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LICENSED CONTRACTOR DECLARATION
l' 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
Professionals Code, and my License is in full force and effect.
License # Lic. Class p. Date
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Date`_ ,�-Signature of Contractor �'` <
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OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perl'ury that I amexempt from the ContractoPs
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) 1 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.
(r) I have and will maintain workers' compensation insurance, as required by
S ' 'on 3700 of the Labor Code, for the performance of the work for which this
permit is jpsy9,(i, t �vyorkers' compensation insurance cam r &wpoji. no. are:
Carrier : td� Policy No. Fd .P21`�t
(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 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 Califomi�and agree that if I should become
subject tQlthe workers' compensation pibvisions of Section 3700 of the Labor
Code.'
e, f, ' Il.fort�iwith.comply with tho aprovisions.
Date: fj applicant
Warning: Fail re 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, 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,. andrState laws relating to the building
construction, and hereby authorizerr'iepresehtatives,of this City to epfter upon
the above-mentioned propertyf ihspection purposes. A _-
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,Signature (Owner/Agent)"l'a' z ^� Date �7
`v3
BUILDING PERMIT PERMITN
DATE VALUATION $42 1,I$3i,1..Oli LOT �'� ^ ��_ TRACT
JOB SITE �,, r� WNITM ' Ci�'d,111 DraV!t:
APN 773,,1704",,,--11
ADDRESS
OWNER CONTRACTOR /gDESIGNER /EN (NE�E•R
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i�!}t.ftildYlC.LV1G) J�cl` Lv �, V�1VJ�l df.l.t.�i:711:, �.[ L'c' 7 ed.Ci`i?�h'r�S [.�1 FtiliC,1'aii'f ;^r1%l'f'.
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USE OF PERMIT
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OS
INCLUDE W4100"" ' A;L?X OR P'0014., N 'u"-14 SPRIN;KLEPi• D.
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4072M, ISF
VC EISME14TI&I, 3F
C;O�1'I'1',tl:�`" AhiC�ir:4`f 3'7$,lt+L�:iu3 L•,�f
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f1yST.s'.FAT'r`4_1*0
(:.►riff'r.,Ul01T)Ct�r?%I' 20)-01 0.41t4._000 $l;7;n.94
PLAA C 1-.'K?Ck' fur, IC,I _Jta0l-4:J4-:31 tr �IO�..St4
tdll<C:I,.A?EYC�?'.!.•:t��Es ��Z-LtiJO-a �1•t70+:f sa�a.aii
FMIEC rWCAL F.V r' l ^ 1-Ou0-xt ttG-Ot U $;5 t' 3,64
PLUMBANG FBF I {� i •(t`Jt7.4 I ;!-O(5fi $tSia`f.(tU
S.TROV.r. "? 'li:3r:: l:t?., i'rEuf;a 01-0t..)_V1-000 $iI.3S
ORA D.1 0 PER 101-000-41� OGO W015
ART IN PUBLIC''T'LACKS • R 1i10.000 -ti 7.,+;,000 SM. 43
s i •.� , .i[ ,? i' A%TI t. P3'.A' G"'rg+ C K
$1 ri,1 ' =4 90
U3,3 FFE-PAM M-3
JUL 03 2
C6Yi'
1FIPd���CE D,r
[RECEIPT
DATE
BY
DATE FINALED
INSP OR
INSPECTION RECORD
OPERATION
+ BUILDING
DATE INSPECTOR
APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
— —
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans i
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 VCJ
Final
BL0CKWALL AP kOVALS
POOL - S AS
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.FX
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: /--3/
Certificate of Occupancy
Titr °f 412"
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 05
Use classification: Al
Occupancy Group: _MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
r
Building Offi al
POST IN A
.Building Permit No.: 0306-213
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 12/06/04