9609-018 (3&4)LICENSED CONTRACTOR DECLARATION
- I+ereby 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 Exp. Date
A/ate� Signature o�tractor
�!�...,.......�..•- `Gr.'s - ' �� _ . � •-`1'1
OWNER BUILDER DECLARATION r
I hereby affirm under penalty of perjury that I am exempt from�th'e 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&RC. 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.
(.1) 1 have and will maintain workers' compensation insurance, as required by
S c 'on 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'Sectiorit3700 ofrthe Labor
Code, I shall forthwith comply with those provisions.
ate: 45 'le/%.�gp.Plicant
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 authori�representatives'of°ihis"City t enter upon,
ri
the above-mentioned property fonspection purposes ,r
ignature (,Owner/Agent)`% %'e" �°' Date
C_._.._.._..
PERMIT # CONTROL #
BUILDING PERMIT
1409-018 3938
DATE �
$'337.2!!3100 LOT � 1: A TRAOU
*
OVALUATION
7
JOB SITE i �yn� z�y zt
ADDRESS 50-7,01.Yl�1'�'f+Sl?IING' ON Si .�1,1W: L 7—t
APN
769 -03e -WO
OWNER
CONTRACTOR/ DESIGNER/ ENGINEER
USA PR4.)PEKIIIIIES f'[.tND
USA FUND
'2200.8 DOUGLAS #,'1550
2200.13 DOUGLAS GLAS fii50
ROS[sV11X1. CA. 95661
916551
CA 96551
(Rit;(7�SEV.CK./LE
�
USE OF PERMIT
&iiAJI-k'AWLYOWELL1:NG
S1.Dti, L 1JN1 I'S 1-13 T Yf% A
PORCHAPAT10 608 00 $F
CxA',Ai3 Jt.t�R �T1'T' 128,00 SF
F-STIMAXED COST Ole C13NS'CltUC-1710IN
33 7,264,00
is.'(l'M�'1't�l:iG:T3t�P1'i'�;'1 iUl-(it1i1-1�.1.K•..tllltl '�1,4'i�.SO
PLAN C'F1. T7 %t-- 101-{} 0141>-3111 S013.111
14 CTIAN1C:AL F11 101.000-421.01!!1 '101l. 0
MAUC".'.1Td,ICA1, F104, $405.12
f3(,1)M4Ra1w; FRI 101.0 -419.000 142n.00
u'I'ONG WYV101,� .hVXI • 1101.0 101 -000 -291 -ow $33.73
610 DING 1' UES, 1.01-000423.000 t20A
tNrRANTt#l.fr".iLff4E F843, 2-25-000-443-342 S6,00.00
:1117' iTT 1101AtJ('; P1.ACr,;, - RE'SIC 103.011(1-255,000 " , 51+93.101
SUB°"1'C11'A.L CONS f UC11Q14 AND PLAN CHECK
$10,4.76.13
LEST C'1tR-1'Ai1J 1 t ES.Ot}
TOTAf, VVRNOT FEF -S 0111+; NOW
$141,476,13
f
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.."
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
(o
Ducts
Slab Grade
Return Air
Steel
(y
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
01
Final
Final
POOLS -SPAS .
BLOCKWAL
APPROVALS
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
&e4IM&
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
ITY OF LA QUINTA •-'iOkElk
BUILDING & SAFETY DEPARTMENT
777-7012
�J INSPECTION REQUEST LINE
777-7153
,jr• Lh UuiNTA
Owner U.S.A' PROPERTIES
Contractor
U.S.A PROPERTIES I 0 ``. 1996
,9609-018
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-701 WASHINGTONM
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 ABOVE HAS BEEN SIGNED
CONCRETE SLAB
/,-
JOISTS & GIRDERS
ELECTRICAL.rAROUND WORK
/ Q,
JOT POUR CONCRETE UNTIL AjelL ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST Z
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION
PRE -ROOF
COVER NO WORK UNTIL ABQNEjiAS BEEN -SIGWlV
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
ENCE & GATE
S EPTIC TANK
FINALS
ELECTRICAL
PLUMBING V
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
Certificate of Occupancy
City of La Quinta
I..
Building and'Safety Department OF
..
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:
BUILDING ADDRESS: 50-701 WASHINGTON ST. L=14
Use Classification: MFD Bldg. Permit No.: 9609-018
Occupancy Group: R-1 Type of Construction: VN Land Use Zone: CN
Owner of Building: USA PROPERTIES Address: 2200 B DOUGLAS # 150
- City: ROSEVILLE, CA. 96551
By: PELLETIER
Date: 6-30-97-
Building
-30-97.
Building Official
POST IN A CONSPICUOUS PLACE