0209-051 (SATT)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. `meµ 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).
( ) 1, 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. WC0029 j
(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 ,,halJ forthwith comply with those, provisions.
.,.Date;,' t s: Applicant l.t,:.�;__,
Warnfng:''Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his Jt
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnif
& hold harmless the City of La Quinta, its officers, agents and employees; U
2. Any permit issued as a result of this application becomes null and void it, U
work is not commenced within 180 days from date of issuance of such.
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above -mentioned property for inspection p&rposes.
.Signature (Owner/Agent)k Date4*_
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS `fi i' f' f`;ik'�4 R+.X'eiii.PT.AX
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
tui1 LAS k4itW1
1 k * E )':'.i 1.'.. fl.:. 4.. f:';J�'i.1'i
I;-Cl X)X 1,503
4700`dM4C.f�;T.�f�t��s�1.�.VY#100
L,N i)i)04TA t: A. 92233
��I WP():f°I7' CA 92f"X1;0
USE OF PERMIT
,ktil0 1")INO h T` PF 8, U72 S,F, SFt,T'WI `,S. PXKU1T !: cW3 NOT
INCt..i A, }1T..r1'10K 1f+YiR1A's Oft Ix::x. IA, PLAT. t.`IUC"•K FEE FOR
MLTLTIPLF )1_&V CHECK 0Y.SAMY, TYPF,
APARTMENTS V •N 5,4 aw SI''
ESHIMMO
I' MMYF I+ KIM A-'R `
C-0-144TRUC TION FFIE I M1 (K)OI-41$_000
PtAN t'*HF5' K FER 101-000-439 3 1 ti; 021.17
MF,(*H,ft.t'IICA 1, FEN 101-000-421-000 $463,00
V,IV. *'rT IC 14JI.I "IX 101-iIC)t's-420--000 $Tafa
PLUM13440 M 101-000.419- M O $1,394,00
S7'k>^ NO MCITICYN FEE • F &.�'7 D 101 AX)IID-Z 1-0(?0 129.3.'f
DF'VF1A'pPXR IMP.AC;'I FXF, S16,ei1k3.fto
ART TN PI,Il IX, I'LAOP'S R—E I
N ISM PRE -PAID PEXIS
f � 1
C1n ppC pEpT.A
FIN
RECEIPT
DATE
BY`
DATE F14ALE ��
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
a
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O
'Exhaust Fans
O.K. to Wrap
,_20.._,� -5 -07
F.A.U.
Framing
2. 02 . o 21 S?
Compressor
Insulation
3 — . o 57
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
"0 5
Drywall - Int. Lath
n-7
A40,
i.
jjVveeA"Q �•Ls•vt 5
'{• / • v s T
Final
Final
BLOCKWALL AVPROVALS
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
Waste Lines
Water Piping
/ -off` 0 �7
Heater Final
Plumbing Final
Plumbing Top Out
.p
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
_
A liances
•��/. 0 3
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) . o
COMMENTS:
'C s
,.,m e§k.n.�aP;sak+ixG 'k rr•r+.x -,�,n� .t fix. _ ' � .„A 'CfiX .. ? � .�. .. . ,t $.s.P+s. �N.�n9ii"st�m°.�'Yr' ..WtF3�"CetRU�W.+'s..wY�,N.� t�, a�.st .: 4,.—arW:'�'aY:':. .? .:. ms's ti'�..i#, ,-.. � ..,.,Ya .:. .'tia. i� ,a :hv;
�Certificate of OccupancY
a
19U
a
OF Building &Safe y Department
t
ff
I
s ` This Certificate is issued: pursuant to the requirements of Section 109°of the California Building
a
:.
Co'de, certifying that,. atz the 'time of issuance, this structure was �in compliance with the
rry
provisions .of the Building' Code and the ,various ordinances of the City regulating building
construction and/or. use.
1
BUILDING ADDRESS: 50-680 SANTA ROSA PLAZA UNIT -41
t,
o
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-051
I Occupancy Group: R-3 Type of Construction: VN Land Use Zone: VC
I
s
ASITAS LAS ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS
Owner of Building: C RS
,E
I
i
City, ST, ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
� s
,t
Date: 12-04-2003
`
Building Official
POST IN A CONSPICUOUS.PLACE
Certificate of Occupancy
4
Building&Safety Department
This Certificate is issued pursuant to the requirements of Section 109. of the California Building
4 Code, certifying that, at the time of issuance, this structure was in compliance with the
`I
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 50-680 SANTA ROSA" PLAZA UNIT #2
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-051
Occupancy Group: R-3
Owner of Building: CASITAS LAS ROSAS LLC
-!dam
Building Official
Type of Construction: VN
z•11-1, I Ll
Land Use Zone: VC_
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
v
- Certificate of Occupancy
'&Y" otFn
INcaseocn7ID�
oF Budding & Safety Department
{
k
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
!
f construction and%r use.
�l
3
-
a
BUILDING ADDRESS: 50-680 SANTA ROSA PLAZA UNIT #3
a
4r
p
y i4
3
I Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-051
ff
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: VC
y{I
C pX
g = ?
