifidatejs.is'sq6d pursUant,to -the req'yire'mentsof�-'Sbction,"109,,,of the Cafifbmia Buildinyi ng - thatj at I e. . ., ttif 'th— Jn copfphance; with theCode, ce th�t._. pf4tsuance, ts,s(fucture, -was,-the Buildifig-_Code4nd the, v�ieio' h§:,of Ci ':re u1atfti_q,bLfi1din4provision of' wtlordnancctY g-kuse.,doastr06tion`6hd16iUILDING AQDRF� S- 50-600 AZA LLC'-B.!..17SANTX 0SAPL u40 -26Z'Use.cl6ssificati n."SINGLEOAMILYATTACHED --�0312- Building _6('Mit No.._0'Land.UseZbfie: VC
dcupaocy Gr.O* UP: Ty e of C6nistr'.1.16tion: V -Np"Address:RD- BOXI 503 - -66 PLAZAILtOwn .6f Buildihg-� SANTA ROSA-;STjzlp: LA QUINTA, CA 92253
XEL',By- STEVE TRA
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.Date=8=17r2U0
,'Build jhq -Officigl
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POST IN A CONSPICUOUS PLACE
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rtific-aMfe a.l1..0
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OR
r of9 r 4 ,ta +BuWding & Safety_ =Depar'tmen t t
This Certificate is° issued pursu~ant'to ,the.requirements of Section, the>>California Building
. ..
certifying. � that, at: the, tiMe- 'of issuance,. this structure, was it), with 4he `}
provisions- of •`the .-Building Code And, the hvarious -ordinances of. the City regulating building
construction and/or, use. w
._.ADDRESS 50-M0 SANTA ROSA PLAZA LLC B 17`..U.8
6UILDING-
Use classification: SINGLE FAMILY ATTACHED ,�,-Building Permit No:: 0312-262
-_,:.Occupancy Grbup: R-3' t - ~ Type of Construction: V.: -N .. Land Use Zone.-'
ti
:-Owner bf BuildingSANTA ROSA PLAZA LLC . 1- , + " Address-,P.O.,BOX 1503' z.
y4 City,`ST,, ZIP: LA QUINTA,CA _92253
r ,
By: STEVE TRAXEL
7� Date: 8-1.7.-2004
f Building Official
...
Post.'IN A cONS�ICUOUS PLACE.' _ . •.' r. ... r is .. ..+'