0306-264 (CGAR)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
04 W Professionals Code, and my License is in full force and effect.
Z; :D ch License# Lic. Class Exp. Date,.
r` Q in
w 7;5970 F3 ZpiT<.a i ��a r1t ,� C
~ Z .Date "" J ') es gnature of Contractors t •r 'I° '-'""'" ` ---
t` (D OWNER -BUILDER DECLARATION
J
W LU ti I 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).
C")O I am exempt under Section
u7 B&P.C. for this reason
N
Date Signature of Owner
O�
d Q WORKER'S COMPENSATION DECLARATION
o X I hereby affirm under penalty. of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self-insure.for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
m-1 Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
d 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
fl rn H permit is issued. My workers' compensation insurance carver & policy no. are:
It Z Carrier,� Policy No.
S
ao 5 AT(41:'IiAis:! 19 4453 2r17i)3
Ci
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, and agree that .if I should become
subject to the workers' compensation provisions of Section 700 of the Labor
3 Code- �iajl f rthwith comply with th' e;provisions.
paten /=� r%APPlicant ,.ice ti
F
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil finesup 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 propely foriinspection purposes. f `
Si nature (Owner/Agent)—t-'�'�' t '" ' l~ Date
0
BUILDING PERMIT PERMIT#
Etir9 -
DATE VALUATION LOT TRACT
$11%2441Wf P)'a Et 44 21
JOB SITE
APN
T.ts'C V
ADDRESS -•'�Q� f<11.f i:l(R�yFI�
7n-y?�}..�a
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
1aF'Mt?�T vS "tv T �� �:t1�14rf F►. VTC :� �'.t31 i P
LucAo CYN.£•; A ,
1 os �lt��►€ . mmlw
31 } "i QUAIL I'fi i? '
NEWPORT REACH G°e7, MAW
NWPO"KT, XM,, -ACR k 9'"-:666
90),V?4.022 t VALA 17.i6
USE OF PERMIT QY- 0. Q
ir
r,XK 3, 6 SPACE (:AAPACIN: i:): D0. #40! T A E'B. ip 'PERMIT IX)IIS LVOT
lv.sCLf YDE RLOCrK' "WALI 73 OR POOL14.4 Y N. Ar01 SPRKLR.
47 AU1LJDWiCIS
f�.�.1�t�tSt1'9C-'..f•11iP�7R�, i,2�1�,0� ;;;:.
.,t�AAIyyS�' f}Z.J�'nT1QTT��Tt� 103 -Cull y4g9e'$-ts�pp ET�;f3. kf+
��yyYF!s
P11
112CYR.1CAL I+"Klt', 101 -00i) -420 -OW fie:?,. 26
P L IIM54IN0r,IXE 10t-02)0-4 19-000 �YIAfi0
Rt71Scf IeIG�IC?Ta.F" F - .END 101-V10-2:41.1500 $2,52
ORADYr 0 IFF.1; 10 t -000•-^12:1-000 $1 a.'irC
►7iYLi-1 l..TA-11 . PSN3,i .CL'1H Qu':,h.-K.
4": i
R3UL)E'RRIVR.1:'FKE6,D0KN()W
RECEIPT
DATE
�''
BY
-
DATE FINALED
SPECTOflf e,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings — P B
Ducts
Slab Grade
Return Air
Steel % — — o
Combustion Air
Roof Deck ..
Exhaust Fans
O.K to Wrap
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 — —
®LOCKWALL 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 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility.Notice (Perm)
COMMENTS:
-
Certificate of Occupancy
Tur °l �W Qr�fw
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. #40
Building Permit No.: 0306-264
Occupancy Group: U1 V -N Type of Construction: VC -N NON SPRILRER Land Use Zone: Zonin
Owner of Building: LUCAS GENERAL CONSTRUCTIONING Address: 111 QUAIL. STREET
Building Official
POST IN A
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 01/21/05