9609-017 (3&4)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F' -Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W'Professionals Code, and my License is in full force and effect.
O M License # Lic. Class 6', Exp. Date
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Zr- /Date Signature of Contractor
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J U M OWNER -BUILDER DECLARATION `
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1 hereby affirm under penalty of perjury that I am exempt from the Con rt a tor's
co License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
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Q WORKER'S COMPENSATION DECLARATION
CL
C:) 2 Z I hereby affirm under penalty of perjury one of the following' declarations:
U-) F_ Q () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code; for the
O J Q performance of the work for which this permit is issued.
m Q U V1/ I have and will maintain workers' compensation insurance, as required by
Q CJ Q Section 3700 of the Labor Code, for the performance of the work for which this
IlZ permit is issued. My workers' compensation insurance carrier &policy no. are:
Carrier Policy No.
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(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, 1,should-become
3 subject to the workers' compensation provisions of Section 3700 o the;Labor
ode, I shall forthwith comply with those provisions.
Date <a "� �,� rs Applicant
Warring: Failure to secure Workers' Compensation coverage is -unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on' his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this -City to enter upon
thabove mentioned property for inspection purposes "
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Signature (Owner/Agent): Datej �"1•
PERMIT# -CONTROL#
BUILDING PERMIT
,£,4#1ry 3939
DATE _ VALUATION S;�,Zb�. i LOT �.�.�, �� TRACTIr%D0 K
JOB SITE
ADDRESS Mi' 701 WASI1191<ii���`ON ST .11,06 K _ I
APN 765 -030-040
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1:utn
USA f-'RC)MI$:'' IES FUND
2200.13 t'lt:tl.;c, U%8 i>'00
220 0431, .AB 6150
RO,S1N11-111: ("A 95,661
ROSMULP C'A, 96,551
01-fi 771.6060
916 773y6k)
USE OF PERMIT
t�tlt.t;1:1-.t�Ait'1it.`S'� 1-)�VRI.:l..i1~1�3
13IA)O b: LMT'S 1-8 IPE A
a RA( i' ;Ul acl'4i�+`t fJi�i d,U16.uii d
1'ORCHIPA T 1� ► 608.00 yF
G-b112A�JCtli�#�fi1tC !2$.(N) 91:
FSTIMATE 0 C0.1W OV
337,2,64.00
�'.�;[di's��'1" $+•.�T�.;�S�Jt1�IV�,t>,��t.'i' .
CONST—RUC"_FIC N1M 101 -OW -41.8-W, $1,171<4
V11 AN CMCKFEE 101.000•=1-19.318 31,31:3.62
MECHAN,[CAL );E 6 1$21 Lw
. FJ. Rr'rRfC.AL FEE 101.000420-000 $405.1,2
PI tND11• G FU.. , 101.000 -41.3 -WO $4247.0
ST( 1110 :A..ia1' ommRts m i o i oW-2•4t 000 S33.73
GRADING FEC 101-000.423x0()0
FNM- MSTRUCIVRF RI? 22000-442; 31`1 soi,(".Oo
ART tN PUBLIC PLACTS S - RESiID 70:1-00H0-25.5000 $591.16
QUO-TCTA1, C"t31�51'1�UGr1�Q1�J A1`li3 PG�tW C,t11iCK.
$.10,476.13
I.E.SS PRE -PAID F131'8
90.00
RECEIPT
DATE
BY .l
DATE 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL P OVALS
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
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)
a
CITY .OF LA QUINTA r
�vOr ~ - `� BUILDING & SAFETY DEPARTMENT '
777-7012
INSPECTION REQUEST LINE
777-7153 kir LI1 l,tUINTA
Owner USA PROPERTIES -F �-T9��
Contractop.S.A PROPERTIES
19609-0.17 I.NrE
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-701 WASHINGTON r
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 A)30VJE HAS BEEN SIGNtD
CONCRETE SLAB
JOISTS & GIRDERS 1
ELECTRICAL GROUND WORK
OT POUR CONCRETE UNTIL ALt AB VE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST fj
HEATING & VENT - A/C r
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP f
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABp E H BEEN GWW
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
JOB COMPLETED
7FMP Pf1WFR
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
I j9A TURN ON UTILITIES OR OCCUPY BUILDING
0f Occupancy..pil,CPerritificate,
ellCit of La quinta.
�.
t CFM FA,°
Bu►ldin . and Safety DepartmenO
. 'This Certificate issued pursuant to the requirements of, Section 109 of the Uniform BuildingCode,
certifying that, at the time of issuance, this structure was in comp/lance: with the various ordinances
of the City regulating bui/ding construction or use. For the following: '
; BUILDING ADDRESS: - r ..50-701 WASHINGTON ST. 'K- 13" a
Use Classification: MFD Bldg. Permit No.. 9609-017
{
Occupancy Group: : R-1 Type of Construction: VN Land Use Zorie: CN
Owner of Building: 'USA PROPERTIES,
Address: . 2200 B DOUGLAS # 150
City: ROSEVILLE, CA. 96551
^ (Ja�Ajq-w
By. PELLETIER
Date.: -6-30-97
Building Official
a POST INA CONSPICUOUS PLACE