9609-008 (3&4)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Gbapter 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 ,
40 521
• • , �� f".' -`fir•'- r; ` ;
Date,/� Signature of Contractor—
OWNER-BUILDER
ontractor OWNER -BUILDER DECLARATIONf . '"-'/-'-'�*
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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.
(V) I have and will maintain workers' compensation insurance, as required by
Se ion 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.
(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,.
Cyb�de, I shall forthwith comply with those provisions. ' ._ ,
\/Date: o' .f_`. -4,4-AAplicant >'. 1
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up`to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant'to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes::'
J� .� C ~ J�
Signature (Owner/Agent) _ '- • '.f L> Date' f <%
BUILDING PERMIT PERMITk CONTROL#
9"9-068 3948
DATE VALUATION S337,2(,�4.t1C1 LOT �1 Y? � TRP,C��i Ij
_
JOB SITE1 r_t p�+e�,1 t� r� y'
ADDRESS :131 -ilia �Vi1a910NC*i�ilON SSI ,[sA.i�.11� H i1
APN 7S14 0304WO
OWNER
CONTRACTOR /DESIGNER /ENGINEER
2200-€3 DOUGLAS #150
21OG-B DOW) LAS N1 50
,F- CSR �)'$ l
RO,eSis"V�i/.� 11. CA,
tR_0S.yh•�fi-'t[
91.6 1 1-6W
x]9655)
910 73.606 ��1JI.�ffi
USE OF PERMIT
WATI-FAMILY DWRi,,1,Ij 0
KIMIr� P UNITS 118 1I1YI':6 .A
TRA40T CC►:tvSTRUA i10N 6,016.00 SH
PORCHt1)ATIO 6010) IF
GA.i3Uk0f JCA'RP(f"RT 1210) 3117
't'INiA.MD COST Off° (3ON:i'['RUC.°TRON
337,2.64:00
�'.4t,4Qti#.f 7` i}' E'a sr: TfJ fVF l'r�1�i 5111
.
®rIWS' C'CTIOWrHF 461-C)0041K- )0 $1,472,50
PLAN �,`#4f:Ct*;.PEE t03•L�4E! 43�-315 3i,313.d�
WC1141kNICALI'lii 101-Ot1fI-42i�vt)i) SZ'1.i..ilii
'
E1XC"i'I1.ICAL E'ER S40532
I'LUNIPI Cr M 1U.1-iiiiU ?i.I�'-Ui)() 5�1m7.0+►
- 1 C?NMMCrfION. FM » 3t1,,31D W! ,(W-2 41-000
xIZi11.ANG .1"Isis
INFHAS1`itIA VURR FEE 1:5,000.0
AR.T.IT4 PuR1,1C PI, ALt r -R IT, 701.•Gi)f)-2i-li(I(} 1$593.16
SMTOTAL CONS` RUCTION ND PLAN C IIECK
$10,476.13
LASS PR&TAD FERS
$0.00
"1`07'AL P:iERINU'T T.+'>4;VS 941lfd NOW
$10476.13
n:
RECEIPT
DATE.
BYDATE
FINALED
INSPECTOR
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 -
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
BLOCKWALL APOVALS
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 /
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
Zz
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL/ AP ROVALS
Temp. Power Pole
Underground Conduit // ,
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors j
Temp. Use of Power
r i .
Final11,7
Utility Notice (Perm)
a
CITY OF LA QUINTA rf
f.o,I,� Sys BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7Agj ur LA UUINTA
U.S.A PROPERTIES Ui-'T 04 1996
Owner S
Contractor
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MU I L APPLICABLE SPACES
JOB ADDRESS MUM`
TYPE A UNITS 1-8
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL /
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
DO NOT POUR CONCRETE UNTIL ALL
B VE HAS 8EE IGNED
CONCRETE SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L OT POUR CONCRETE UNTIL ALL ABO E HAS BEEN SIGNED
HEATING & VEN1 -AIG
FIREPLACE
COVER NO WORK UNTIL ABOVA HAS EN SI
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
CE & GATE
�9EWEWSEPTIC TANK
FINALS
ELECTRICAL S -
PLUMBING
FINAL GAS TEST
P—TING - A/C
i 'E NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
Certificate'pf'Occupanc*
City 01 La Quir ta
,MovLaw.
Bu�ld�ng and Safety Department'.OF ;
This Certificate issued pursuant to the'requirements of Section 109 of the Uniform Building Code;
`certifying that, at the #ime of issuance, this structure was in compliance with the various ordinances .:
of the City regulating building construction or use. For the following.
BUILDING .ADDRESS:, `'' 50-701 WASHINGTON ST'.' B-10
Use Classification: MFDBldg. Permit,No.: 9609-008
Occupancy .Group'. R-1 Type of Construction: `VN Land Use Zone:,CN
Owner of Building:. USA PROPERTIES. Address: ;. 2200 B DOUGLAS # 150
U City: ROSEVILLE, CA'. 96551
By: PELLETIER
Date: 6-30-97
Building Official -
POST IN A CONSPICUOUS PLACE