0312-260 (MISC)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.
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
O I am,exempt�pder Section B&P.C. for this. re o"-"` f
Dater=—><��i l� Signature of Owner/ ,
WORKER'S COMPENSATION DECLARATION
1 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 SSEE SU0 L11SPolicy No.
(This. section need not be completed if the permit valuation is for $100.00 or less).
(-y):;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,l should become
subject to the workers' compensation.provision--s�of._Section6700 of the Labor
Code,,kslialllforthwith comply withlhose provisions•
Date:•Y/� Applicant/ �� 11•t
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in `
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made& each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner%Agent)' j �r Dates
.1, ,.. "BUILDING -PERMIT PERMIT#
DATE j} -, VALUATION LOT '3)i1 TRACT
p fy 2
JOB SITE��('�
APN
ADDRESS `50-620 SAWLI, IZOIS . PLAIM
-
OWNER
CONTRACTOR / DESIGNER / EN INFER
SFeWA R,(.)9, A PLAZA LLC - DAN .13RSJV+)At
UWNILI't - BUILDER
1'0 BOX 3 503
11A.QU10-A CA 92253
() CPIIU$
USE OF PERMIT
SU`PPLl MZNTAJ,TO PERMIT 0301.121 TO REF'LIM;T CHANGIZ OF
CONTRACTOR TO OWNER SUILD.RIZ.
ESMIAIZD CWTr OF CO.MMUMON,
i�,4Fti
k KP.Wf M, 9 MMARY
SUPPLUMEN AL PERMIT PEE 101-000.423-000 54,50
SIM -TOTAL CONSWUCI l01f *a) ►?I." C1. UX`-
$4.50
ia.EM PRE -r kM F
$0.00
XO'1 AL Pl I?–MTr M.8 :D ILE NOW
W%0
RECEIPT
DATEt
/, ��
BY-'
DAT INAL
INSPECTOR
_ Jcam-
M
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 DeckZ2.3,0-.63
T
Exhaust Fans
O.K. to Wrap
2- 1 -0 L4 SrF.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. Lath12-11-0457
Final
Final 72i7 IEZW
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
Rolsgh Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) �O
COMMENTS:
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o & SaeY:D.epartmen.tBuWit-g�f ` r
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:This Certihcate'is:,issued ursuant to ahe re uirements of -Section .109, -of the California ,Buildin ' '
_ A q,
Code,, certifying:, that, at . the.. time -. of .issuance; this structure was= 'in :.cor` liance ;with 'tie
..
provisions of -the -:'Building Code ,and the.,various-ordinances of. the. City'regulating -building
construction and/or use.
-BUILDING ADDRESS:_50-620`SANTA ROSA:PLAZA LL -CI 945 U-1
' LE FAMILY ATTACHED u
Use classificationSING lding.
_ ,;Bui`Permit No.: 0312-260
-Occ4pancyGroup'R4 _ -" ' , • ,Type of ConsftLfd _ion: V: -N Land'Use Zone:<VC-. ,
Owner-of8w1ding:'SANTA ROSkP.LAZA'LLC ,. Address, P.O. BOX 1503
_ hf t City, ST, ZIP. LA.QUINTA. CA 92253 4
By: STEVE TRAXEL
!
dj^t a , r Date: 8 17-2004' k ~y
:Building Official
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Thh§=Certificate "is issued pursuant -to the. requirements. of Section •109.of the California Building
Code; certifying . that,`: at the,:. time - of , issuance, ,this :structure ;was in: conil*once with ,the
provisions .of the Building 'Code and the various, ordinances"of,- the- City regulating building , 1
construction and/or use.,,.
