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LICENSED CONTRACTOR DECLARATION
u hereby 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 # 7 1pLi_cy., Class Exp. Datje_
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Date ' E' JSignature •of Contractor f (l ` t _- ti
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) 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 —Signal ure 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.
4( ) I have and will maintain workers' compensation insurance, as required by
Setion 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 :3'#'A't} l�l2f Policy No. 17f9t;3 luit;
(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 tpp the. workers' compensatio�i provisions of action 3700 of the Labor
Code I A.al orti�vith comply with(t se provision
raddiate' ! Applicant •'f.
tion
arning: ailuro to secure Workers' Compensation co rev age is unlawful and
hall subject an employer to criminal penalties and civil fines up to $100,000, in
to the cost of compensation, damages as provided for in Section 3706
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 personal
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 authoris�e-representatives of this City to enter upon
the above-mentioned propertydo) inspection purpops. 1
"a
�Sif3nature (Owner/Agent) �'�!• �•-� ✓ Date �
BUILDING PERMIT PERM'T#
06.12)ti.t
DATE VALUATION $ A jA�s� j ¢j,e�(?! LOT TRACT Y ?•, ,;,07'11
JOB ADDRESS}•:Yflt�,1}:'t�l�ljJi�1,'.Et���:
APN
OWNER
/DESIGNER/EN (=N^E�ER
IRNfLi�i,.r�1 �M'L:l•{Y'(yly+�:l
iCONTRACTOR
7TYAT11;
j".'.A. 94`660
P 4+P0Y:'I �B., ll—,I CA,
USE OF PERMIT
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PLAN Cta rs; 1F`.ET 101-0;D0-439-316
Ai:r:1iKilii(7,1'!r % 1n-Ct!N-421-Goo S1!0.`01,
)iii-0100.4.?.t)-Q01�1',�!.
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F.T.P.GNIG> 04,10,1 FFF11, t,;S:+mN 1W)-C,00.-�41 004'; �4�-.M9
.ARF 314 :KIE11 IC Fw'1t`ES COGS; ' '7-tl(1Ua• 45-t)f){r :,O. d. ;tf
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RECEIPT
DATE
BY
DATE RNALED
INSPE
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
nX
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
a
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
E)derior Lath
Drywall - Int. Lath
�,- Z •-
Final
Final -
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Unes
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
$eawW-L�-al ,+
�? - c��
Pool Cover
Sewer -Connection
9 _ _
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final.14-
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)
COMMENTS:
-
01/26/2005 08:44 17603401819
PAGE 23/27
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INSET _"MRTIFICATE
Tft Is to cw* mutation, Caltbmia �AdmIshuft CodeTitle24, Stft of lifania, in the building a
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Lit Quints Village Apsrtme La Quints. Cali omis
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TYPE. B��
MANUFACTURER: Celtainiaed
MANUFACTURER: CertaintmA
THICKNESS; R-38 s
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THICKNESS: R-13
GENERAL CONTRACTOR: Lucas tonal Conftang Corp„ LICENSE*?
syz: — 'TITLE:
PARAGON SCHMID BUILDIN43 PRODUCTS, A Masw Company LICENSE # 221617
BY: 1l&Y[L 11TLl;: ACCOUNT REPRESENTATNE DATE: 1/30/2004
A This is tD y #W
regumm, Cafibmia
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TYPE.
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TYPE. Baft
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has been installed In COnfbanance with tha current energy
Code, `title 241 S ate of Cattbmia, in the building boated st
MANUFACTURER:
GENERAL CONTRACTOR:
BY:
THICKNESS:
THICKNESS:
LICENSE #
PARAGON SCHMID BUIUI G PRODUCTS A Maeca.Compalny\ LICENSE # 221517
BY: !! TITLE: ACCOUNT REPRESENTATIVE DATE: 1/3%2004.
Certificate- of Occupancy
Taye 4 4 QAA&
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.
Use classification: A3
Occupancy Group: MFD
BUILDING ADDRESS: 50-660 EISENHOWER DR.REC BLG
Type of Construction: V -N.
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP._
Building Official
POST IN A
Building Permit No.: 0306-234
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11/29/04