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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
phapter 9 (commencing with Section 7000) of Division 3 of the Business and
rofessionals Code, and my License is in full'force and effect.
License# Lic. Class Exp. Date
�73r�??5" N k➢..i;" �� ��21t)�11:�C
;Date Signature of Contractor ('.6
V
r OWNER -BUILDER DECLARATION
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 thg project (Sec. 7044, Business & Professionals
Code).
( ) 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, forrthe performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier gT•Ayg,. UN i) Policy No. 1714AU•:V-X-
(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,
l shall not employ any person in any manlier so as to become -subject to the
workers' compensation laws of Californi ,and agree that�if I should become
subject t9�the workers' compensation ovisions of Section �390'of the Labor
Code, J>S allorth with comply with fh rovisons.L ,•L_- ^•
,Date.,1 Applicant f' -
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 authorize representatives,of-.this City to enter upon
the above-mentioned property fc(r inspection purposes.:' �
Signature (Owner/Agent)411b
Da,
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39
BUILDING PERMIT PERMIT#
DATE VALUATION LOTTRACT
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APN
ADDRESS � 1.. 1►t� 7L�iFi :�%�-�y P !�TJVp
7 Yet TII? is11"�.
OWNER CONTRACTOR /'DESIGNER / EN (NEER
AI''ARTTvin', Mi YMTA l-PLX.; .&ILIF.,U 113r"W-61On— IERAl, C*Cv0'17RAc."1'. (3C:•0.1l P.
1�'IiJP' RT BEACH CP. 92660 Nr, WPC7RT kTtAC11 CA 924-60
(94".74-CIZI 17561
USE OF PERMIT cLlr-q g
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Itilk aa-') SPAPLZ ZAFA- Oa 4t 04113RY ili.,1 G. 0. 37, T'v'P'g U.I. Es!?TfVIT
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a•r tatrctr�r:�c'fs
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01-000-4) 8-000 *M",4
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PLAN t HYCK iN Z 101-CIC6-43V-31S tfiz;�.23
ME ;AVICA,1, YEE 101-000-4121,000 $'fix.:+
H.1.;~;L.; �'t;;C.,�L NT+:E 9 U1 ••S1t:IR-4�F�-f>r�J3� �?a.'2
PL -IJ M'RINX):iri.E 1'JI•Ut'>A-41 •i)F)0 $�t,�t3
.x.?. EZ�7?t�l'9 f1RC17°1LSN E +?'r'w:fi 1 i11-UCs0-/11-{tJ 'X9.�I I
op,4:1'1'10 FW aa: -000-423„000
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$tt).r'fr;.
'RYTA1, PVRPS(ri't It'1':1ES Dye% �,dAY
RECEIPT
DATE _�
,BY
DATE FINALED
INSPECTOR
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
-
Exhaust Fans
O.K to Wrap
y r i /
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
7-/-
-rDrywall
Drywall- Int. Lath
Final -
Final 2 —
HLOCKWALL APPROVALS
POOLS - SPAS
Steel
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 Lines 77r
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
- ti
Equipment Enclosure
Shower Pans
O.K. for Finish.Plaster
Sewer Lateral
Pool Cover
Sewer Connection
-►
Encapsulation
Gas Piping
Gas Test
3 - Z - y505
Appliances
Final
Final
UU14 Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vobge Wiring
Fixtures
Main'Service
Sub Panels
Exterior Receptacles-..
G.FS,
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
Certificate of Occupancy
4r'1' ot xP Qa�"fu
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.
BUILDING ADDRESS: 50-660-EISENHOWER DR. #37
Use classification: E
Occupancy Group: U-1 Type of Construction:. V -N
Owner of Building: LUCAS GENERAL CONTRACTING CORP.
Building Official
Building Permit No.: 0306-260
Land Use Zone: V -C
Address: 1111 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 02/28/05
PLACE