0306-214 (MFD5)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N U) Pro'fessionals Code, and my License is in full force and effect.
License # Lic. Class /'l E -Date
r-- Q
c Z ti `Date" V LIJ
Si�nature of Contractor����
Zo 0. ,
J
I- OWNER -BUILDER DECLARATION `
W .a r I hereby affirm under penalty of perjury that l am exempt from -the, Contractor's
CO) 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 isnot 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).
Cl) () I am exempt under Section , B&RC. for this reason
LO
N
Date Signature of Owner
O�
a Q WORKER'S COMPENSATION DECLARATION
C) I hereby affirm under penalty of perjury one of the following declarations:
U') H O () 1 have and will maintain a. certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
m J Q performance of the work for which this permit is issued.
Q 0Q ,j 1 have and will maintain workers' compensation .insurance, as required by
O U Q Sion 3700 of the Labor Code, for the performance of the work for which this
d F- permit is�irssju workers' compensation insurance ier g pgll no. are:
IT Z Carrier v °:,& ;�UND Policy No. `171iIx�`$-ab
Cb d
g (This section need not be completed if the pemtitvaluation is for $100.00 or less).
( ) 1 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, an'd agree that if)l should become
3 subjec o�ihe w rkers' compensation provi6ions of Secti6rv3700 of the Labor
C9de, alj fgrtt�witlfcomply with thosefvisuog : y
,iDate: d _'! r(, Applicant-
Warning:
pplicant 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 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?11-City, and.State laws relating to the building
construction, and hereby aut r&ze representative of this City to enter upon
the above-mentioned prope ,for inspection pines.
Signature (Owner/Agent)--
PERMIT# -
BUILDING PERMIT
DATE VALUATION ,WWW LOT} �)' TRACT
JOB SITE 4r'
ADDRESS Wt%o1F".1F'Vq.11.0 rr-.R ?l�'.?�TiR:
APN 13--131'7410)
OWNER CONTRACTOR/DESIGNER/EN &NEER
APAIA:" nlj;CS4101' :.•ACli`iz`iT1�.�i (�, C;S;�, s, i 1a1:�kM4i Gt.�KSTII I,
) {i;
INSPECTION RECORD
v OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
-j 123
Ducts
Slab Grade W—/
2-/9-3
Return Air '
Steel
-
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 Lines
Party Wall Firewall
Exterior Lath
"
Drywall - Int. Lath
Qv
-
Final
Final 0
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
;O -
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APP90VALS
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: /-1c-9 Pr-rAM+ '0; •W o/'c
-T.>/3 ,—�s%dE 3-�.�yt
`
01/26/2005 08:44 17603401819 PAGE 13127
INSULATION ORTIFIOTE
This is to oaay that InsulaWn has been Inslalled in contbrmanoe with the ammM energy
regulation, CanfomleAdminisbad Code, TWe24, State of California, in the building at
LA QuINTA VILLAGE APARTMENT*" i!,,tAauwrAcA
TYPE:BATTS MAUNFACTURER: CertWnb.%d THICKNESS: R-30
WALL$—
TYPEt BATTS MANUFACTURER: Cortainleed THICKNESS- R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE #77<(?
TITLE:_Sj,
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE0221517
TITLE: ACCOUNT REPRESENTIVE DATE
INSULATION CERTIFICATE
t0 oBrtfy that W ' conkmnam wfth ft curmt energy
24, State of California, in fto building =r=c7 =,
CEILINGS:
TYPE BATTS
W&US:
TYPE: BATTS
GEN7"C
BY:
LUCAS GENERAL
THICKNESS: R-30
THICKNESS: R-13
S,QORP LICENSE #
PARAGON SCHMID BUILDING PRODUCTS AMASCO Company LICENSE M517
BY: TITLE- ACCOUNT REPRESENTrVE DATE;. _%
Certificate of Occupancy
Tmt °F 4QKt«m
Building 8 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 06
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
ire
���l
�.;
INA
Building .Permit No.: 0306-214
Land Use Zone: V -C
Address: 11.05 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER.
Date: 12/07/04