Owner of Building: CASITAS .LAS ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS -
City, ST, ZIP: 4700 VONK-ARMAN AVE. #100
€
By: STEVE TRAXEL
Date: 12-04-2003
Building Official
POST IN A CONSPICUOUS. PLACE
•
�-a-� ���ofOdcupanc Certificate Y
f•
A,
i
'r � _ �II�I��
4
pq`
�t
� � Irioaaoiihn� - -
f:
OF Building .& Safety Department
This Certificate -is issued. pursuant. to the requirements of Section 109 .of the California Building
Y I i
,a
= Code,, certifying 4hat, ate the, time ?of issuance, ` this structure was , in compliance with the
provisions " of the. Building Code and the various ordinances aof the City regulating building
if
construction and/or use:
" BUILDING ADDRESS: 50=680 SANTA ROSA PLAZA UNIT #4
I
" Use classification:. SINGLE FAMILY.ATTACHED Building Permit No.: 0209-051
r !x
zti
d>
Occu,pancy Group: R-3 Type of Construction: VN Land Use Zone: VC
{
E
i
z.
) k
I
i
Owner of Building: CASITAS LAS ROSAS LLC Address: JEFFREY STONE DBA SUMMIT BUILDERS
a City, ST, ZIP: 4700 VONKARMAN AVE. #100
6
` By: STEVE TRAXEL
Date: 12-04-2003
h
Building Official
T
$
eri;
`,
; POST IN A CONSPICUOUS PLACE _...
o ., Cerratcate of Occupancy
.5
.r -
Go9 Bu�ldng & :Safety Department
This Cer#ficate is issued pursuant to fhe requirements of Section �109,of tlie:.California Building
;., 1 �:..
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
h construction and/or.use.
;BUILDING `ADDRESS: 50=686,.SANTA-R0SA-,PLAZA..UNIT #5
` Use classification: SINGLE FAMILY ATTACHED Building Permit -No.: 0209-051
Occupancy Group:{R-3. Type of Construction: VN Land Use Zone: VC
r
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
POST IN A
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST,' ZIP: 4700 VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
Certificate of Occupancy*
TWf 4 4 Q"
Building&� Safety Depadine it
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=68WSANTA'ROSA7PLAZA UNIT -46
Use classification: SINGLE FAMILY ATTACHED
Occu.pan.cy Group: R=3
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Type of -Construction: VN
Building Permit No.: 0209-051
Land -Use Zone: VC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700VONKARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
`a- Certificate of Occupancy
• a rev
oF.9 Building & Safety. Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Coale, certi of t�n that, at the time of issuance, this structure was -in compliance with' the
fY,..g
provisions he - Building Code and the various ordinances of the City regulating building
.
;construction and/or.use:
BUILDING ADDRESS: 50-680, SANTA ROSA PLAZA UNIT#7 t;
SY
Use classification: SINGLE FAMILY ATTACHED Building Permit No.: 0209-051
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: VC
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
POST IN A CONSPIC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VONKARMAN. AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
a.
Certificate of Occupancy
T4hf 4 4a�rw
Building A Safety Department
This Certificate is issued pursuant to the -requirements of 'Section 109: of the California Building
Coale, ceriifying 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 50-680 SANTA ROS4.PLAZA UNIT #8
Use classification: SINGLE FAMILY ATTACHED
Occupancy Group: R-3
Owner of Building: CASITAS LAS ROSAS LLC
Building Official
Type of Construction: VN
Building Permit No.: 0209-051
Land Use Zone: VC
Address: JEFFREY STONE DBA SUMMIT BUILDERS
City, ST, ZIP: 4700 VON KARMAN AVE. #100
By: STEVE TRAXEL
Date: 12-04-2003
PLACE
DE.C-.2:4-03 WED .12: 44 PM, .. 111" ` CO; FIRE- ME' I ND I O FAX "YO. ` 1 760 :,863 7072
errm
.�; RIVERSIDE• COUNTY FIRE DEPARTMENT
In coopera(lon wr h'the
C Calrfonr`a Department o/ Forestry and Frre Protectron
F..
2 est San Jacln q venue• Perris;
ToM .Tisda!a
Fire Chlef
`Protidly serving the j)ccctriber 24, 2003
.:Unincorporated
Meas of Riverside
'Cotinty and the City of La Quinta
Cii�cs of . j3uitding Department
T3anning ,
Re: Fire and, Life Safety Clearance
Calimcsa�%� .
Canyon LakeThe Riverside County F><re Department.v ••granting i fire and life -safety. clearance
.
Coachella
t• for the followmg prglect Casitas'•Las Rosas`for pha>e'I and`II, located 50920
Desert slot Springs Avet>ida Bermudas; La Quanta:`` Please call if you should have arldQuestions.
�`SANTA I ?A,•
Indian Wells
eo
Indio
s.3'v:e E'ss:rtor.:
0
La Quints Respectfully
V
Moreno. Val ley
Palm Desert
PRANK KAWASAKI
>. Chief Fire. Department
Penia
Rancho Mirage
San Jacinto
�c U CU 'BY Al
Tey:
Board or supervisors:'
'Fiie Safety Inspector
. Boe Buster.
District
John Tevuglionc,
Disleict 2
Jint Venable,
District 3
Rcy Wilson,
riei 4
Marion Ashley.
District 5
EMERGENCY SERVICES DIVISION . PIAI INING SECTION . INDIO OFFICE
82-675 Highway 111, 2n° FI., Indio, CA 92201 • (760) 863-8886 • Fax (760) 863-7072
P. 2