0312-258 (MISC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chepter 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
Date17X_// '� Signature of Owner / %-r l
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 SEE SUB -LIST 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 Section3700of the Labor
i: -�_1
Code, I shall,forthwith comply with those provisions.
Date? ��'� Applicant �F'
I 1
Warnik g: 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) :4 Date,/ •T �-°-�
PERMITH
-'REBUILDING
PERMIT
DATE VALUATION d LOT 9 ryry TRACT rya`
JOB SITE`
APN '
ADDRESS 5 ES SANTA ROSA T'.luAZA
OWNER
CONTRACTOR/ DESIGNER/ EN INEER ►,
8V41•A ROSA 1-11.XeA LLC - DAN
O WTt3ER - BUI DID?
PO BOX 15013
LA Qd.TJR1TA CA 9223:3
CB1.*
USE OF PERMIT
IvSWEII.:ANTEiOUS
SUPPLEMENTAL TO PlMMIT 03014 19 TO REFLECT CHANCTiL.? OF ,
CONTRACTOR To OWNER BUILDER.
EF.t'ZgA' CD COST OF COMIS�"i IJM3 014
0.00
PIUMUFbM 9UMMARY
A
SUPPLEMENTAL PERMIT FEE )01-000-423-000 34.SD
1 r
3XM- OC 'EM_ CON'TFI2iTC TION AND IT
TA-50'
LESS PRE -PAM 11—M
TOTS, J'lER-A4] _° F�}'S D`U-V,.. V(1W
4. 3
RECEIPT
DATE
BY ��
D NAL
INSPECTOR
V • `S,)
,1,•
6 0
V t:/
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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 6
POOLS -SPAS
BLOCKWAIIAPkOVALS
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:
-pip car/ 9,tgd 7XS7 !• $ • VY S 7
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Yoitage Wiring
Fixtures
Main Servicer,
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) _p
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This .Certificate is issued pursuant to thelrequiremenisAof� Section` 109'.of. the. California Building
_.Co certifyih '.that, At -i a .,time of .%SSUance;; this stiucfure'.was ,in �'CO%1lpliance with 'the.
provisions - of the:` Building Code.: and the -various ordinances_ of. the City,. regulating building
construction and/or use.
•
BUILDING ADDRESS; 50-640.SANTA:'ROSA PLAZA B-13 1i=1
`
..Use classlfcatton:�SINGLE-FAMILY ATTACHED:.: � .BulldirlgaPermlt No.: 0312-258 '
Occupancy.Group,:R3 pe of Construction: V:N Land Use Zone: VC
Ty
.Owner of.'Bullding .rSANTA ROSA;PLAZA'LLC `' Address.-P:O. 60X'1503 k'
.. _ '1' • -
- Tld(
,City; ST, ZIP: LA QUINTA, CA 92253.
}`y STEVE"TRAXEL
Date: 8-16-2004: - f
Bullding Official :« ;
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.. 'POST
1 IN A-CONSPIC000S'PLACE.. °a
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a0T.7�T off` Occupa. Cy
_ s . jJ00RO.n7f,�f ~ r •.. L t r � ' , 41w,
t G
OF9w $ BuildinV.&Scjjfet De artmenry ,
This .Certificate is issued pursuant to thelrequiremenisAof� Section` 109'.of. the. California Building
_.Co certifyih '.that, At -i a .,time of .%SSUance;; this stiucfure'.was ,in �'CO%1lpliance with 'the.
provisions - of the:` Building Code.: and the -various ordinances_ of. the City,. regulating building
construction and/or use.
•
BUILDING ADDRESS; 50-640.SANTA:'ROSA PLAZA B-13 1i=1
`
..Use classlfcatton:�SINGLE-FAMILY ATTACHED:.: � .BulldirlgaPermlt No.: 0312-258 '
Occupancy.Group,:R3 pe of Construction: V:N Land Use Zone: VC
Ty
.Owner of.'Bullding .rSANTA ROSA;PLAZA'LLC `' Address.-P:O. 60X'1503 k'
.. _ '1' • -
- Tld(
,City; ST, ZIP: LA QUINTA, CA 92253.
}`y STEVE"TRAXEL
Date: 8-16-2004: - f
Bullding Official :« ;
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.. 'POST
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.Ttiis-.Certificate`�is issued-pursuant t64he requirements of Sectioh,109 of the Californiav-Bu�ld ng
Code, .:certifying - that; at; the-'- of `issuance; . this --stru�tu"re was "in compliance with the
provisions of -the `-Building_ Coale_ -and the xvarious `ordinances `of the: Cit}i ;regulating building
construction and%r use: y !
