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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury thatI am licensed_ under provisions, of
Chapter 9 (commencing with Section .7.000) of Division -3 of the Business and
Professionals,Code, and my License is, in full force and effect.
License # Lic. Class Exp. Date
B Mir
Date, Signature of Contractor-
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OWNER -BUILDER DECLARATION
I hereby affirm,under`.penalty of perjury that I am exempt from the Contract6es
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 structures 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).
( ) 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 of
O 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.
(y!) 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:
Cartier Policy No.
(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.forwhich this permit;is Issued,
I shall not employ any person in any, manner so as'to become subjectrto the
workers" compensation laws of California, and,dbree that if should,6ecome
subject to the workers' compensation,prgvisiohs of`Section 3700,of,the Labor
Code,-I;'sh�ilLfor0w h comply with those,Wp isiop's!,
Warning: Failure to secure Workers' Compensation coverage is unlawoul,and
shall subject an employer to criminal:iDenaltieszand 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 herebymade to the..Directorof 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 di
whose request and for whose benefit work is performed under or pursuant tc
3ny,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 it
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 1 have read this application 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 a ter uson
the above-mentioned property for,` inspection purposes �,
,
Signature (Owner/Agent) ? ` ` A f- - Date
,.
777
BUILDING PERMIT PERMIT# '
DATE VALUATION LOT TRACT
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JOB'SOWNER
ADDR s
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CONTRACTOR1 DESIGNER/ ENGINEER
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FIi'Sa?MCE DEPT:
RECEIPT
DATE T
BY +
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8' Footings
Iq — —
Ducts
Slab Grade
- —
Return Air
'Steel
9_,z2_
Comt ustionAlr
Root Deck
—
Exhaust Fans
OX to Wrap
F.A.U. �
Framing
— 2,
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace TaO.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final —
Final
BLOCKWALL' APPROVALS
POOLS - SPAS
Steel
Set. Backs
Electric Bond
Footings
Maim Drain
'Bond Beam
Approval to Cover
Equipment Location
Underground. Electric
Underground P14 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
Temp. Prover Pole
Underground Conduit
Rough' Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior 'Receptacles
G.F1
Smoke Detectors
Temp. Uie.of Power
Final
Utility Notice (Perm)
APPROVALS
COMMENTS:
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Certificate of -Occupancy,
T -W
Building & Safety Department
This Certificate is issued pursuant to, the requirements of Section 109 of the California Building
Code, certifying that, at the Iftne * 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..
I BUILDING ADDRESS: 50-660 EISENHOWER DR. #46
Use classification: E Bpildihg Permit No.— 0306468
00- Group: U-1 Type of Construction: V -N Land Use Zone- V -C
Occupancy rou
Owner of Building: LUCAS GENERAL CONTRACTING CORP.
Building Officral
Addre-ss: -11111 QUAIL
L STREET -
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER.
Date: 02/29/05