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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
758735
.71 `' ! \
Date• /r Signature of Contractor!, L_,
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 & Professional's Code),
( ) I, as owner of the property, am exclusively contracting with licensed.
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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.
(,) 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. My workers' compensation insurance carrier & policy no. are:
Canter T,6T9 Policy No. l'7i�3!kl t`!J•
(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 Califomia; •and agree that if I should become
subject to tMe workers' compensation provisions of Section 3700 of the Labor
Codc';l"gh U forthwith
Domply with thps' provisions.
f i / pP
ate`. ` ' ' A licant /-
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 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.
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 aut rize representatives of this City to enter upon
the above-mentioned property/yfor inspection pur 1,oses. .`
I Signature (Owner/Agent) t I `'
3
BUILDING PERMIT PERM €244 21<KS
DATE_ VALUATION $33,1614.00 LOT Ess K11/4 TRACT F`" ''cY/I.1
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JOB SITE ;V_0 0 1..TFIRTY0V-:' 9R DI VE.
APN 771-31;j
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN. (NEER
AJ YAfe Li'J I..A V ,,!-,ASiV . T..1 Q�. NERA¢ ex ITI-RACI Y ,: i C01tP,
11 G Qup.r, , arrcv,,�-.V 1111 Q=-VAJL 5TRE-E z
Mk:Vi�''i.ritT B At_'L.1 cA y wtS l iJETW✓ti?tV D.KAL'3-� OA
USE OF PERMIT
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�qr petr
114 ` AJDF. 81)DC:i. 1VALL•tu' OR POOL, ",J- I V__N, WON &F'[l.lti'T R,
�lvi➢.%F.ti`;:��.`� �'.i?3^"r`.t' 4?]N' f;.'.£�1`'�+'I'Fk'f.:f:.'`fi�!Pd
w<;;;�`.�.-0•.�;�
CIOVUTRI !CITI(Y.10'' PER 10, ._(3f?0-418.4?09
Pr.AII Ci'iWX KE til).- tQi! •"_19 ;31P $3+fi.9
ELECTRICAL FEE =f?1 �P3�3-�l �Q-:104t 571.8�t
PLUTASING FEE. (e
ro` I! ,r.:ltl'( r-u1111{1A1.01(3
`i'itC'►�7�:;',i�+:�"i'Xr ?01
QRAAVfN0 ".-E • - .KJ (71 ^ ;J')',?-��::W-�G•`.1 $ t 5. fsli
_ ftiTit ': TAL CC;kd'�l:ti: rt'"IM.N .i'AIM P11, ,tJ 0151i''Y;
Com A..t.t°EIR)NMi FES DUF- .W(lo 1V
V�'='0X1;?
/
RECEIPT) - 1
DATE —
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
SetBacks
Underground Ducts
Forms & Footings
//— 2 _3
Ducts
Slab Grade
Return Air
491
Steel
Combustion.Air
Roof Deck
f
Exhaust Fans
O.K to Wrap
_
F.A.U.
Framing
.. 9/
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
—
L5t
Drywall - Int. Lath
— //— A?
Final -
Final 3 — -5
BLOCKWALL APPROVALS
POOLS - 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
— zo, 'y
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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)
COMMENTS:
�.�3 L � r-,•. !•v� v�%i// ®�, l2/of'/ice -�
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
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.
Use classification: M.F.D.
BUILDING ADDRESS: 50-660 EISENHOWER DR. #35
Building Permit No.: 0306-255
Occupancy Group: U-1 Type of Construction: V -N Land Use Zone: V -C
Owner of Building: LUCAS GENERAL CONRACTING CORP Address: 1111 QUAL STREET
-7—'S, /4ft;zz� -
Building Official
City, ST, ZIP: NEWPORTBEACH CA 92660
By: G. SHOWALTER
Date: 03/08/05