0312-256 (MISC)LICENSED CONTRACTOR DECLARATION''
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ctiapter 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'ejempt under Section B&P.C: for,.this.reas7/1
n`•_ _..-
Date 1 �/. Signature of Owner / ?`/ - ! / 1
_ -
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:
Carver SME SUB -LIS Policy 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 I should become
subject to the workers' compensation -provisions of. Section ,370 �of the Labor
Code, I shall forthwith comply with those provisions.
Applicant
Warni 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) Date,.= i
t - PERMIT# -
BUILDING PERMIT
0312-1215.6
DATE VALUATION �{ j7j��� LOT ��.����. TRACT 299-09
JOB SITE `� w
APN
ADDRESS .5."60 SANTA. ROSA FLAM
- -
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
SANTA ROSA F11—AZA I:t C - DAN BliOWN
O\rJ:eaIR - Ei UILDn
PO BOX 1503
1.13QL'ffldrA CA 9225:3
f j - (7733L,4
USE OF PERMIT
gl.JPl't.F•1b1N,?d'f F.t.1't) P1'.itl�tiT•030t..il'7't'O itEI�l:irr'f O}i.rltlCi)a OF
CONTRACTOR O OBdWRR OUILDEP4,
ESTI A7iM COIST OF CONSrIMU1710N
ft.C�d3
Msw x,12 FfiMR'1URY
RYPPLLMEN AL PEP -A- ' PEL+ 101-000-4Z3-000 �4.si1
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M 1.W'-TC3 AL.. l.vMETI.[a TITMON AND 2`.6s."U.�f lox. r.L•K
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7. 33 PRE -PAID .P3 E.3
$0.00
'1'(YSI>si., `z E DUE NOW
$4.50
RECEIPT
DATE
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BV'
DAT I ALED
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
/a •oq . p 3 s17
Compressor
Insulation
A4 S7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-7
1171. 4
Final
Final
BLOCKWAL A PROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
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
, p
Appliances
Final
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) ,
COMMENTS:
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oF��.u�inafee p. This'Certificate is ►ssuetl pursuant'to the requirements of Section 1;09of the California Bu►Idirtg:,
Code, certifying that, at -<the` -tone: of issuance;'this structure was in compliance with'+provisions ofthe Building Coda- ands the wario>us` ordinances of the ;City regulating bui ding , construction'and/or_ use.BU.ILDINGADDRESS;'50=660wSANTAROSAPLAZA B-1'1 `U=1Use`ciassificatiort'SINGLE"FAMILY•ATTACHED ' . 'Building Permit"No.: 0312=256.Occupancy Gro"up R=3,',J Type of'Construction: V -N s y Land Use Zone:.Owner of�Buiiding ,SANTA:ROSA PLAZA LLC K `Address."�P_ O,60X;1503 City,' ST ,ZIP:`LA QUINTA, .CA.92253;STEVETRAXEL.
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,This :Certificate is ;issued pursuant to •the requirements of Section °109 of the }California Building .
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Codo, certifying-: that; at `the .time of , issuance; this structure was 4n-:', compliance' with the
;provisions .of #tie Building Code and the. various ` o Winances of_. the City regulating building
construction and/or use: -F .
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BUILDING ADDRESS �SM6Q SANTA,ROSA PLAZA B=1'.1 U-2 .r
Use 'classifcation: SINGLE:FAMILY ATTACHED T _ Bulld'ing Permlf No.: 0312-256
Occupancy'Group. R-3 :�. .` Type of Constructlon:,V-N L Land'Use.Zone: VC
Owner of=Building:-:SANTA:'ROSA'PLAZA LLC : Address, BOX' 1503.
City; ST, ZIP. LA-QUINTA, CA,02253
..�- 'By )STEVE .TRAXEL y Y,
�x Date-.,-8-;1'6.;2004' .
BuIlding Official_ t� ' : ter
r APOST,IN A.CONSPIC0003'PL:ACE' .. i
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Certificate t6 d-- '66ht,tb,the'*,rq�qyiremenitg,-i)f,�§��tioh,-"10.9
,"Code,certifying that, *atthethhb ;twf issuance, -this structure -%,Wa§:.in"-conpliande" - ithth
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f 'the - Bundipg Code and M6. Vim p ous- ordinances: of the (City au . ci building'
provisio,4§ o reqyi
construction andlo us
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.BUILDING-ADDRE'SS�-50�=66b'SANTA .ROSH .PLAZ.A - b-1 I U�3
WGLETAMILY ATTACHED buildi Permit, No:: 0312-256 'pSe Classification SI (O:,P b " it. N -156
'DqcupancyG,roup%R-3 e�bf ConStru66io
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PO. -OW.ner Of Building: SANTA ROSA PLAZA LLC -Add6s"MP; 1503,',
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By . STEVETRAXEL
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This Certificate s issued, pursuant forthe requirements of Section .109 of�the Califbmia Buildin
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Code, .certifyingt that, at ,the : bine ' f� .issuance, f !this structure' was.- in compliance ._with 'the ,
provisions of the Building- Code ;"and the : v_a*nous= ordinance$ , ' f the;, city regulating build F
. construction and/or.use _ - 4. 'g
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BUILDING ADDRESS: 50-660SANTAROSAPLAZA.'B-11 U=4.
