0312-259 (MISC)LICENSED CONTRACTOR DECLARATION
d 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).
( ) 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
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 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,
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 PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
APN
At
ADDRESS ;�i) (01:.;i..Fv111"A �{O fii. �V.[aA .,�
OWNER
CONTRACTOR / DESIGNER / EN INEER
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USE OF PERMIT
`0PPLZMENTAI.,T0 PERMIT 0301, eo TO
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RECEIPT
DATE. _
Bd(�. _
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-
NSPECTOR
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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
,. -T
Compressor
Insulation
.. A
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
J- - 01-4 57
Drywall - Int. Lath
• Z ..O 37
Final.
Final —
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
zWaste 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'iReceptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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This Certificate is jssued pursuant to.. the�requirements of; Section ,109 of the California Bu�ldin a
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Provisions - of =the :Building Code. and the various ordinances of• ,the City regulating building
construction and%r use. R
ti BUILDING ADDRESS "50-630 SANTA,ROSA PLAZA B-14' U-1
Use classification: SINGLE FAMILY ATTACHED `' .. •Building Permif No .0392-259 ,,
0ccupancy:Group R-3 .: Type of'Construction: V �N , �. a ' _ Land Use Zone'�VC
Ownei of Building: SANTA }ROSA PLAZA LLC ' L, S �Add'ress P.O BOX 1503
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This Certificate}is 'issued pursuant to the" requirements _ofSection`109 of the California .Building.
Coale, certifying, that, -at, `the time `of: issuance, this `:structure •was in compliance with the
provisions of the Building;YCode and the ;.variou's ordinances. of the,- City regulating building
' construction and/or usej.,-, -
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BUILDING ADDRESS: 50-630 SANTA ROSH. PLAZA LLC
Use,cla"ssification: SINGLE FAMILY ATTACHED _ Building PermifiNo :0312-259`
Occu ancy GroUP R=$ ' V _ �� Type: of Constiuction:' V -N `z Y land Use Zone : VC
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'Owner of Building: SANTA ROSH PLAZA LLC ,, Address "P.O. BOX 1503
-City;'- ZIP: LAAQUINTA, CA 92253
g STEVETRAXEL'
Date819-2004 A:
Building Official
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construction and/or use.
BUILbING'ADDRESS: 50=630 SANTA ROSH-:PLAz��'LLC B-14'- U4�
Use.classification:'.SINGLE`FAMILY'ATTACHED ; Building•PermitNo :.0312-259
Occupancy Group ;R-3, Type of -Construction: V -N Land ,Use=Zone:-VC
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Code, ;oektifjiing that,. rate ,the #erne 'hof issuances.. `this 'structure' was in compliance with the
provisions, -of the.,, Building_ 1.— 1 -
the various•',ordinances of . the City regulating= auilding`
:construction and/or use.
BUILDING ADDRESS: 50-630 SANTA ROSA-PLAZA:LLC sB-14= U-6
Use classification: SINGLETAMILY ATTACHED •, 4`' - Building Permit No.: 0312-259
Occupancy Group R-3 Type of Construction:=V -N �' Land. Use Zone -VC
' Owner of Buildi r^ LAZA:LLC 1 - _ 4 ,
ng SANTA ROSA�.P �,�, •Address .P.O: BOX 1503
City, ST,. ZIP LA`QUINTA,wCk§2253
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STEVE TRAXELa
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This Certificate is issued-parsuaot-to,.the re u�rements. of Section*109 of the Cal fora a_Buildin
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certifying that; 'a> 'thee time of° issuance; this 'structure was in " compliance ,with nfhe.
provisions ;of" the- Building -'Code", and fhe�-'various ordinances `of, ,the City regula>tingabuilding
construction and/or use. _
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{ BUILDING ADDRESS. 50-630 SANTA ROSA�PLAZALLC B-14.• U4,
Use classification; SINGL`"E' FAMILY ATTACHED f :. Building.Permit No:: 0312-259
Occupancy Group: R=3 : `. Type of` Construction: V =N ?� Land` Use Zone: VC,
Owner of Building: SANTA ROSA PLAZA'LLC...-. -Address: Ro:.BOX 9503
.iM f C� 'ZIP: LAQUINTA -CA 92253 = _
By .STEVE TRAXEL
.EY , : F ,• ` t Date: 8-19-2004
` .Building.Official: r F , �l . x} 477777 A
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,This Certificate ►srissiled . pursuant #o the require►nents of Section 109 of the 'California Building
Code; "certifji�ng that;= :at;,'the time ar issuance;' -this `strtictufe' was' n compliance with the
provisions 'of the Bu ldin Coale Wand: 'die' .various,, rdinances, .of the .Ci re ulatin baildin
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construction and/or use. .
BUILDING,.ADDRESS.; 50=630 SANTA-ROSA.PLAZA LLC B-14 U=8
We.classification SINGLE FAMILY ATTACHED - r
- a <�• .Building -Permit No 0312 259
Occupancy Group: R=3 `° 'w Type of'Constructlon: V -N' Land'Use Zone ,VC
Owner of Buil
ding: "SANTA` ROSXPL-AZA LLCw t Address: P O. BOX 1503 i.
{ City; ST,fZIP: LA QUINTA.:CA.92253 -
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`�. ' _ ' • <',� By: `STEVE TRAXELj
Date ,16-19=2004
BUllding Official
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