9609-009 (3&4)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
. hapter`�3 (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
''.
ate Signaturebf Contractor -141._e';
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 woIrkers'
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.
(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 they, workers' compensation provisions'of Section~3700 of the`Labor
�C de, I shall'forthwith.cdmply with those provisions!''
te: '�/' ' �''rApplicant.. ? r+}f. �•✓` i ' �'
Warning: Failure to secure Workers' Compensation coverage_is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null.and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the"above-mentioned property for inspection purposes!'
Signature (Owner/Agent) =� �•�-' Date ! r
BUILDING PERMIT PERMIT# CONTROL#
9411,14-09 . 3947
DATE VALUATION LOT TRA C ,
. •-11i�`' _y l ,'le'ibflt�J��N1 '`�"',r
JOB SITE
ADDRESS { '�t� 1"frl.�.H�.irlCx'� :�.�1 ���,�{� 4 -
API 769-030-040
OWNER
CONTRACTOR/DESIGNER/ENGINEER
r ('Cr'i.' aisi•�i�'C'�f !'ft: i" Fr "111 f
aJl.r
F [�-M1 pe-%llLl'Y^'�•'t� -v r.,^.
y�.i�i. ♦.LA ew ,,ar .,. sr•r-r as
.221-6iklGAIAS Wt
220041 DOUGLAS 54
PIOSIVI.EX CA 95661
ROSEV(wIA CA 06551
,)1(: T1:3.40M)
'alt; 771-606 Cl 81.#
USE OF PERMIT
I;t1fu'E I,L4.RIG
61.1313 C 1:'') ITil 1µ4 TYPE 0
lfl(Mllil CONSTRUef 1.014 slf,'
(`sARAC,tgsfE;t\RPOC2'1' MAO 31
L `'I'UHATED COST.OF C( N9..(JRUC-r10N
168,632.00
1'�:i121lfi1'1' �'6':•N' tiliA9.Ii�l.e'�it1' i
CX) NS'rR Kt ' 'TO'NfME 101--OW418.000
T't ANCIMC:KH101.x'000-439,31$ 57773,81
k1f.a4AMCAL f~'i:6 101.000.4.21-000 $'113400
.i'G"t'ftlC;ti1. T 1?i� 101-000-420,-0 J %4.156
T'i,.ff 3h Qf3iN(I F"1. '101. 00:4.Mft) $236.90
STONG M.01 ON i• E*2 - RLS1D 101-000,241-000 $16.86
ORAV.IN FIX 101-000.423.000 $i20M
WF RAFs'YRUC':I`1T.RI M, 'j75-000-4 4-1-142 53,7033.25
ART Thi PUP,.1.3'C PLAt`0,0, - €j3-$1 , 701.-000.1255.00() $T7:1..5g3
STJB-:1YJT.:ALr CONSTRMCIION MD PLAN .CHECK
$6,02.06
L'SS PRE -PAIL) .1~ )SLS
$0.009
T0'I AL if''t>t.1$i1 Ur.IFFTS IDi:11 NOW
1%,152.06
RECEIPT
DATE
BYY4eDATE
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL tP VALS
POOLS - SPAS
steel
Set Backs VElectric
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
Encapsulation
Gas Piping
Gas Test
Appliances
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)
COMMENTS:
a
s
_ CITY OF LA QUINTA
frr, OF ^ s� BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REOU � T idbNTA
7771471 SV
Owner
U.S.A PROPERTIES � "T 04 1996
U.S.A PROPERTIES r.+RIANCE DF°T
Contractor
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
SHINGTONtBLDGA
JOB ADDRESS
TYPE B UNITS 1-4
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING
PRE-GUNITE
%
DO NOT POUR CONCRETE UNTIL ALL
ABOYE HAS B Ey SIGNED
CONCRETE SLAB
(p
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
(.- r
C bT POUR CONCRETE UNTIL ALL ABOVE HAS BE N SIGNED
RnI1r;H FI FCTRIC
ROUGH GAS & GAS TEST
HFATI Nr, A VENT - A/r:
COVER NO WORK UNTIL ABOV9. HAS BEEN S GIJEP,,l
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
i Jt NUMtftH,
,I101R r:r1AAPI FTFr)
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1!96 TURN ON UTILITIES OR OCCUPY BUILDING
Certifi C -at
e of Occupancy
. G
City of La Quints
Building. and -Safety. c�MOF��°
.
V This Certificate issued pursuant to the requirements. of Section 109 of the. Uniform Building Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating. building construction'or use. For the following:
y
BUILDING ADDRESS:. 50-701, .WASHINGTON ST. C-9
Use Classification: MFD Bldg. Permit No.: 9609-009
Occupancy Group: R-1 Type of Construction: VN Land Use Zone: CN F W -
• Owner of Building: USA PROPERTIES Address: 2200.6 DOUGLAS # 150
City: ROSEVILLE, CA. 96551
By: PELLETIER
-7;:;�,. All
Date: 6-30-97
Building Official
POST IN A CONSPICUOUS PLACE