0312-261 (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 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).
O I am exempt under Section B&P.C. for this.reason
Date ^" Signature of, Owner,.
/
y WORKER'S COMPENSATIONrDECLARATION
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:
Carrier SER SU0-LUST 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those -provisions./
,Date: ,Applicant/
_ r
Warning Failure toi•secu.re'Workers'l ompen atio coverage is unlawful and
.Warning:
hall 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.
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Signature (.Owner/Agent) i / ! Date01111-1,
i
PERMIT#
"BUILDING P--ERMIT
DATE VALUATION f LOT r� TRACT
JOBISITE}'r�,��
ADDRESS
APN
.µq0-61 Si T�.A JRC.rSA P�.,AM
OWNER
CONTRACTOR /DESIGNER / EN &NEER '
BA)JTA ROS.A 'PLA .t� LLC - T)AN 7CiFtO kV..'L4
O WN.a. - BUILDER
FO BOY 1503
LA WNTA, CA 92253
►. ,
USE OF PERMIT
MSCE11-ANE,OUrI
SUPPLZMENTA], TO PERMIT 0301.122 TO RI?!*�..LT T CH.MJ:IE OF
CONTRACTOR TO OWNER BIJILDLI:.
E :�AIXD CUhl' OTP C'.CDI'bf,IRUCMON
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P?Fc(IX €"RE 611h.0 ,(e RY
SUPPLEMENTAL PZnJIT Fl?F 101,000-423-000 31.58
STIB-TCYf'AL CO2d8'%€LLI_rc:TJE'.X AND PL,AH CI•ZF�".1rt.
$4.50
1733 PRE -PAID FEES
:fit ml ,
TO`rAJ, J"'LV1V .T Tit'E.E S D CTL NOW
$4.SO
l
RECEIPT DATE
Y1
IV
Dy7¢ FINAL D
Iev
INSPECTOR
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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 Lines
Party Wall Firewall
Exterior Lath . O
Drywall - Int. Lath L • 21 T
Final
Final d
POOLS - SPAS
BLOC A' APPROVALS
Steel
Suet 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:
?isT S• o y i
7
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) - 3 7
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This 6,dkffica#e is.issue_d puirsuant to the -requirements of_Section .109 of the -.California Building
Code; :certifying that, at the ' time of issuance,.. this structure was' in compliance :with":the
Y` .provisions of the Building Codd. -and the -various ordinances of- the. City regulating Building
construction .and/or use.
• , .BUILDING•ADDRESS: 50-610;:SANTA ROSA PLAZA'LL-G B=16. U-2
Use'ciassificatiow- SINOLE FAMILYATTACHED ,:. Building.Permit`No.: 0312-261
(�ccupancy;Group: R-3 Type, of Construction V'' -N "J '` ,Land,UseuZone: VC
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' Owner of Building:' SANTA ROSA PLAZA LLC . '' ss:,:P O-.BOX-1503`�
Addre �+
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City, ST; ZIP ;.LA QUINTA., CA 9225371
-STEVE TRAXEL
Date 8-26-2004 J
'
Building -Official
'POSTIN`ACONSPICUOUS�PLACE
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'Bum'&SafetyDepartment
ioh-109of tfie�.Ci mThig'Ceitificate, Is: issued pursucint-to,the,.-requireiniDnts of Sect lito b6de,_- de thaf;,', at 'M6d 6` 6f iisuJhcp,-,this-�st dture.'was jil witk 4he.
pfiahqq,-of�-,Ofthe,-Builc ing. o e and aoces.� thb-City. regulatin bPA*Visions C9.0donstruction andl6r"use.'ILDINGADDRESS, 5-bu 0-610 SANTA ROSA PLAZA LLC. B46 U-41-nefi it No.: 0312!.261se cls�si icati 3, IdihgPfi idh:,SINGLE�FAMILYAT—TACHi6,'-li�p�Of�Co..Occu pancy up: -A4 nStrpCtj6h:V;Grq Land" We'Zom VC,
dO fB01 d ina:,SA' TA"RO" SA, P LAZA-L0 A drds8::lP-.O.,BOXA503
C T Z R IAQUINTA 'rA,92253,''EIdi bg
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,, C.ertfica te. if Occu
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.This ,Certificate is' issued ,pursuant to the, requirements'.W'Sbcdon. 109%.-oFlie ,California
'Buildihg,
Code,cekifyipg Mat thetimeof issuance,--, 47n--C
omplian ;the
br6visi6ns 'of ;the Building Code and' th ,vanous o'idlfia
nces of-
444fing.,, building
,
construction afidlor'use.
