9609-015 (3&4)e� .
LICENSED CONTRACTOR DECLARATION
,`,,hereby affirm under penalty of perjury that I am licensed under provisions of
rChapter 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 AExp. Date
/Date%/'Z$ignature 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).
( ) 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.
XI 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 sliould,become-
subject to the,wo�rkers' compensation provisions of Se tion 3700 of the Labor
Code, I shallJorthwjtt comply with those provisions.
Date: /di` �• Applicant.-
Warning: Failure -to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to. the building
construction, and hereby authorize representativesof this City to enter upon
the above-mentioned property for inspection purposes.. '
/ignature (Owner/Agent). r Dater"+
BUILDING PERMIT PERM T# C°NTR°`#
►09-4)1114 3941
DATE VALUATIONp� 3,'264+ LOT. .RA
t, TRAIi�� 1
ADDRESS aYC-I :% WXSIONCr' ON ST ��LOV. �1. — / I �JOEI SITE
APN 76 "3"44)
44)
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1SS ; PR.01' ;lt'! WS R " D
I.1SA i'ROPr?1"i 11":# S Ff N'D
27W -L4 r I io
2200-9 DOUGLAS 01.50
Rt SHV L1.:11 t.'A (),R*I
1ttJS13VI1.LE CA. 96551
91,6 773�(ilfii)
016 7-7 14-506 fr'BMI
USE OF PERMIT
E41#.�C;1'1-1�AAs.lI..1 L7Wh'1..1,,1NO
111. X; I UN I'S 1-$ '.I'YPF AL
#`fttrr:"C t tii1VS'I12tic 1lUta S,fll.ti.Ui1 SF
POR,044JA TIO 8
GATtAfy 0CARPUR7' 17fi.f3fi SP
OSTItVIA7 FU) COST OP CONSI RUCTION
337,.264.00
PERMIT F14% SUMMARY
CONS'f'RIJ(T TfC:Vf FrA? tot -00"184)(110 $1.47�;50
PLAN C1IFECK rHE 101.000-439-318 51,3.1162
2v1L' 'HalaiteAL F88 1t1l-0.00-1121.000 $211.00
RLEC I RICAT. Kh S40S.12 .
PL TlViAM, ME 1 t11>(1E .�11 ! Of)0 $427.09
STO*101,10TIt?N.Va13-Ttvsttj 101.-1 0,241 -ow 333.143
GRAJ)IN0 I 101-000423-000 Sa9.f
TA%JF'RA,VrR1X'I'CRH PER 225.000443-,V2 S6.000-00
AT tN Ptl#'i1..1C }=1 AC.6.1 - RRII C 701 µ0t 0-255.+-01y) $5,911 16
SILWICTAT L'ONS'1`RUC'.7 ON AND PLAN CHECK
$10,476.13
,ESS PRE.-PAif711 rS
solx)
--� `#°()'f AL P11 kl4El`t' .E1~.»'� DUE NOW'
$10,476.13
RECEIPT
DATE
BYDATE
FINALED
IN
INSPECTION RECORD
b' OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
/ (o
Roof Deck
O.K to Wrap -
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
I BLOCKWALL APPROVALS
Set Backs
PLUMBING APPROVALS
Shower Pans
Sewer Lateral
Sewer Connection
Gas Piping
Gas Test
mnai
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit //
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utllity Notice (Perm)
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
Condensate Lines
Final
POOLS - SPAS
Steel
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
F nnami datinn
•,
a ,
_ CITY OF LA QUINTA
• BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153 y r Lh1 WU I NTA
Owner U.S.A PROPERTIES ; I �, n. 1q9g
Contractor -
U.S.A PROPERTIES
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
.:5U-701 WASHINGTON 1
1 JOB ADDRESS
TYPE OF INSPECTION
DATE INSP.
FOUNDATION & SETBACK
FOOTING STEEL
/
MAIN GROUND SYSTEM
GROUND PLUMBING I,&Av ppr
// G
PRE-GUNITE . 4419.iV
DO NOT POUR CONCRETE UNTIL ALL ABOVE HAS BEEN SIGNED
CONCRETE SLAB
/
JOISTS & GIRDERS
ELECTRICAL G OUND WORK
D
/
OT POUR CONCRETE UNTIL ALL BO E HAS B EN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
j
PRE -ROOF
COVER NO WORK UNTIL ABOVE HAS PEEIJSIG
DRYWALL INTERIOR
EXTERIOR LATH /
POOL PRE PLASTER
FENCE & GATE
(SEWEA SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
'TING - A/C
,`�SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1 /96 TURN ON UTILITIES OR OCCUPY BUILDING
rti
'of OccupancyCert�ficato
Cityof La Quinta
OW
Building and Safety Department'. MOF
:This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,'
certifying that, of the time of issuance, this structure was in comp once with the various ordinances .
of the City regulating building construction or use., For the following,-,
BUILDING ADDRESS: .. 507701: WASHINGTON ST.. 1-11
r
Bldg. Fermif No.: 9609-015 '
Use Classification:, MFD _
pccupancy,Group^: R-1 Type of Construction: VN . Land Use Zone: ^ CN
~Address: 2200 B DOUGLAS '# .150
Owner of Building: USA PROPERTIES
City: ROSEVILLE, CA. 96551
By: PELLETIER
Date: 6-30-97
Building Official
POST IN A CONSPICUOUS PLACE