0306-250 (MFD5)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
CINIM professionals Code, and my License is in full force and effect.
G =) ce) License # Lic. Class ap. Date
L% jl t �r`
Z P.- Date ' �` ` SigKiature of Contractor
to
J U W OWNER -BUILDER DECLARATION
HUJU~ I hereby affirm under penalty of pedury that I am exempt from the Contractor's
U) 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'') () I am exempt under Section , B&P.C. for this reason
LID
N Date Signature of Owner
OC
d Z WORKER'S COMPENSATION DECLARATION
It C3, a:I hereby affirm under penalty of perjury one of the following declarations:
r H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w u- compensation, as provided for by Section 3700 of the Labor Code; for the
mJ Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
O 0 Q Section 3700 of the Labor Code, for the performance of the work for which this
11:. LO H permit is Issued. My workers' compensation insurance carver & policy no. are:
? Z Carrier :�MTIESt Ktti.'D Policy No. J[17I_ ?18.2 193
cb Q
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
3 subject to the workers' compensationjprovisions of Section 3700 of the Labor
Code.,<I'shall fo (lwitf►epply with thoseprovisions. f
-Date:' 1T' A plicant i ,.2_.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1.00,000, 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 Ouinta, 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 Slate laws relating to the building
construction, and hereby dutfiorize representatives of this City to enter upon
the above mentioned property for inspection purposes. �• t
Signature (Owner/Agent) _ w•--- Date ( r"
BUILDING PERMIT PERMIT
0
C3'.9aa-21SII
DATE VALUATION . ;: ry , °� y^Lj l (% LOT �'11R.4/4 TRACT Asti 3021
1 �
JOB SITE
�A)_ ►GYRI J�I•r'i��`�.Y�OVIEs:1..NI-MI,
APN l 7:'�`�: A)-al.1
ADDRESS
OWNER CONTRACTOR / DESIGNER ENdIINEER
CZ'f.TDrt' ::Y. tai.L,I-AGE, LT 111, ",.'�,ii' 01:•1'ti�fij..r,".•�;Aii,7>,�hl : i]%.SCi :.iPP.
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CM6 -056
USE OF PERMIT
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iii.?.; Map V:1101 YqE 14100,41 900fli 0',',1.10
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RECEIPT
DATE
i
BY
/
DATE /- FINALED
�-
INSPECT
��
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
j r3.
Ducts
Slab Grade J
Return Air
Steel
— / -
Combustion Air
Roof Deck
!- U -Q.¢
Exhaust Fans
O.K to Wrap
-4,
F.A.U.
Framing
,�. Q.. y
Compressor
Insulation
ed
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall,lnsulation
Condensate Lines
Party Wall Firewall
AA
Extedor Lath
Drywall - Int. Lath
-
Final I 27t7 -T
Final — / `
BLOCKWALL 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
e21-1-516—
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
Fbdures
t>dain Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of, Power
Final
Utility Notice (Perm)
COMMENTS:
01/26/2005 08:A4 17603401819
INS LA C9811FICATIE
This is to certify that insuldon has been instalft In conformance with the vAmit energy
mguww, Caliromia AdministrativeI Ooft Title 24, State Of C81ftMI8, in the building at
LA QUINTA VLLAQE.ApAjrrMENTjE8:L-W4:1LA QUINTA CA
CEILI
TYFE,BATTs MAUNFACTURER: Owens Coming THICKNESS: R -U
PAGE 18/27 �
WALL$:
TYPE. BATTS MANUFACTURER: Caftntsed THICKNESS: R-13
:ZA'9�t*
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTINGCORP LICENSE#
TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MAGCO Company LICENSE # 221617
TITLE: ACCOUNT REPRESENTIVE DATE:
INSULATIgN CE&TjFICAT-E
This is to omtfy that insulation has been insolled incontemns with the cu
kti"hly
reauon.4aliftmis AdmIniftv9ve Code, T109 24, State of Callibmia, in ;WIdl*n�"g located at
X
6 41
ICA.
WALLS:
TYPF-. BATTS
GENERAL CON
BY: -
LUCAS GENERAL
SCHMID BUILDING PRODUCTS A MASCO
THICKNESS: R-30
THICKNESS: RA3
CORP UCENSE# _
BY: TtTLE-. ACCOUNT REPRESENTIVE
# 221517
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.
BUILDING ADDRESS: 50-660 EISENHOWER DR. BLDG 04
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Building O.ffi I
Building Permit No.:. 0306-250
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11/01/04