BUILDING ADDRESS: 50-610,;SANTA,ROSA'PLAZA -LLC. :..B=I ->,Q
-5, -
• Use classification:'_u
B. - ,
SINGLE FAMILY. -ATTACHED
Wing,Pefrhit No 0312-261
-- ---------
i0ccupancy, Group: R-3 e Zone-
6ristrubtion,N'-i
_-Type_,ofC --N Land Us VC
LLC
INAOSA PLAZA Address: P 0. B
Owner 6f,Ruil,0jng;.SkN BOX 1503""
'City,
T"ZIP: LAdUINTA.'CA92253,.
By. STEVE TRAXEL
Date r8r26.2004
.
BUMM6,.. Official
=•POST IN A:C6oNSP'I&Q0USRLACE'
yam__ _ f • - .;F .fie 1 ` - -
' t (,Q 'moi F ,'T �--•. -•: (1� i M �I�i�/ II�law,
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-Buildn & Safef Dan
artment
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t This Certificate -is' issued pursuant to. the r requirements 'af .Section ,109 ofxheCalifornia Building
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Coale;, certifying that - at the ifthe 4 of issuance,. ahs tructure was. �n. ,_&ompliar ce v the e. he'�
,
rovisions of tthe Buildn Code and .the : various,ordinances of .the Ci re ulatrn bu�ld�n
P 9 g g, g,:
'Construction and/or'use. "
BUILDING ADDRESS: 50-610SANTA ROSA'PLAZAlLC. B-16 U-6
Use classification ':;SINGLE FAMILY ATTACHED`° BuildmgPermit°No '0312=261;
Occupancy Group: R 3. `iu Type..of construction -:V -N 3 _ Land'Use Zone: VC
0vVi 6r,of Building ,;'SANTA ROSA PLAZA LLC r ' '' , f:, Address:�P O 60X';1503
City, Sit; ZIP LA QUINTA,JDA 92253.:,
By: STEVE TRAXEI
:Date 8-26-2004
Bul'ciingOfficiai f �. , .
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c :4f =, - �d s` ` :. o; < ;h :POST IN"A CON$PlCUOUSiPLACE
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a,n.�-IN-(', NJ l- 4 Ce e. 0,OccupYk A'-
'sBuildihg
feI"WDepamen
This -Cbrtfflcat6,is issuedpqrsVant,to-lh6_rp ts, of Section 109'bf the California- Buildingquirem,en
'"Code,,,, certifying, that " at, the lime "of -14s this .structure a in �00
su nce, is. stru Mp tance with the�
W
-Ci ilding,
Building Code,a n" G
piovisioils of "'Me and, -the rdinanc is, of h City regulating.
9 e -various 0
construction and/or use. -
BUILDINGADDRESS: 50=61.0 SANTA ROSA, PLAZA.,LLC Ba -16"U-7
Use.blassificatiow SINGLE' TAMILY,'ATTAC'HEb' ..0
--BUilding :P66 -hit No :0312-261
Type 0 t -We Z06e,.,VC-
bccup'an'cy Qroup*�&3 of ons ruction: V �-N Land
,-,'t'Own'ier,ofBUildind:-SANTAROSA PLAZA:
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TRAXEL
By. STEVE
"'Date. '8-26-2004
0
BU'id; �j q Official , I lr�
VV POSTAN A CONSPICUbUSPLACE
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-erffica toof,-Occu n-,
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- This' 'Certi'ricatb,,is�issued:puesuant:to,thb.�nr-eq'u'ir'e-ment.-§ -6fSectidiii 109�60hew-Cdlilbehia "Bdildhid-7
iCodb- --.,6ertt6qhg'-'-lha t at ,the --firnei W.,,liidihce-;' ffiio,�#iuchMe - Was- 4h, compliance, With"M6;.-...
r.
7- igWating;by
C
;!!,ordinances. -of, -the". it YOPO
provisions of ih&--BWlding,CodL, e, various y
construction, andl6r"Use..
.
"-,,BUILDING.ADDRESS:,,50--610-"SAWTAjlOSA,PLAZXLLC;B'16"U -8
:7w
BUilding,F:!6rm -,Nd.:-, -261
Use cWs6ftafion--. SINGLE :FAMILY ATTACHED it 0312
and Use Zone;
O' u�p`a:' nq y. 0 ro L fp: 'R-3 - T` Const L- Zone; -VC'
;4
in sANT,-A: -,ROsAPLAiA Address:;P O' BbX 1503
OWner,6f.,Buildpb
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LA-QU 6k§22511,
STEVE, -TRAXVL
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D tj '`8;26-2004T,-, x
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