0312-257 (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:
( ) 1, 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 , 1,' „i t„ 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 t9.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 e VALUATION LOT TRACT
JOB SITE
APN
ADDRESS 0..('',SVNA'.N'1A 1't,.i;.,(.i
OWNER
CONTRACTOR / DESIGNER / ENGINEER
i-A QX.TNTA OA 1172 1
USE OF PERMIT
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CONTKACTOR 'TO 0W HF;P 1}l.l tl. DF.R..
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SUPPLEMENTAL .PE:RMTFEE 100 000-42344)0 $4,50
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SMI-TOThL. C01,rTm1'1C"T oK AND i-'.t�,�a ."T:�FC`Y�
'T(.)TAL MtMT;~.E;ES DIT,E N'0p{
RECEIPT
DATE
BY
D=1NALED
i/T d
INSPECTOR
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—/2-30-03S
Exhaust Fans
O.K. to Wrap'
S
F.A.U.
Framing
.
Compressor
Insulation
-p 9
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
A I I-0 A
Drywall - Int. Lath
—Ism
Final
Final
POOLS - SPAS
BLOCKWALL
A PROVALS
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:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
jtough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) p
of -Occupancy
cw, Certifcate
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• gum rloj
B"; ig -
'ildit-,,.Safety-Dqpartment
OF
This Certificate is issued pursuant to the requirements of Section 109. of the,California Building
n compliance. with athe
Code- certi in that, at' the time of issuance, this structure was
f IA:
Yi 'ordinances of the City regulating buildin
provisions of the Building Code and,the various 9
nstruction and/or use.
BUILDING ADDRESS: 50-650 SANTAROSA-PLAZA LLC 13-12-U-1
Building Permit No.: 0312-257
6se classification: SINGLEFAMILY ATTACHED
p - Land -Use Zone: VC
Type of Construction: V -N
Occu ancy Group: R3
11,11"t"I - POST IN A
Owner of Building: SANTA R Address: E.Q. BOX 1503
OSA PLAZA LLC
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXIEL
Date: 8-17-2004
A
Building Official
11,11"t"I - POST IN A
Certificate of Occupancy
T4&t 4.4 Qu&rw
Building & Safety Department:
This..Certificate is issued pursuant to the,requirements of Section 109 of. the California Building
Code; 'cern m that, at the. time of -issuance, this structure was in : com'phancp - with: the
fY _ g
provisions of -'the Building Code and the various 'ordinances of the . City regulating building
construction and/or. use.
5 ` BUILDING ADDRESS: 50-650:SANTA ROSkPLAZA LLC,,B-12U-2 } `
a E
a 5F5 I
a Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-257 ,
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: VC
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
POST IN A CONSPICUOUS
Address: P.O. BOX 1503
R t.
City, ST, ZIP: LA QUINTA, CA 92253 y E
By: STEVE TRAXEL - t
Date: 8-17-2004
Certificate of Occupancy
Building -& Safety -Department
This. 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 _compliance with the
provisions- of the --Building Code and the various _ordinances of the City regulatingbuilding
construction and/or use.
BUILDING ADDRESS: 50-6%SANTA ROSA PLAZA LLC B-12 U-3
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-257
.ti
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: VC.
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
POST IN A CONSPICUO
Address: P.O. BOX 1503 i! ?
City, ST, ZIP: LA QUINTA, CA 92253
i 4
By: STEVE TRAXEL
Date: 8-17-2004
Certificate of Occupancy
Titf
4,'�,Qa1Krw
Building &Safety Department
This Certificate is issued pursuant, to .the requirements of Section 109 of the California Building
-Cddb' certifying that, at the time. of issuance, this structure was in compliance with the
provisio ns of the -Building Code *a,n, d the various ordinances of the City, regulating building
construction anal/or use.
BUILDING ADDRESS: 50-650,,SANTA ROSA PLAZA LLC B-12 U-4
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-257
Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: VC
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
IN A CONSPICUOUS
Address: P.O. BOX 1503
City, ST, ZIP: LA QU I NTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
Certificate of Occuancpy
4ui�ctcv
Bijildi6cf& S a
Mt D'
y .- partment
,
This- Certificatejs issued pqrsuant'to' the .requirements: of Section 109 of the` California Building
• the.
str&cture' was, in compliance . with
.Code;-certifying;that, at the. -time- of issuance', this
issuance, 1ri.,. rdinances of the
"BiMdin�g, Code an
wo�Aidhs,bf the d the various, o City regdiating buildingi
P
construction andlor.use..
BUILDING ADDRESS: 50-650,SANTA ROSA PLAZA LLC B-12 U-5
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-257
Occupancy Group- R-3 Type of Construction: V -N Land Use Zone:'VC.
I owner of Building: SANTA. ROSA PLAZA LLC
Building Official
Address: P.O. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXIEL
Date: 8-17-2004
PLACE
.a--Q-�- fca to of Occupancy
Certi
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u cv
GOF'9w Building & Safety��Department
This 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 compliance with the
provisions: of .the Building. Code and the various ordinances of the City regulating building
construction and/or use.
,R
BUILDING ADDRESS: 50-650 SANTA ROSA PLAZA LLC B-12 U-6
.
t`Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312=257
k 4 S
�?y Occupancy Group: R-3 Type of. Construction: V -N Land Use Zone: VC
i
R [
3 Owner of Building: SANTA ROSA PLAZA LLC Address: P.O. BOX 1503
r: City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
% Building Official
IN A CONSPICU
Certificate of Occupancy
Building 'A Safety Department
This Certificate is issued pursuant tojhe requirements of Section 109 of the` California Building
�. ;Code; . certifying that;, -at the - time of: -.issuance , this structure ,was in compliance with` the
provisions of the Building Code and;:the various: ordinances of :the City regulating. building
construction and/or use.
BUILDING ADDRESS: 50 650 -SANTA ROSA-PLAZA LLC X1342, UJ
Use classification: SINGLE FAMILY ATTACHED
Occupancy. Group: R-3 Type of Construction: V -N
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
POST IN A CONSPICUOUS
Building Permit No.: 0312-257
Land Use Zone- VC
Address: P.O. BOX 1503
City; ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
Certificate of Occupancy
Building & Safety Department
.This. 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 compliance with the
provisions of the Building Code the various ordinances of the City regulating building
consttuction and/or use.
BUILDING ADDRESS: 50-650 SANTA ROSA'PLAZA`LLC .B-12. U-8
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 03.12-257
Occupancy Group: -R-3 Type of Construction: V -N Land Use Zone: VC'
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
POST IN A CONSPICU
Address: P.O. BOX 1503
City, ST, ZIP: LAQUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004