0306-247 (MFD5)N
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LICENSED CONTRACTOR DECLARATION
I'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 # Lic. Class Exp. Date„ -
7af3786•f B B"XIC ;' 2"
r r:1:4
r
Date -'Sig'nature of Contractor
OWNER-BUILDER.DECLARATION
I hereby affirm under penalty of perjury that.l 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Sectibn , 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.
(�) I 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. Myy,, workers' compensation insurance carrier & lic_ no. are:
Carrier STAJE i+L04.0 Policy No. 1`7144 2^51K
(This section need not be completed if the permit -valuation is. for $100.00 or less).
( ) (•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"subj/ect to the
workers' compensation laws -of Califomiayarid agree that if I should become
subject tote wo ers' compensation provisions of Section 3700 of the Labor
Code' A.� ittL�cnj mply with those revisions. ( .
Dace: + Gj Applicant
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 3.706
of the Labor Code, interest and.attomey'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 Ouinta, 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 authorizg' representatives of,Ahis City to enter upon
the above-mentioned property for inspection purpos
(Owner/Agent)`,, ,�.��L��/� `�_,_..' Datel—!-
Signature
BUILDING PERMIT PERMI d�4 .-m
DATE VALUATION V;1NQ37•.0 LOT J ,bJ•;3r4 TRACT 1430 21
JOB SITE :1I 1r> i k�F11<t� �4t1. �J.(4 "
APN r'%.� , �' ✓S� 1�i
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN (NEER
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1756
USE OF PERMIT
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D11VVLCir'ER Z(k?PM $ig9fifJ.U1�
CQM11'RVsCIlaY'iAI f�AT PLA14 fit, .E-
$4 .3 3 e.). :34
IMS PRE -PAID FRE..";
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RECEIPT
DATE
BYDATE
FINALED
INSPECTO
'�/
_
—
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings - 3
Ducts
Slab Grade !` O
Return Air
e9 j
Steel
Combustion Air
7 -
Roof Deck Z = 2 -
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
2
Final
POOLS a SPAS
SLOCKWALL 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 I
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
a
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)
01/2612005 08:44 17603401819 PAGE 10/27
MUMON CERTIFICATE
This is to certify that insulation ha been Installed in oonkwnw= .with ft cuffentemm
regulation, California Adminhowitin Code, Tiffe 24. SUM of Calffornia
In the building at
LA QUINTA VIUAGE APARTMENTC a QUINTA CA
C-EILING&
TYPE-BATTS MAUNFACTURER: Carlaintwd. THICKNESS: R-38
W S:
ALL
TYPE: BATTS MANUFACTURER., Certainteed
THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE* '7�8 -7yT—
TITLE
r le,
PARAGON SCHMID BUILDING PRODUCTS A MASCO COM138"Y LICENSE # 221617
BY 10k TITLE: ACCOUNT REPRESENTIVE DATE:
INSULATION CERTIE&M
Is to certify that Inaulsdon has been Installed in cmftmwm with the curnmt energy
California Administrx0e Code, TINS 24, ftft of Califomia, in tha building located at
'BATTS MAU TURER: CeftlTHICKNESS: R -x
WALLS:
TYPE.- BATTS RER: Carta THICKNESS: R-13
GENERAL CO R: LUCAS GENERAL
CO CORP LICENSE 0
BY:
TITLE:
PA4eON SC14MID BUILDING PRODUCTS A MASCO Company LIC
0221617
BY.
TITLE; ACCOUNT REPRESENTWE DATF_
Certificate of Occupancy
may' °F 4 Q"
Building & Safety Department -
This, - Certificate
epartment
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: M.F.D.
BUILDING ADDRESS: 50-660 EISENHOWER DRIVE # 21
Building Permit No.: 0305-247
Occupancy Group: B-1 Type of Construction: B-1 SPRINKED Land Use Zone: V -C
Owner of Building: LUCAS GENERAL CONTRACTING CORP Address: 1111 -QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 02/23/05
Building Official
FEB- 7-0.5 MON 1:14 PM RIV, C'0, FIRE PU INDIO FAX YO, 1 760 863 7072 P. 1
Crafo E. Anthony
Fire Chief
Proudly serving 1110
unincorporated
areas of ltiversWe
County'and the
rides or:
Banning
4
Beaumont
4
Calimesa
Canyon Lake
fi
Coachella
Ps
Dcsert Hot spaings
a
Indian Wells
0
Tndio
4
Lake Elsinore
4
La Quinta
.Moreno Valley
Palrn Desett
4
Perris
Rancho Mirage
a
San Jacinto
4
Tcimcula
Board of Supervisors
Doh BU q1 x,
NOW I
John'ravaglianc.
uimict.2
klT stone,
Di4tiiiat3
Roy Wilson,
l..)istriout 4
Marlon MINIev,
Dietrict 5
'RIVERSIDE (]OUNTY
FIRE DEPAF:TMENT
�1
82-675 Highway 111 • Indio, California 82201 • (.'60) 8638886 • Fax (760;863-7072
i
February 7, 2005
'lye
City of La Quinta
Building Department'
Re: LAQ-05-BP-044
C'
Buildings 19 thru 25 and.27
i
The Riverside County Fire Department is granting the clearance for a building
permit for the following project located at, 50-oF—Eisenhower Drive. La Quinta.
Please call if you should have Questions. W
Respa-dfully
FRANK KAWASAKI
Battflion Chief / Fire Marshall
By •fitORS
-O�'`t -
Tarry De oucy
Fire System Inspectors