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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
4lhapter 9 (commencing, with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effedt._' " ,
License# {'Lic. jClass Exp. Date {
Date �� t. :Signature of Contractor
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 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$) 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 issue My, workers' compensation insurance car,�&'er ` ��Zr1i no. are:
Carrier r €�T �'�'1'1,) Policy No. +, t f fir':.
(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' compe,psation laws of California, and agree that if I should become
subjecL„tcg�the orkers' compensation pro )sions of Section 37,OO(of the Labor
Code, shill hwifh comply
Be ns.
r`'r
Date:F:.
Warni 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'.Safetyy
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 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•thatthe,above information is
correct. I agree to comply with p�11 City, and State laws relating to the building
construction, and hereby aut drize representatives of this City to e(iterrttpon
the above-mentioned prope for inspection ' 'rposes. `
Signature (Owner/Agent)W.
4{
BUILDING PERMIT PERM 03� f+},6
DATE VALUATION $1231530M LOT PAR,3/4 TRACT M
JOB SITE50-6,010 r>,,+S.:?:.�1:�f 1MR—.t3 VE
APNADDR
OWNER CONTRACTOR/DESIGNER/EN &NEER
.APA.I'.:tMWI Si Pial' .i A, Ql:Tr.W.'A +M:1:AGE, :F I.L'TC.AT, i3S),NMRAL i C:N7 I 1X, L•t'li`4J
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5'2660 AEUJi?CyPTItF.AX"K
USE OF PERMIT
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I:SMArr Ia'L,R Rii.11MsiTLY
0;*5T11'i:+".` KX4 F -TE 10.1-000-4'1 F' t(.X'o $1,773.59
PIAN G'I•ii•; IK £? 101-01110-+ 39'•:118 140'3.56
WRCHANICALSS284.04
FilECTRIC'AL FEE 1.17 -X700-d �(?•t�0 �51'?.63
1?C�It�iFj}�+I�`+I''A„L' iq}•�.UUt)-�I�«t�QO '1tbG`F,pO
STR.01,4CIMOTION :?+'EZ-IZES110 11)1 -00 Z. 3s .
43PIPJANO FES J i}1 at1(a0-A ? -f9(1(? MIX '
ART i.N I'UBUIC' 1141 :J,�?. XA - i. ]IL 270-000—W-000 3$39.83
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RECEIPT
DATE
BY
DATE FINALED
I
i
INSPECTION RECORD
t' OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings ,-
Ducts
Slab Grade —
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 Firew oll
Exterior Lath — S —
Drywall - Int..Lath
Final
— py
Final — o
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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 9
Plumbing Final
Plumbing Top Out .,
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection —
Encapsulation
Gas Piping
Gas Test
Appliances
A,,
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.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) _
COMMENTS:
01/26/2005 00.44 17603401819 PAGE 11/27
ILATIQN CER TIEICATF,
This Is to car* #wUnsulation has been,inshilled In conformance WIM the current snow
reguldon, Carr AdminishOm Code: Title 24, Stets of Caftnia, In the building at
LA QUINTA VILLA43E APARTMENTF— 9 LA qUINTA CA
CEILINGS.,
TYPE: BAITS MAUWACTURER, Certsintoad THICKNESS: R-30
iW-E—,BATrs MANUFACTURER: Certahtwd
THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE #-7S-R'*-79-�
By
TrrLF-
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 221617
f BY, a,TITLE: ACCOUNT REPRESENTIVE CV%TE-.'5hd&/
INSULATION CERTIFIQATE
'Ro is to coo that tn
sulation has been instatled in conformance with the current energy
reg n,.Calilbmia AdrMnMvWe Code, TIM 24, State Of California, In the building logged 6t...
CEIUNGS:, .
TYPE: BATTS
TYPE' BATTS
GENERAL CON
BY..
LUCAS GENERAL.
THICKNESS: R -W
THICKNESS: R-13
LICENSE S.
SCHMID BUILDING PRODUCTS A MASCO Company LICENSE
BY: TITI-E, ACCOUNT REPRESENTFVE DATE:
Certificate of Occupancy
Tw!t 4 4 a"
Building & Safety Department
This Certicate 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: 50-6.60 EISENHOWER DR. BLDG 09
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Building Official/
Building Permit No.: 0306-216
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACHCA 92660
By: G.SHOWALTER
Date: 12/09/04