0306-265 (CGAR)LICENSED CONTRACTOR DECLARATION
I. 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
Cn
04 W Professionals Code, and my License is in full force and effect.
E; 5 C) License # Lic. Class Exp. Date
I 'r -
W
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Z r- /Date Signature of Colace4-
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I.—
_J L) OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z ( ) 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).
( ) 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
LO
CQ Date Signature of Owner
ON
M
d< WORKER'S COMPENSATION DECLARATION
—
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Z
a: I hereby affirm under penalty of perjury one of the following declarations:
0 ( ) I have and will maintain a certificate of consent to self -insure for workers'
X LU compensation, as provided for by Section 3700 of the Labor Code, for the
mperformance of the work for which this permit -is issued.
< 0 1 have and will maintain workers' compensation insurance, as required by
O LOQ Sedperformance Seddon 3700 of the Labor Code, for the. performanof the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
10, Z
cb 5 Carrier pt1 Policy No.
(This section need not be completed if the permit valuation is for $100.00 o ' r 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 3700 of the Labor
Code, I all fortHwith.comply with tho's4iprovisions.
I I 4
Date: A'p"olicant—
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 3.706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby madeJo 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 lawsrelatingto the building
construction, and hereby authorize, representatives of this City to enter upon
the above-mentioned property foi'inspection purposes
Signature (Owner/Agent) D4e
7
BUILDING PERMIT PERMIT#
DATE VALUATIONLOT TRACT
JOB SITE
APN
ADDRESS 1rJkJ.(160 YfOWij' 11�1;
,!R DR
70 SJO 3
OWNER
CONTRACTOR DESIGNER ENEINEER
Ia. QuwrA TMIAGF, LT
1105, QXJAIL
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WIN01-119R 17, BV-,JC1Fk1 (!,A 92660
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(94-9)4140?--A,'A' OSLO
USE OF PERMIT
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41 BUILI:14 %_S
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$414,94"
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CITY OF LA QUINTA
FNrIWCE
RECEIPT
DATE
By
DATE FINALED
INSPECTORp4��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade 3
Return Air —
Steei
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 Unes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
ELOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main 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 ti —
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Cohnection C),—
Encapsulation
Gas Piping
Gas Test _
Appliances
1-1
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
T-Vf 4 412amm
Building & Safety Department
This Certificateis 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: "E"
BUILDING ADDRESS: 50-660 EISENHOWER DR #41
Building Permit No.: 0306-265
Occupancy Group:
-M.RD. Type of Construction:
U-1 V -N
Land Use Zone: VC
Owner of Building:
LUCAS GENERAL CONTRACTING CORP.
Address: 1111
QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.. SHOWALTER
Date: 03/10_/05
Building Official'