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61
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 ln'full force and effect.
License # Lic: Class Exp. Dyyate J
�4!<e %Rk1 � .!t'%I:.I� i' • i%:�ffr�L:�
Date +l r ` Qnature of Contractor
OWNER-BU1 LDER: 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
sale .(Sec. 7044; Business & Professionals Code).
�( ) I, as owner of the property, am exclusively contracting
Contractors to construct; the project (Sec. 7044, Business &
Code).
O I am exempt.under Section B&P.C. for this reason
Date Signature of 'Owner
WORKER'S COMPENSATION DECLARATION
or offered for
with licensed
Professionals
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•forwhich 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:
Policy No. I'�14t1ij8:'�irll$
(This'section need not b& completed if the permit valuation is for $100.00 or less).
O I certify that the performance of the work for which this permit' is issued,
I: shallnot .employ any person in any manner so as to become subject to the
workers' compensation laws of California,•and agree that'if I should become
subject to thew kers'' compensation provisions of Section 3700of.the Labor
Code',�l sh I[fo withYcomply with thos` 'provisions.
Date. :F ) ) Applicant ff , If
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost,of compensation, damages as provided for in,Section 3706
of the, Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby madeto the Director of Building and Safety
for a permit subject to the conditions .and restrictions set'forth on his
application.
1. Each person upon whose behalf this application 'is made & each person at
whose request and for whose benefit work is performed under or pursuant.to
any permit issued as a result of this applicaton agrees to; & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject: permit to cancellation.
I certify that I have read this appiication,and state that the above information is
correct. L agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives'of this City to enter upon
the above-mentioned property for,.�ihspection pury os S.
Signature (Owner/Agent).'• ; +f ', Date '
BUILDING PERMIT PERMIT.
c "i<.�,�• ,rf
DATE VALUATIONLOT. � TRACT
-
JOB SITE
APN
ADDRESS "k?-$epvn"�►j><.�>w7�':L} ;fy
TIM -
IM
OWNER
OWNER CONTRACTOR/DESIGNER/EN INEER
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APr K-r1vTaT T, iT T'.�A C;i�TPTY1 ;:3.1It l:, G; LUCK, j,2. s s.f",
,ri'1
1) 05 QUAIL 4TRkk,-,Y
WMPtll=:' RT By" i, me v. i?%;"ar j? �A ,, Y,
USE OF PERMIT q a
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CO; STROC i°ION FEE 101-o(10•418,000
PLftN CHECK FrF 1014100-439-3 18
t+lif.CK&MIf :AL IFYZ 01-000-421-0,"* u2 . xGi
XLZC TPkCA6. frrAt ,, ; fi j l�?f� 7,G�•E?tN] .l::tc�
PLUJ1 B NC ME d M -M-419-000 SMO
STRC5NO MOS YtGR ; -K • RESITI 10-1-00fk-241-004
0R%DR1W10FF;ir '10'•-Z'00-$23=000 YS000
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RECEIPT
DATEBY
DATE FINAL
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/
Ducts
Slab Grade
Retum Air
Steel
i
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
3 :—1
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 —
Final —
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 APPROVALSGas
Test
'Electric Final
Waste Lines.
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateran
1
Pool,Cover
Sewer Connection
..
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
42
Utility. Notice.(Gas) /L -
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring —
Low.Voltage Wiring
Fixtures:
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
SmokeDetectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Certificate of Occupancy
�'x'i'°f.(WQslum
Building & Safety Department
This Certificate is issued pursuant to the requirements of Sectim 10 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 04,9sificati6n: - E
BUILDING ADDRESS: 50-660 EISENHOWER- DR., 445,
I 'ft;k%'ft
Building Permit No.:, 0306-262
Occupancy Group: U-1 Type of Construction; V --N' Land Use Zone: V -C
Owner of Building: LUCAS GENERAL CONTRACTING CORP. Address: 1111 QUAIL STREET
Building:
City., ST, ZIP: NEWPORT BEACH CA 92660
Building Official
POST IN A
By. G. 'SHOW
Date- 02128/05,