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'cassifcation SINGLE'FAMILY'ATTACfHED.Use
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nt�No- 03i2-26 g
. :Occupancy Group: R -F Type.of Consfructio r
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Land Use Zo VC
Owner of Building SANTAI�ROSA.PLAZA LLC " :Address' PaO; BOX 1503
City;; ST, ZIP. LA (UINTA. CA 92253'
(ate ~Lz By STEVE TRAXEL
Date 46=2004 t Y
E�Uilding Official _ -
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This :Certificate isy issued: pursuant oto the Mrequirem6nts of;S:ecf on ,109`° ofryttie; Cali 'Id'
• fornia Bw - ing'
certifying-- hat ate the , time= of, -;--issuance this structure was in com liance with the
pro. visions • of 'the=Buildin Code: and the various ordinances . of the Ci ire ilafin madin '
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`construction-and/or`use..
s-BUILDING,ADDRESS 50-660TSANTA'ROSA.PLAZA
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Use classific-ation SINGLE FAMILY ATTACHED.' Building Permit=No: 0312-256
Occupancy Group R=3 ' `, ,- :' -Type of:Constructlon`V-N'' Land Use Zone ' VC
Owner of'Building^SANTA'ROSA'PLAZA°LLC ` , ' 'Address PO 60X'1503 , s
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Cit ST, ZIP LA -QUINT& CA .92253.,
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By: STEVE TRAXEL r..
Date; 8 16=004
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cs-issued pursuant: to the requirements of :section 109 of the California•Bwlding,�
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Code, certifying .that, at th
e _ time'' of ,issuance;. this structure:. ,was in�- compliance .wifh tl eu, -
provisions of theBuild�ng Coale:'and the. various ordinances <of the` City regulatingf butlding�
construct►onnand/or use. t ' ti. :.: w ,�4,
BUILDING ADDRESS ''50'- TSANTA'ROSA PLAZA B-11 'U-6+ ' y
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Use classification. SINGLE FAMILY ATTACHED t ' .� ' Building Permit No ; 0312-256..
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Zone. VCOroR=3 a ConstruLand ofcfionVN
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City, ST, 71 P.
LA-.QUINTX CA 92253
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This Cert�ficate..rs, issued pursuant •to -- e-requ ng
�rements of.Section. -109: of the California Budd
Code; cert�fy�ng ' tha# at` 'the =time ° of ::issuance; this structure' was .:in compliance _ with',�fhe
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.. provisions of the' Buildin " �. Code° and the various ` -ordinances'-6f the.- ._Ci .. ` re *dn bu�ldin
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construction and/oruse.
-BUILDING ADDRESS '50=660' SANT i4 ROSA PLAZA B -4I U=7' 3
Use`class_ ification-SINGLE F_AMILYaATTACHED `;' Building Permit,No:: 0312=256
_ Occupancy Group: RR �. TYPe n V
of Co structlOn: N Land us
VC
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ownbK of;Buildi6q . titA-ROSA PLAZA LLC " # .Address! P;O,-BOX 1"503 r 4
L:Ci S ZIP LA QUINTA,fCA 92253 ,
• , gym, t ,t 'STEVE•TRAXEL
Date: -8 16-2004 w =
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This Certificate �s-issued-pursuant to=the. requirements of Section.109 of the California, Building
iCode; =cern in tthat,~ at thefiine'"of.issuance,> this =structure was in com `Bance ,with :the 3
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provisions of the'6uilding Xode ;and :.the,- various � ordinances. of, -the Crty`regulafing 'building
co nstruction,,.andlor use .. = x `
•Y :BULLDING.ADDRESS' 50=660 SANTA ROSH PLAZA B=11 _U-8
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tJse°classification: SINGLETA_ MIL•Y ATTACHED; �* > Building Permif No ..0312-256
Occu ancGrou R=3 '
P Y, P r' Type of Construction VW.
Land -Land 'VC
-<Owner of Building:=SANTA ROSA=-PLAZA LLC.. r
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_ - .. �A :dress P,O, BOX 1503 .
ST,•ZIP: LA QUINTAL CA 92253.
By:' STEVE TRAXEL ,.
.Date: 8=16-2004. v
Bullding..Officlal }� x
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POST CONS CUOUS PLACE