0303-112 (SFD)LICENSED CONTRACTOR DECLARATION
?.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 t Exp. Date
640934 n 6/30/03
D��
ate r i Signature of Conti, ctor2
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
performance of the work for which this permit is issued.
VI have and will maintain workers' compensation insurance, as required by
SectiDn 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 , WiT9ONAL 41014 F. Policy No. 7089309
(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' compensationlprovisions of Section 3700 of the Labor
Code, h111.for hw �h comply with ftho se,provi ion
Dater Appl'iccant
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 attorneys 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
pefmit, 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
�prroperty9fo inspectiion purposes.
c3�1
Signature (Owner/Agent) t" - Date I
BUILDING PERMIT PERMIT# ,V, -1i2 +
DATE VALUATIONLOT TRACTJOB (t�2
ADDRESS il+ .{.. M.!1iaf��o C.,��:k f
APN
OWNER
CONTRACTOR /x DESIGNER EN (NEER
f�2 h A
iSrl'7.i,.A.Y..[•'. RIII.I.V A,.fy ;F.tR��,:
�y/
k7.+;]d:�i.i1 %Sr►L:a7 .
60.311 TiZ,17..rJtrY PMUMAY
81-260 AVENUE 62
1AQ1«lurm CA 92253
UIABII&L CA 92883
(905)835.89916 (MLO 6616
'
USE OF PERMIT
S1dC24.irP.'pG�dtLi��Y;° lNld 1' ,iJ "iL:r L*i4J.t .t6Y4 .l3 rJ11
13LOCK WI&TA P0014 SPA OR
ou Co
CUSTOM MNS T:kZUCTIC+A1 1,917.00 s1t
PORCI-YPATIO 177.00 SIS
t'�, RACK Cx;l;t'GF.� 498,00 OF
Eb7Ud3:1XD C. 09- 0Y CONMUr-n %N
161,253.20
PTMMn1VXEtT 71 1
CON10TRUC` ION FES: 101 -000-41e-000 $996.30
'
PLAN CHIM" MID' 101-000-439-318
M8G:UNIC4AI.1 FEE 101-000-421-000 S$U.00
I:f.rr T91CAI, VEF 101-000-420-OIDO $I.if15G
'
PLUMBNOIRX 5146 M
STI`,faNf3MOTION PPE # MID 10I-•000-241-000 $16.13
OUD 10 F319 101.000.423.000
wT��>I;.a'mn IMPACT ru,
'RED ?POSIT 101-000.439.318 4750.00
i. •tom J . .i�'.EE� mm X.'!ow
F11A_R z 4
SL -. 7f�= 2
zca3 . ...
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE:� M,
BY
D FI AE�D�j
I CTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
4;2Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
p
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
.Sewer Connection
03
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
Final
Utility Notice (Perm)
7 2S
Mainiero, Smith and Associates, Inc.
Planning /Civil Engineering / Land Sun;eving
`''V77 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 l -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
t 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
16i
60-392 Lavender Court
432.50
432.5 i
+0.0-1
162
60-414 Lavender Court
432.20
432.20
+0.00
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
1428.30
428.33
+0.03
166
60375 Chelsea Ct
1428.50 1428.52
1
+0.02
Very trul yours,
Steven J Va , L.S. 6500'
SJV:tt
r
cc: Hector Guzman, Engineering Department
tN Mike Groessl, Shea Homes
S�,;� SAND SVSG
STEVEN J. VAN F�
REG. EXP'
k
�cm
�F A/Q