0306-259 (CGAR)LICENSED CONTRACTOR DECLARATION 3
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04
W Professionals Code, and my License is in full force and effect.
Q
C) License
y#@oLic-Class Exp. D(a{tee,/(,� r
r* W /FJI��CY 4,�Lf, f f Jli4iJ4
Z r- $Igi'iature of Contractor -�
r` L)
J I OWNER -BUILDER DECLARATION
W a CID
hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z ( ) 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).
M () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
Q)
Q WORKER'S COMPENSATION DECLARATION
It 2
cc I hereby affirm under penalty of perjury one of the following declarations:
1 FQ- p () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 1 : compensation, as provided for by Section 3700 of the Labor Code, for the
Om _ Q performance of the work for which this permit is issued.
Q U ( ) 1 have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which this
fl H permit is issued. My workers' compensation insurance carrier & policy no. are:
It ZCarrier n�•I p: fT17Nry Policy No.
Cb 1'11149#2.20014
r CJ
g (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 a rid agree that if I should become
3 subject to thdworkers' compensation' provisions of Section 3700 of the Labor
Code,+*1l forthwith cr�mply with thpse''provisions.
D�e,."....e / Applicant t �'ti.
Warning: Failure to secure Workers' Compensation coverage .unlawful and
shall subject an employer to criminal penalties and civil fines up to $100;000, in
addition to the cost of compensation, damages as provided for in Section_ 3706
e of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
�1 any permit issued as a result of this applicaton agrees to, & shall, indemnity
dao & hold harmless the City of La Ouinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 dayswill subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and Sate laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property, for inspection purposes. `r y.
Signature (Owner/Agent) r, t/ %!� ' r._:. Dat
BUILDING PERMITPERM"/y
tt
�3111J'Le.A."�
DATE VALUATION � � ��. � LOT �?� ;.:v TRACT
)VI 3017TI
JOB SITE
ADDRESS - .,f {�6 .�`i;Pi t r$i� �.
APN 7 75 :•':.110 f,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
APAPI?v : 473 A'1 L A,�ZU3f'A VIU..:AU , LX
;
f•�C3iJ"Sis'.
)t3LAf y:R(ry
111 Y �, F. vs, zumm j'
taIFi F'C5k_1'3 1 CA 51660
14TKUU'I}OFO 13I:M CI3 (,'•.A e 2660
t 9 49)4?4.0221 + `imwff 1711" 6
USE OF PERMIT
_.. .r %ea
-Ir F"'33
MFD.?SPAC'Z0ARACTL&,L14DPV :Hi., 0.03: TYPR1,4 PP',PJWIT
DOES NOT 13dOMD:3 Di,�..i�CK WALLS OR. POOL, '04 Y.Vl, MSY RKLI1.
ctirt*`:,1?l!/��f1tii�R1` 1i3;9.lZdl OF
Es"7:i19f!!ti.'T111? cogr OF,
CO'NST42i1UHCt 4 RE 10)-000.418-000 1317,60
PLA14 CHWill :r' FI4, l (i 1-0t)S3 X43 it• ti 1 9#J.93
M1F.t-HAN1CAL YSY- 101-f1 J0 421-000 0'21. 5 4
laLPCTRIC L, IvZE 101-000-420- :110 .;la
isi.i,iA+lB.C90 FUL: 10 ; -060-419-000
STRO1410 M011014 FEE - Rl&- IrP 101--00(1.24 � -000 9:!.•y f
ORAD(NO MR 101-000423-000 � i; .► d
.
:131',B40ZAL CO1`lSTRUC'UON AA17t! ItiLAK (71-19CR
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RECEIPT
DATE
BY f
DATE INALED
INSPECTO
..-3-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel /S/ • —37
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap 3 — z _
F.A.U.
Framing
Compressor
Insulation J
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final — 3
BLOCKWALL APPROVALS
POOLS a SPAS
Steel
Set Backs
Electric Bond
Footings
(Wain Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
_Fbdures
:Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Certificate.of Occupancy
Tw!t °F 1WQU«ra
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 andlor use.
Use classification: DL
BUILDING ADDRESS: 50-660 EISENHOWER DR. #33
Building Permit No.: 0306-259
Occupancy Group: M.F.D. Type of Construction: U-1 SPRINKLERED Land Use Zone: M.F.D.
Owner of Building: LUCAS GENERAL CONTRACTING CORP. Address: .1111 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 03/02/05
Building Offc' I