BU1L'D1NGADCRESS:'-50-640 SANTA R0SA,PLAZA`.;B-13 U-3,
!
Use:classification! SINGLE,FAMILY.ATTACHED ' -Build. ngPerrriit,W..A312-2.58,
Occupancy Group; R-3 Type of'Construction- V=N', „'� f - Lands:Use Zone: VC
,.
Owner of Building SANTA ROSA PLAZAILCti Address:<P.O. BOX 1503 - .
1 ,, • ,..T, Z A'QUINTA.:CA•92283'
City:SIP
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PY7 STEVETRAXEL 1
{Date'8-16-2004
= i Building Official, F
POST IN NCONSPICUOUS PLACE.
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aTh!s:-.Certfficate'-is, issued pursuant ;to the. requirements of. Section _109`of the: California Budd g
1
Coder- certifying :that, . of ,then time of. issuance- this- structure was in compliance with the .
--provisions , of the ;Building Code` and the various 'ordinances --.of -the..-City- re`• u/atin biiildin ,
g. 9. 9
'coristruction and/or•'use. - �3
r:•' t BUILDING ADDRE .;
SSa50-640 SANTA:�ROSA,PLAZA,&- 3 U-5
Use.classificafion: SINGLE FAMILY ATTACHED Budding P,ermlt No:; 0372258,
Occu anc 'G41r
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Ou . R 3.
P Y P • - a, }' pe of Construction: V ,N
TY Land.Use'Zone: VG
Owner of Budding, SANTA ROSA'PLAZA,LLG °' -IX -Address. P. ;O. -BOX 1503
Clty,,ZT,.ZIP..LA QUINTA, CA 92253
By: STEVE. TRAXEL v. f
Date:• 8 16-2004"
Building Official. f
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_ POST:IN:AW"CONSPICUOUS PLACE ..
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ia Safety ,Depa
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This,-'Certificatois isuea,pu"rs ii to the requiremenh �ec'tion"109 f the-C61ifb
mia B`Waiho, -
certifying time; of, issuance;;, h structure In CRTpliance with th.
Code; ithVind t#dtj.'.,-at "the, t, e
provisions. dF._.the'-.BuilditJg Code and the 'various: ordiijancelsPf {the 'City' regula ting.
,.construction and/or ,usb.-
BUILA
DINGDDRESS50:640 SANTA R08XPLAZA"z. B=13 --_UJ.",
Use :classification,; So UNIGILEIFAMILY-ATTA HE Building; PermitKNo.:'0312-258;.
ru n: Land U
ccupandv Group., k -a, '�! . - _se,Z VC
0
one:.
Fype ..f Qoi�st ctio V44,
'-: BOX,150 3,'
Own.er'of.B,bildinci:-,,"SANTA ,ROSH . PLAZA LLC"AddressP.O;.
all City,,'PT -dA 51
-ZI LA Ul
..P.,,. 0 NTA; .-920
Bv: STEVE, TRAXEL,
'2004
Date: 8'
n ffibia
`POST IN A CONSPICUOUS -.,
S Iduclos-PLACE"
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,sale'?,► � + Cerfificarte of} OcsCu; an'c
bkowrcm
OF, r 'Safety. D6,0 -i men t:
This ,Certificate is .issued.pursuanf o the}requirementsof Section X09 of the California Building
m . Code,. certifying that, at� the 'dime of " ssuance this structure. , was in compliance With, the
provisions- of _ the BaUdin Code's and : the: various ordinances; of , the(- Cire-igulathig building
construction and/or use.
m.
4 f BUILDLNG°ADDRESS; 50-640 SANTA FMA PLAZA .B-1'3 U-8 °
Use classif cation'SINGLE FAMILYATTACkEiD r y '�' t :Building Permit No.: •'0312=258,
Occupancy Group R=3 T Type of Construction. V -N' =Land Use Zone: VC
j",
Owner of Uilding,' SANTA, ROSH` PLAZA LLC : '• Address P., O BOX 1503;
City; ST ZIP _LA QUIN -A,. CA:.92253, s:
u z f
By STEVE TRAXEL
d!� Date :8.16=2004
Building Officla}
+ - ry Fir . .e •, r s ? . t
POSTxIN°ACONSP.IC000S PLACE