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LICENSED CONTRACTOR DECLARATION
I her affirm under penalty of perjury that I am licensed under provisions of
Cha; it 9 (commencing with Section 7000) of Division 3 of the Business and
Profes 'onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date.
>3 titer acs;]Zf' r' l.� edn't
Date! Srighature of Contractor ` r
OWNER -BUILDER DECLARATION
I 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 rstructure 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).
O 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 jissued. Myy workers' compensation insurance carrier &..policy no. are:
Carver !11-01.'.1 E IAC?:l,D Policy No. I :"f �4'�'a••'20Vt
(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
subject to tqe wofkers' compensation pr visions of Section 3790 of the Labor
Code, I.sh or with omply with thosr provisions.
tttttt t ,,
Warning:TFailure 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, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter
upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) i'y„� ^• r' Date r—!%
W�
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BUILDING�p PERMIT PERMITN
DATE - VALUATION �y'i G:” ,; �. ,{� LOT TRACT h) 3cr;l n t
JOB o. 4f 3
APN r ` 7 •'1oi�'Z
ADDRESS ,
OWNER CONTRACTOR ) DESIGNER/EN INEER
T L yL f 1 r
ACI.i'-k. Yrs'J3..i �T. �i�!���:b�,�l.•7J`�`�ty kl J.�,�L u���'}.y .:1 :VLdJI�I.I f'"•i'2 F_.iC�4j.r �,'�l i:��i 1J1\�tii ��1..!1LC'..
T± ;Y: rI?:'c : ��►C'.4., :.: , 9266"') :a� 1�'+��RT P . , �',. � r �°�ti 93}t�,f
USE OF PERMIT
MULT., _4�':�, •.i i .`�t' a:''i T ':{.S I1 ;4
.} i�l,•' 1 • L • \v a� .1 U{.It. ♦ ♦, !. 4 i Jn, ♦ •4`
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iIMVt UO.' fl, HOT 'N,�MUDr "d' AL U3 OR
li �11F• i'1'•?"�. 'iI►Ft�eYFti3.A;14?i3. 47 BUILiJrNas"
ala>dCFI1:.010 F'vq W f jt
CFilS IOR fi,4u m-* Si
ICL •- R 2�:�Y1541` T1.&1 1011100 81F
I .-ij4TRAC.','t A1440 tr a 9"y I Gi.4ti LI
X&M. t :" 1 C'OS':", OF
P.CMI YX' KUY+MARY
i;.":T> C:`ffAt: X F'iF X 101 $'0`5.24
�421•'0�y'�
1"Lu m'C41110 FE '101 -000-41141-t1(;? j t1y, ri1
O
«rl'I' C14iytii VDTIi?:3 iCWE REWD 101 -000-241W
_00r).423-000 1< ai,Qf
i;J .�it?9.� r`lL1Z IMPACT FEZ
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'd �•:1'. i1� J..S:-aik pj.►.l1 RJc:
_'.8.MIM
RECEIPT
DATE
BY
DATE FINALED
INSP O
41
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
UndergroundDucts
Forms & Footings
J"Q --3
Ducts
Slab Grade
17,1 e 3
Return Air
Steel
-3-
Combustion Air
Roof DeckExhaust
,-
Fans woe
O.K to Wrap
_ Z
F.A.U.
Framing
Compressor
Insulation
-J -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Unes
Party Wall Firewall
Exterior Lath
12 -2 -
Drywall - Int. Lath
- // -
Final
FinalD®®L
BLOCIWALL APPROVALS
-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
p
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
y -
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELE(jTRICAL
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)
•_
, AP ROVALS
C�M NTS' � 2— � - y �s
01/26128.05 08:44 17603401819
INSULATION CERTNAYCATE,
This is to cerWy that.insulation ha been installed in oonkmance with the Current fimW
rmuiation. combmia Administrative Code, r4a 24, State of CAlftmis, in the building at
LA OUNTA VILLAGE ApARTmEmTkBQb
_04JA QUINTA CA
CEILING&
TYPE:BATTS MAUNFACTURER, Certaintsed THICKNESS: R-38
TYpe. BATTS MANUFACTURER: CerMdntLed THICKNESS: R"13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSEO�Z
TITLF-
f 101'
PARAGON SCHMID BUILDING PRODUCTS AMASCO Compmv LICENSE 8 221517
)464xf TITLE: ACCOUNT REPRESENTIVE ON
IN§ULATION CERTIFICATE
le to ce
r* that insulation has been installed in conformance with the current energy
reg on, CalNomin Administative Code, Tile 24, $to* of Callibmia, in the but d at
ACTORTTS MA rt6eed THICKNESS: R-30
WALLS*
TYPE- BATTS MAUNFACTUREk: THICKNESS. R-13
GENE CONTRACTOR: LUCAS NERAL CO NG CORP LICENSE 0
By, TITLE:
PARAGON SCHMID BUILDING PRODUCTS AMASCO Company LIC�#221617
PAGE 14/27
t
BY; TITLE: ACCOUNT REPRESENTIVE DATE;
Certificate of Occupancy
Toar °l 412aba
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 08
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Building OfficiaK
INA
Building Permit No.: 0306:251
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH. -CA 92660
By: G.SHOWALTER
Date: 12/07/04
PLACE