0312-255 (MISC)LICENSED CONTRACTOR DECLARATION
I herediy 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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
I, as owner of the property, am exclusively contracting with licensed
60?ltractors to construct the project (Sec. 7044, Business & Professionals
Code).a'
O I am exempt under Section i B&P.C. for. this* reason _ /
Date � I � I� 'Signature of dwner /—Y'.
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'WORKER'S COMPENSATION DECLARATION
I hereby affirm .under penalty of perjury one of the following declarations:
( )' 1',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 SU SUB -1,12T 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,
,(sh11 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— / ./_ !. /,« G r
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),'-, .�- �r j'(-' %^r` Date -/r
PERMIT r , PERMITk
1,_BUILDING
DATE /i % VALUATION LOT TRACT '
JOB SITE
APN ,
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ADDRESS 5"70 i' ANT.Ai 'RO A. PLAZA
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
SAYfA ROSA. iJI.AZA UZ - DAPI' 33RO N
OWNMR - 13'MDER
PO BOX 1503
;LAQDINiA CA V22. s
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USE OF PERMIT
SUi'PLFM.L�NTAL T'O PCRmn, 030i-1tb TOILITFLEi:T CkiANCt� OF
CtiW7'.IiACTOR TO OWNER BUILDER.
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I lEffivill:If'YX duhIA Y
'SUPPLYMEPJTAL PEPWIT FEE 101000;423 -Otto $4.50
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.3lTL= CC)TA(, COMM. "O•f''4 011 AND PI -A.11 C:3-1ELIC
I',Z,,J PRE -PAI% . M 1 , 3
MIA].. P.ERXTQ'F1, :S zi TE NOW
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RECEIPT
DATE iy
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BY-
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DATE FINALED
INSPECTOR
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9
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
- • m -
Exhaust Fans
.'
O.K. to Wrap
.Z .O ST
F.A.U.
Framing
, p
Compressor
Insulation
,2._ -O
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
.p
Drywall - Int. Lath
67
ogy .Na%
d - • o
Final
Final
BLOCKWALL A PROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
.Utility Notice (Perm) .�
COMMENTS:
Certificate of Occupancy
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Building -& SafetyDepartment
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This Certificate is issued pursuant to -they requirements of Section 109 of the .California Building
this structure was . in com fiance with .the r
Code, certifji�rig that; a the time of issuance, p ,_
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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=670,,SANTA`ROSA PLAZA LLC B-10" U=1
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312=255 {
Occupancy Group: R-3 Type ;of Construction: V -N Land Use Zone: VC
Owner of Building:`SANTA.ROSA PLAZA LLC
Building Official
1173
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,, Calif mia Building
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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.
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BUILDING ADDRESS: 50-670 SANTA ROSA'PLAZA`LLC B-10 U-2
Use classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3
Owner of Building: SANTA ROSA PLAZA LLC
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[ � , Building Official
Type of Construction: V -N
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Building Permit No.: 0312-255
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 4s issued pRursuant to the requirements of Section 109 of the. California Building
• g this structure was in com yl nce with the
Code, c wti 'in that, at the. time of}issuance, A, ,
provision`s of the Building , Code and the various ordinances of the City regulating building
construction and/or use..
BUILDING ADDRESS. 50-670 SANTA ROSA PLAZA LLC B-1 :0 U-3
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Use classification: SINGLE FAMILY ATTACHED
-3 Type of Construction: V -N
Occupancy Group: R
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Owner of Building: SANTA, ROSA PLAZA.L•LC
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Building Official
POST IN A CONSPICUOUS
Building Permit No.: 0312-25.5
Land Use -Zone: VC
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Address: PO. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
Cerificate of Occupancy
449�M'�ww
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.
BUILDING ADDRESS: 50-670 SANTA ROSA PLAZA LLC 13-10 U-4
f Building Permit No.: 0312-255
Use classification: SINGLE FAMILY ATTACHED
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Type e of Construction: V -N
Occupancy Group: R-3 yP Land Use Zone: VC
Owner of Building: SANTA ROSA PLAZA LLC
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Building Official
CONSP
Address: P.O. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
401 Q��Certificate of Occu ancy� p �.
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This. Certificate is issued pursuant to -the requirements of Section 109 o_ f the California Building ,
ACode, certifying- that; at the time of issuance, this structure was in,- compliance with the
#: rovisions -of the Building Code and the various ordinances of the Ci#y regulating building
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construction -and/or -use.
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BUILDING ADDRESS: 50-670..SANTA ROSA PLAZA LLC .B-10 U-5
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3 Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-255 a
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Occupancy Group: R-3 Type of Construction: V -N Land Use Zone::+VC
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Owner of Building: SANTA ROSA PLAZA LLC Address: P.O. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
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By: STEVE TRAXEL
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Date: 8-17-2004
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Building Official t
IN A CONSPICUOUS PLACE
Certificate of Occupancy
4 ,�,Qatiifw
-Building .&-Safety- Department
This Certificate is issued pursua"nt to the requirements of Section 10.9 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
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construction and/or use.
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ESS: 50=670 -SANTA ROSA-PLAZA LLC B-1-0 U-6
BUILDING ADDR
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Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0312-255
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Type e of Construction: V -N
Occupancy Group: R-3 yP Land Use Zone: VC
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Owner of Building: SANTAROSA PLAZA LLC
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Building Official.
IN A CONSPICUOUS
Address: P.O. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
to of OccupancyCert�fica f
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Building .& Safety 'Department
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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
K provisions of the Building Code and the various ordinances of the City regulating building
k construction and%r use.
BUILDING ADDRESS: 50-670.SANTA ROSA PLAZA LLC 'B-10 "U-7
Use classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3 Type of Construction: V -N
Owner of Building: SANTA ROSA PLAZA LLC
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Building Official
IN A CONSPICUOUS
Building Permit No.: 0312-255
Land Use Zone: VC
Address: P.O. BOX 1503
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004
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Certificate of Occupancy T.1
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Building &.Safety Department
--of the California Building
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e is Issued pursuant to the requirements, of-Secti
This Certificate 'compliance with .the
.that, -a# the- time of. issuance, this structurewas, in c
i�e�d�ing
proy!s�ons �.dW - the Building ' Code and the various ordinances of the city regulating building
C hstrui�
0 tiomandlbr use.
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BUILDING ADDRESS: 50,-670 SANTA ROSA-PL,AZA LLC B-10 U-8
'Use classification: SINGLE:FAMILY'ATTACHED Building Permit No.: 0312-255
'Occupancy Group: R-3 Type of Construction: V -N Land Use Zone: VC
Owner of Building: SANTA ROSA PLAZA LLC
Building Official
POST INA CONSPICU
Address: P.O. BOX 1503 -
City, ST, ZIP: LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 8-17-2004