0210-314 (MFD5)LICENSED CONTRACTOR DECLARATION
jhereby 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
04
WProfessionals Code, and my License is in full force and effect.
5 M License # Lic. Class 'Exp- Date
LU
6zDate -.7 '�ignature of Contractor
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L) 0 OWNER -BUILDER DECLARATION
UJ LU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
F- [L
U) License Law for the following reason:
Z_ ( ) 1, 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).
1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
Cf) I am exempt under Section _, B&P.C. for this reason
LO
C\I Date Signature of Owner
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WORKER'S COMPENSATION DECLARATION
0 Z cr I hefeby affirm under penalty of perjury one of the following declarations:
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, FZ 0 O 1,have and will maintain a certificate of consent to selMnsure for workers'
X w Y: compensation, as provided for by Section 3700 of the Labor Code, for the
m_J < _J performance of the work for which this permit, is issued.
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I have and will maintain workers' compensation insurance, as required by
CC
CC S 3700 of the Labor Code, for the performance of the work for which this
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0) is Js "Mq,, %,wgkers' compensation insurance cam_ & no. are:
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Z Carrier VA, Policy No.
CIS ::i
(This section need not be completed if- the permit valuation is for $100.00 of 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 h kers' compensatioiypF6visions of Section 3700 of the Labor
,,e w
.foArK,!
Code W comply with tho provision
Date: J Applicant—,
Warning: Failur& 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, indemnity
dao & 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 repi6sentai_iVes of this City to epter upon
the above-mentioned property or inspection,purposes.
Signature (Owne....1_...)
BUILDING PERMIT PERMIT #
DATE VALUATION -IA2.�.510.100 LOT Pz` 'V4 TRACT )'l
JOB SITE
APN
ADDRESS
OWNER CONTRACTOR DESIGNER EN61NEER
APARTME1,1111 AT 7, -Q'U_,14TA V ZUMTF, 11, P.
-105 QLTtj.r J11 '37
ky0XV4111BFA`H. ok, 9266() CS11 11 66i
USE OF PERmrr
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411�
Q. 41E �4A#41'11 4 N_
DICLUDE RVXK TALU-,' OR POOL,,, R fit' -)f 101HIQKLMED,
47 BUILD1110-1:1
P o RC,!, Y f iA T 11 0 1,r,' fT� S17
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ol P I UN K L AY P R, "', il, L00 SF
C 014 7 PU � CT . P4 0 U I i T 3140,90.W LIS
ESUMATrun 0V
ASTRUCTKY14 i;VE t' .773 50
Jl 0 -000-4-1 F�0174'� �1
I" CHWK r�y_ 10 ti,ot,.23
MEPC�HANIOAIII YER. 101-000-421-004) U500
PIAN)"VD1,10 FEE, 101 -000-4 9-000 tool, 00
STRONT) N.01101- 101 -'M;0-241 -014DO $42-311
ORAWNGIVIRIF,
GFIVYLOPS-9 1WRACI-31 "'t
ART IN FIASUC PLACT91 - ME 270.000,44• -00,_'t
FEE DEPUSIT C, 1 1 ci, 4 0 13 0
PiND MAN C'�RM('.
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RECEIPT
DATE
BY
DATE F
INSPECTOR
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4 -1
..,
I
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade .- s-
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
.Z. -
Exterior Lath 2.2 -
Drywall .-
Drywall - Int. Lath02
Final _
Final — —y
BLOCKWALL APPROVALS
POOLS a SPAS
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 -4
Encapsulation .
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)�R
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 Prover
Final -
Utility Notice (Perm)
COMMENTS:
45
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Certificate of Occupancy
Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction'and(or use.
BUILDING ADDRESS: 50-660 EISENHOWER DR. BLDG 01
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP._
d'kt
Building Official
POST
Building Permit No.: 0210-314
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 12/07/04
01/26/2005 08:44 17603401819
INSULATION CERTIFICATE
This is,to certify VW.InsulWon has been ingelled In oonbrmanos with the mffreM energy
mgukftn, Callibmia Administrative Code, Title 24, SUftr of CWftffft, 10 the building at
LA QUINTA VLL.AQE APARTUDITI—FiC&
:tj- JA QUINTA CA
CEILINGS:
TYPE:BATTS MAUNFACTURER. CertmInteed THICKNESS- R -W
waw
TYPE: BAITS MANUFACTURER. Cartaintwd THICKNESS: R-13
PAGE 27/27
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP - LICENSE- 0, '7S4 7-!r-
TM.E:
PARAGON SCHMID BUILDING PRODUCTS AMASCO Company LICENSE #-.221517
TITLE ACCOUNT REPRESENTIVE DATE.*f/—dg
Thisi's to certify that insulation has been installed In conbrmsomvkh the current enerenergyw
reguMm, 069f0mis AdMInMk8bVe Code, Title 24, SUft of CaNdmis, In the building located at
CEILINGS:.
TYPE: BATTS
LA QUINTA VILLAGE APARTIIIIENT8*00k" QUINTA CA
MAUNFACTUREFt Cerbdntmd
WALLS:
TYPE:,BATrS MAUNFACTURER; CerWn%ed
THICKNESS- RAO
THICKNESS: R-13
GENERAL CONTRACTOR., LUCAS GENERAL CONTRAC11MG CORP LICENSE 0Fx--
BY:
PARAGON.SCHMID BUILDING PRODUCTS *A MASCO Company LICENSE 0221517
BY: IIAAA�JA TITLE.- ACCOUNT REPRESENTIVE - DATE:
1j, :W.C.