Loading...
0303-116 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of ,hapter 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 640934 13 6ia0f(33 Date(' Signature of Contctor� 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 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 p rformance of the work for which this permit is issued. ) I have and will maintain workers' compensation insurance, as required by Setion 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 NAT it3.WA), t'NIONI IT: Policy No. 709.5309 (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, 1,sha119f rthwith comply with' p_rou sig• ns. 'Date: .J- APPlicanf-_,_) 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 aV t 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 Lpon the above mentioned property*.for inspectiori purposes. ' r.� Signature (Owner/Age nt)-""" Date• .- � BUILDING PERMIT PERMIT0p30�1A6 DATE t VALUATION SA 77,040--M .LOT . 162 TRACT 30024 JOB SITE ADDRESS (A -•4i4 ,,AVXPW COCA �. APN 76� H7C2-03 5 OWNER CONTRACTOR/ DESIGNER/ EN (NEER 60-313 '.f'.[.)7.{ GY PtJMVAY 81.260 Mi Uri 62 .3C.k QNINTA CA. 92233 7BF ..L Q',A 92883 (909)88.8996 Com.# 6876 USE OF PERMIT �trrc�;I.�• T��gAdZLY �� IZY�� # . a`i'X7 * Lu ,1 104, r"V 3.3 155 P'.9« "iitlidJiJ E.c7 i' LI1 1 N 6 .U" 9: J+4i ".3w WA,W4 P0014 SPA OR D13IVLOWAY APPROACH CUSTOM CONSTRUCTION 2122190 O PORCH/PATIO 1111.00 sr 0ARAWCARPOR.T 478,00 SFS X.'.VX).R"SL•P,M COSW 01r coffisllzUc.+G. of 1 F tk'U"Yil.00 plaw-r FIS, 8@.TYA"R CONSTRUCTION ITEE 301-000,418-000 $912,0 PLAN C:t1.+ K M, M2.90 MECHANICAL RE 101.,000.421-000 sa's0 ' ELECTRICAL T EL 101-000-420-000 I'Rt1Tl�IC�P'!3•E "t 01^�YOG-�#79Pi}tFa �1:?6.0�1 ."�Iti9t MOTION PSE ReSID 101-000-241-000 GR:A.raINO I -ME 1.01-001-423.000 Ia,fi1� DEVELOPPM.IMPACT FEE 1z4©�.QO tr'FL�I�1'���Is ft?I.0f;0��'39.;"18-6,17ti - AND PL.E'1f)i i..f.6�A.rY. $4,404,93 t t 1Z33 PE -PAID REFIS -0—so.00 ; DIUK OW "AW93 ri A.fM',r:FK Y •I ; 1 _ MAR. 2 4 2003 CITY OF LA QUINTA FINANCE DEPT. RECEIPT DATEt 7 BY f p D E F D INSPECYOR P. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 6 Footings Ducts d 3 Slab Grade Return Air Steel Combustion Air Roof Deck a Exhaust Fans O.K. to Wrapp . m F.A.U. Framing p Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines JM23 4z Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection D Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: 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 zry Final Utility Notice (Perm) P 4 1 ` 4DMainiero, Smith and Associates, Inc. Planning / Civil Engineering / Land Surveving 777 East Tahquitz Canyon Way,.Suite 301 / Palm Springs, California 92262-6784 Telephone (760) 320-9811 / FAX (760) 323-7893 - e-mail info@ mainierosmith.com - www.mainierosmith.com May 13, 2003 Department of Building and Safety CITY OF LA QUINTA 78-495 Calle Tampico La Quinta, CA 92253 Re: Form Certification Tract No. 30023-2 Construction Sequence 1-E Gentlemen: This letter is to verify that the following building forms have been checked for elevation and horizontal location by Mainiero, Smith and Associates, Inc. and found to be in substantial conformance with the approved Precise Grading Plans. Finished floor elevations for lots 121 - 126 and lots 157 - 166 are as follows: Lot # Address Plan Field Difference 121 81-687 Brittlebush Lane 431.80 431.78 -0.02 122- 81699 Brittlebush Ln 430.80 430.75 -0.05 123 81711 Brittlebush Ln 429.70 429.62 -0.08 124 81723 Brittlebush Ln 429.00 428.98 -0.02 125 81735 Brittlebush Ln 428.30 428.27 -0.03 126 ' 81747 Brittlebush Ln 427.60 427.62 +0.02 157 81-858 Brittlebush Lane 434.90 434.92 +0.02 158 60-431 Lavender Court 431.70 431.72 +0.02 159 60-407 Lavender Court 432.20 432.23 +-0.03 160 60-387 Lavender Court 432.50 432.51 +0.01 161 60-392 Lavender Court 432.50 1432.51 +0.01 j-162- 60-414 Lavender Court 432.20 432.20 '---4:-0,00-- -`+0:00-163 163 60-438 Lavender Court 431.70 431.70 +0.00 164, 60419 Chelsea Ct 427.80 427.84 +0.04 165- 60397 Chelsea Ct 428.30 428.33 +0.03 166 60375 Chelsea Ct 1428.50 1428.52 +0.02 Very trul yours, Steven J Va , L.S: 6500 SJV:tt cc: Hector Guzman, Engineering Department Mike Groessl, Shea Homes OND STEVENIVAN F� v REG. D(P,.� N0.6500 Q J�9TF �o�� ,OF C 0-