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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
0! Code, and my License is in full force and effect.
License # L1Lic.CYllass Exp. Date r' 5c
f jw 785 T3 %!1 e/
C'' � '� r .W 9/0
.Date Signature of Contractor
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OWNER -BUILDER DECLARATION
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).
( ) 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 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
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. M workers' compensation insurance carrier &poky no. are:
Carrier ra t' 11►.krt Policy No. 1?1443$-r:
(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 hick this permit.is issued,
I shall not employ any person in any maKiner so as�to become subject to the
workers' cOmpe sation laws of Califofr�fa, and agrees that ,if I should become
subje tofthe orkers' compensation provisions of S coon 3700 of the Labor
Co,shaUtf wjt comply with th� prgv's�oPs.
Dat Applicant /. �' f ? r -1a _
Warn! ,g: 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, indemnity
& 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 pemtit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with allQity, �nd.State laws relating to the building
jze
construction, and hereby authorrepresentatives of this City to efter upon
the above-mentioned property,fjbr inspection pytposes.
Signature (Owner/Agent)
` /71/
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BUILDING PERMIT PERM N 11'12
DATE VALUATION $423Y541M LOT PAA _R314 TRACT 1y; 'i ..' u• i
F
JOB SITE A �.� �,)i!�(w �
APN 77,,� 370. 0y.
ADDRESS
OWNER
CONTRACTOR / DESIGNER lENGINEER
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USE OF PERMIT
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47 BUILDlY+ US
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Wyll'T2U:15014 FEE, 101.OM-4.18-000 so
PLA?a CHT:::£: ML 101-000-439-318 �4 ;.%
MEC IL6aiik;.A,►, "'El 10 + -000-4'x: 1 -000 $'x.60
ELECTRICAL LINK I 01 13,G6
P�..LIf►9�tR3ti F%E ?lel -00,41 X1.001
STRO140 tdiOTIM: *LZ • RaSI ?. I I;b1-•'•.'00_ 11 .0D0 $0 5
ORAI)(NO FRE 101 000.423.00n 70'" .
r Is'It'E110PIVIR. lTtr R111:�" g PFIX $I
AU N 110blalC i'x;,ar'Eff • RESP, 270-OkND-445-0(<0 Fll <4,831
SfJB•T!:5 EAL C0 7701--1 AND F+IAK CMC K
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RECEIPT
DATE
BY
DATE.FINALED
INSPECTOR
r, a
INSPECTION RECORD
v OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings C!J — 3'
Ducts
Slab Grade -- _
Return Air
Steel — —
Combustion Air
Roof Deck y
Exhaust Fans
O.K to Wrap
F.A.U.
Framing 2 • ,Z • •
Compressor
Insulation — AJ
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Pa Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath —/Z— y
Drywall - Int. Lath
Final
Final —
POOLS -SPAS
BLOCI' WALL APPROVALS
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 j
Heater Final
Water PipingPlumbing
45-
Final .
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 0
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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Final _ _ - �
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduitr
Rough Wiring
Low Voltage Wiring 4
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power •
Final
Utility Notice (Perm) —
01/26/2005 08:44 17603401819
PAGE 20/27
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INSULATION CERTIFICATE
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This is to certify .OW insulatlon has been itwlaAed in mftrrttarm wM the current eneW p
mgulation, Carftmia AdminlBnM Code, Title 24, State of Catifomia, In tate buiidttt ,at r
LA QUINTA VILLAGE APARTMwcrC:- Dt3"71;LA QutNiA CA
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TYPE: BATTS MAUNFACTURER: Certaintaed THICKNESS: R-30
P
y TYPE: BATTS MANUFACTURER: Cerlainteed THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE g 76'7 7 n'
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BY:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE 0 221817
ElY: TITLE: ACCOUNT RE5'RE3ENTIVE DATE I ,i" v�
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3 SON CERTIFICATE
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This is to cw lfy #0 insutatlon has been.inet W in oonfa marm wHh the cumeM energy
4 regub ttcn, Calftnia Adminlstrative Code, lift 24, Stade of Calllbmla, in the building beaw at
r CA QUINTA PILLAGE APAIi VENT ', .pi 5, ,, A QUINTA CA
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TYPMAUNFACTURER: Certelntwd THICKNESS: REQ
BATTS MAUNFACTUREFt Certaint"d THICKNESS: R-13
GENERAL CONTRACTOR LUCAS GENERAL CONTRACTING CORP LICENSE: #�P �
ttllf` ��I TMY-- �
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE 0.221517
BY: TIi1E: ACCOUNT REPRESENTIVE DATE_:
vr•nri�i.'�rv•nV7r/ref/aA,'HNrA�I►Alri�l►aNAC0�►7�YA1/IOJVIrMWYM�biurwrwwir��....r...:.........r�__._.���'__—_—__-__ .. -.
Certificate of Occupancy
Tilf ot 4 a"
Buildings & 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: A3
BUILDING ADDRESS: 50=660 EISENHOWER DR. BLDG 03
Building Permit No.: 0306-212
Occupancy Group: MFD Type of Construction: V -N Land Use Zone: V -C
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP. Address: 110.5 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11/01/04
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