9609-021 (3&4)LICENSED CONTRACTOR DECLARATION
U) ' Thereby affirm under penalty of perjury that I am licensed under provisions of
P-, t '1,apter 9 (commencing with Section 7000) of Division 3 of the Business and
CV UJ 6— ---Processionals Code, and my License is in full force and effect.
E Z) M License # Lic. Class. �,.' Exp `Date' r•,�.
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W— i1�1 1(�
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OWNER -BUILDER DECLARATION "
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) 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). I -
co () I am exempt under Section , B&P.C. for this reason,
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C\1 Date Signature of Owner
ON
O)
Q WORKER'S COMPENSATION DECLARATION
C:) Z I hereby affirm under penalty of perjury one of the following declarations:
Hp () 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 � Q performance of the work for which this permit is issued.
m Q C) I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
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fl C) H permit is issued. My workers' compensation insurance carrier & policy no. are:
Z 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 thatf�1'§hould-become
subject to the workers' compensation provisions of Sectidn 3700 6f theTcabor
ode, I shall forthwith, comply with those provisions., I �.
Date: !'- .%'%f 1",�'Applicant f,..
Warning Failure to secure Workers' Compensation coverage is unlawfdl 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
�^Vip & 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,
uilding,,construction, and hereby authorize representatives of.this;City to enter upon
the above-mentioned property for inspection=purjposes.
Signature (Owner/Agent); ¢`<' % �� Date
- - BUILDING PERMIT PERMIT# CONTROL#
��9-02 3935
T
DATE ALUATION LOT 1'YV- A - TR L.1.x., U
ADDRESS �7 .%{F� F�e� at l� 1�1 i ���}f.s {a ..I JOB SITE
APN 769-0304040
OWNER
CONTRACTOR / DESIGNER / ENGINEER
USA I'VIO-PERIUS MIND
.2200-f3 iSOUGI Ns- relit)
2200-1:31".fOUGLAS 9150
lt()SIRIV.11.LeE CA 9566+1
ROSfsYi.LLE* CA, 96-551
�a 16 771-60' Jo
916 773--600 C131A .
USE OF PERMIT
n1Ui,;!`i:-�f1f1i11��' .i:1ti�/ N�..I.i3�c ►•
1li,;DG i7 UNITS 14 ;i°1 Pr, A,
it +si.°1 C Cilvtis,ltll%"!'tc uti 6,06.(w SI
vcsli.Clii'I'Axto 608.00 3V
a AllAGI✓,ICAAR ft',f' 124:40 sr.
1.,St'1C,lilfi.d'IED COST Cid' CONST [t:lUiCTION
337,.264.00
CONS'PR( fC.TrON FFk t01 -000 -418 -OW $1,4 112,50
PLAN IUMCK PEE 101-000=439-318 $1„313,62
M;G 1f NICAL.F 1.01 -000 -421 -OW ,211.60
I;I:T3(a'WCAL %'1•.'p: 101.000420-000 1ff5. 12
PL'UNIAlT.dtiv FRF 1fllwf#00 �tY9-t)tKi. 5127.00
.Jf,1'0rr,ry NJOTsOrf r. m. - PF 1) 101-�00.1111•-= U1. 73
01RA TING- VISE S20:W
riv'_ RV,;'3`RUC'1 LW3, VCE :1254-1443-342 $61000.00
MIT 'IN PU1% ,K.' KAM',%- KESTr `,01-(100-255-000 $593.16
SUB -IMA CONI S'Md.lMOAt AND PLAN CHECK
$1Q,476.13
'LESS �F1K -PAID FEES
$0.00
'I"O3AI, PURN4i'1 FEWS DVE MAY
$10147613
M
R@CEIP
DATE
BY
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
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 PROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final ,I
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 AP ROVALS
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) EE Y
COMMENTS:
l
sITY OF LA QUINTA �?
Ak
�`o,�,fi ``�
i BUILDING & SAFETY DEPARTMENT e/
777-7012- I
INSPECTION REQUEST LINE
777-7153 .
uIs . ulri-.Pi'aiQ114i.r,
Owner U.S.A PROPERTIES
Contractor U.S.A PROPERTIES
°.9609=021 �'asnh;r I.hq
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 50-701 WASIIINGTON1, E EN
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 BEE IGNED
CONCRETE SLAB /
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
L OT POUR CONCRETE UNTIL ALX ABOVE HAS BEEN SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST W N171
HEATING & VENT - A/C
FIREPLACE 42 jo
ROOF /
BOND BEAM
O.K. TO WRAP 2- r
GROUT ❑ 4' ❑ 8'
FRAMING `
INSULATION
PRE -ROOF
'�.., COVER NO WORK UNTIL ABOV9 HAS BEEN SIG
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK /
FINALS
F'LUMBINU
FINAL GAS TEST
� JC fVVMOCI'1C
inR Frimpl FTFn
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
Certificate.of Occupancy
City of La Quinta'-
o�
Buildin andSafetYDepartment °
This 'Certificate issued pursuant to the, requirements of Section 109 of the Uniform Bui/ding 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. .0-15
Bldg. Permit No.: 9609-021
Use Classification:.. MFD 9:
Occupancy Group: R=1 n Type of Construction': VN Land Use Zone: CN r
Owner of Building: USA PROPERTIES Address: 2200 B DOUGLAS # 150
City: ROSEVILLE, CA. 96551
By: PELLETIER
Date: 6-30-97
Building Official
POST IN A CONSPICUOUS PLACE