9609-023 (3&4)LICENSED CONTRACTOR DECLARATION
I herebyg'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
4051
Date � Signature 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.
1 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 l,should become
subject to the°workers' compensation provisions of Section 3700 of^the Labor
ode, I,shall forthwith comply with those provisions. f
Date:,l,+^,r/'�'" 'Applicant '�'� • C"�- ( -'� '' �.
Warning: Failure to secure Workers' Compensation coverageois unlawful and
shall subject an employer to criminal penalties and civil fines Gip 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.
I 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'relatirigito the building
construction, and hereby authorize representatives,of'his City to enter upon
the above-mentioned property forr,inspection purposes. % /f
Signature (Owner/Agent)"
....f
BUILDING PERMIT PERMTk C°NTRDL#
. 9609473 3933
DATE VALUATIONLOT TRACT
3.3 M264:dii� FYf 13 A tss.lha 0
JOB SITE
ADDRESS 54i-700 ia4,e3sS`�i11'�C� 'i GN SYl BLO 0
APN .70-030-040
OWNER
CONTRACTOR/DESIGNER/ENGINEER
U'SA PR f '1E.S ,'f.R1111
I,NATWPCiEI.'Y.E1 S FUND
2200-lti iii}ut<± As # 1516
2200-i3 DOWLAS A50
1208RVI13A C'A q_M50t
I10SFV9,LE CA 96551.
tllti 773.+5ik�il -
qt6 7�3-� C�'l,tt
USE OF PERMIT
Kit. II,'1°.I-1'.AN1UN I,tWf-.L ,,YN0
TYf IR A '[3T;W Q ! WTS 1-f3
L
i K.A� `.i C."uf`i:A`t' LIC TKYN -- 6.016-11JU SF
fiAREA,`�Plc""AT{1't')t2'I, 12#1.00 SE'
*411111Ax 1x1 COST € F CONKCRIX I'M
3.17,2".00
PIIIN At 11' FFC'N'tI Nil Af31'
>!'�'t' NS`f`RV ON FIEF 10i -W-418-000 $1,472.50
PLAN IrITM Ftp 101 Q{EO-439-318 51,313.6
ME(', tMICAL 115 101-000.421i410 $211.00
f 0,EG"t'TUCatAII .FEE 1.0.1-aiti(3••424}-fl4ti $405.12
PLUNIRTMO F11E I01 -(M! -4194X)0 $42""1rt 0
Sl'^..aTMfO N101110.4M - REESID 101-000-241.000 X33.73
t.I';rlIANG
M4i,AC')'tz11C:t'LFRAFTM 225-W-443=342 $C:i) o,(`r(I
' ART fN PUBLIC PLACES- RESM, 7C11- t)-2S.`+-il(![) 5593.36
FrX.17 TO'ST ' a52�(t:Qp
SUR -TOTAL COQ I;MUMON AND PLAN CHECK
W,476.13
LESS VRE-1 Alb RES
4250.00
TOTAL 1'F.lijti IT HORN DUE NOW
$10.226..13 .�;:
E£ IPT
DATE
BYDATE
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 / 3
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 PP OVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
.Bond Beam
Approval to Cover
Equipment Location
Underground Electric
s
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
Final It AA Aj19
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)
COMMENTS:
CITY OF LA QUINTA
ay% BUILDING & SAFETY DEPARTMENT
777-7012
INSPECTION REQUEST LINE
777-7153
t
Owner U.S.A PROPERTIES
Contractor
U.S.A PROPERTIES
Permit Number
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
Jos ADDRESS 50-701 WASHINGTON RED.
IC
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 ALL ABOVE HAS gFfrp, SIGNED
ROUGH ELECTRIC
ROUGH PLUMBING
ROUGH GAS & GAS TEST
HEATING & VENT - A/C
FIREPLACE
ROOF
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
Z
FRAMING
INSULATION
PRE -ROOF
/ _ _ '_
COVEIVNO"WORK UNTIL ABO EEN GtAW
DRYWALL INTERIOR it
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE & GATE
SEWER SEPTIC TANK
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TEST
F' -'TING - A/C
SE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
1/96 TURN ON UTILITIES OR OCCUPY BUILDING
f OccupancyMica to oCert
o�
Cit
of La
Buildingand SafetyDepartment MO
This Certificate issued pursuant to the requirements. of Section. 1.09 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. Q-17
Use Classification: MFD Bldg. Permit No.: 9609-023
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 Official
POST IN A CONSPICUOUS PLACE