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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 p�F'��'f��'��'1.? :�"�.�J.,�JA,!i 117•�NA.M. 7',f:.. �.fd'L!Z`1 .1�OW 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