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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
pate r A /� Signature of Contractor 1 t
' 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 & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the 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
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
SeC(ion 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:
Carrier 01'.fz`Px. FUND Policy No. i;'1140fsu4M
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 Califomip,, and agree that if. I should become
subject to He wor�ers' compensation Rjpvisions of Section 3.776 of the Labor
Code,41halll fiitthwith comply with thos jprovisions.
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 prdpertyfor inspection purposes. /
Signature (Owner/Agent)• J
't - �... ' Datt e
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT 4.06.O.'CI.J TRACT
JOB SITE
APN
ADDRESS�wao"wER.. Dmr
773-3
OWNER CONTRACTOR/DESIGNER/EN 1NEER
,&PA'a?"[ ,�'�.tdTSATL." QF.JD47 t,VFfLA,,,!Y,%C.F T.f`rCARGEWE RAL. l':C9,17RAC'CligrjLOR'.['.
310'.5 q''.TAIL. �,rTR `,F; f �' 11 j 1 QU',AK, 3TRF'J 3'
piK4;1'FOx"i BEACH C''A, 92,660 %vEWP(*, i, RMAK-712: CA !;IL66'?
CAI* MSC,
USE OF PERMIT Q3
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CONSTRUCTION F?,F 101-060-4111-000 illl%, ii
PLAN +v:fUXX PFL 10114)00-439-3 11' $306. tip
ELECTRICAL PSE 1611216
ilM6"NO PPIZ I01 _0010-419-(.1;00 15 .00
:sTROHO MOT1014 FEE - P155117 101-K-40-24143"00 5h,31
ORA 1140 FEE '1014)(100-42 3-000
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RECEIPT
=TEBYD
E FINALE
-2
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & FootingsDucts
Slab Grade
r
Return Air
Steel
1 5
Combustion Air
Root Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
_ jB -
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath ra —A9 —
Final
Final
POOLS - SPAS
BLOCKWALL
APPROVALS—'Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . Test
Final
I I
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
B ► zt
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
~
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)
1
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. #39
Building Permit No.: 0306-263 VC
Occupancy Group: U1 V -N Type of Construction: VC -N NON SPRILRER Land Use Zone: Voninal
Owner of Building: LUCAS GENERAL -CONSTRUCTION ING Address: 111 QUAIL. STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 01 /21 /05
PLACE