,
.rBUILOINGAD.DRES_S; 50-620 sANTA..ROSA PLAZA LLC B45 U-2,
Use classification': SINGLEFAMILYATTACHED: Building Permit -No 0312-260 ;
Occupancy -Group R-3. Type of-Construction:.V N Land Use Zone: VC:
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,This. Certificatd-', issued. pursuant�'to the r, uirements of'Section.109 of `the; California Building;,
Y ` Code, certifying .,tha`t,- at the 'lfihb :of" ss ance this, structu,'re` i was in compliance wifh ` h0,'
provisions 'of the-, Building Code, and ,the- ,various. ordinances of the -City regulating building ,
construction. and/or "use
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` '• BUILDING ADDRESS.50-620 SANTA ROSA PLAZA' LLC" `B-15 U4
Use classification: SINGLE FAMILY�ATTACHED ,.„ Building Permit'No:•: 03"12.260
Occupancy Group R-3' 'Type of Construction: V -N; V:� Land Use Zone VC
_.
Qwner"of°Buildin .SANTA ROSA'pLAZA LL'C
9' r ;Address .PO. 90X-1503 • a
-ZIP: LA QUINTA; CA 92253 - y
'STEVE.•TRAxEL y r
; Date: 8474004 _ g
` Building Official t`
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Ullaing & Safety Departrnent�
his Cerflficate is issued>pursuant,; to,the,requirements of''Section 1 M of •the, California_ Building
Code, certifying '�#hat,: yat: the. time of, ssuance; 'this `,structMre' ;was n compliance ,with : ;the
i•
� provisions: of the. �Build�ng�°:Code and the -various ordinances M of .the:' City regc #1 t' bu laling
construction and/or use - - -
z 'BUILDING ADDRESS:s50-620''SANTA' ROSH PLAZA LLC :b-15 -U'5,',
+Use•classification: SINGLE -FAMILY ATTACHED i, Building Permit-No `. 0312-260"
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,0 R-3, �R-3. Type o€yConstructlon � V f=N� •Land bse Zone-'�VC
Owner.,of Bulldlh SANTA.ROSAPLAZA LLC
9 r: Address PO BOX.-1503
City; ST, ZIP LA QUINTA, CA 92253:
` t t_e By: 'STEVE`TRAXEL
Date 8 17.-2004
Budding Officiate
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POST-IN XCONSPI000US-PLACE
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F9 u -.."Build�ng & Safety Department
This Certificate°is issued`p-ursuainfto:the reA 6' encs' of. Section -109 of'the';Ca'lifor`nia Building` •."
Code; certifying that, at the .t time of issuance, this. structure - was -in compliance with_ the
provisions' of. the Building Code: `and--athe various:.- ordinances of the City -'regulating building
construction and/or `use. ,
' B.UILDIN•G ADDRESS: 50-620.SANTA ROSH PLAZA -LLC .,B-15 -'U-7
Use classification: SINGLE FAMILY ATTACHED
0
- •: Building Permit N :0312-260
Occupancy Group: R-3 Type of COnstructlon: V -N: Land Use Zone: VC
` Owner of•BUllding:'SANTA ROSA'PLAZA'LLC• . Address: P o: BOX 1.503
-City, ST; Z; 2.53
IP SLA QUINTACA92
.._---►' . By: STEVE TWEL
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�-�.. - „ • - Date:- 8-1-7-2004.. .
Building Official
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This Certificate_ is, ►s`sued pursuantu.to, th&Te'quireinents of,Section;.109 'of the �Califor'nia Buildin
g. ; x
r Code, certifying ;that, wat" the �°t►me of. issuance, this `strucI.ture "was . -in, ,compliance with ,, the l
`Provisions,- of the Building °Code and :the various ordinances of ;fhe City -:regulating b Ilding-
construction and%r use: ' i
_BUILDING ADDRESS: 50-620 `SANTA>ROSA PLAZA"LLC B-1"5 U-8
Use classifcatlon.;SINGL' E FAMILY'ATTACHED • w -# 0312-260• `
- Building Fermit`No
,Occupancy Group R-3�
_Type of 'Construction: V N ' ` tand:Use 'Zone V_ C
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Owner of Building 'SANTA ROSA`PL�AZA:LLC,. ^': t Address P O: BOX 1503
. a City, ST,aZIP tA'QUINTA,-.CA 92253
By'STEVE;TRAXEL
Date 8 17=2004, w
Building Offrclal a -
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. `. :POST IN A CONSPICUOUS PLACE : �:. :. ... , . � .. .._ ., •:-. - :. .._