0306-217 (MFD5)co
LO
N
00)
UQ
It2Z
cc
r H 0
O�Q.
mQ0
OV
tl Ln FQ-
ra
J
LICENSED CONTRACTOR DECLARATION
J 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. w,.
License # J Lic. Class i F_zp. Date
B HIC M'� 8/0.5
i
Dater ,r �tignature of Contractor
f 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.
( lzj� 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 isg�Iee�� �yy workers' compensation insurance c� r & ppI no. are:
Canier
X','L F Uld 3 Policy No. 3 �f?x?S iti�t
(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 )x I should become
subject to the wSirkers' compensation provisions of Se 'dn 3700 of the Labor
Co e;' I;s/►iall,fgftnwit0 comply with th4e provisions.
Date: Applicant
I
Warning: Filure 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. 7 _
Signature (Owner/Agent) t -'2 Dai
y^9
BUILDING PERMIT PERM i9.2x':
DATE VALUATION. $42_345X� W LOT i4}�. f � TRACT 11r:; ' •% :i�'�
;j ,
JOB SITEfj j(j .tl rv��irt f h 10' D11Y .
APN `.ai-..t rU V;S
ADDRESS
OWNERCONTRA,C}TOR / DESIGsNtER / EN INEER�7m
yy y` y*y y. +� A r r t t•p a r
.�'21".a��Y: i,[7�LL•�'; l.ii .!t��..:...li ��}7.�C�.iri'��i...l.�^+�1.7}.� .Ls �iLi�r °8yj �}i.u`f in � Y�:t: �.1 yAVI1:lhS 1.�.�it.Y '��.�.i'� C'.
}►7►7.3y j(Tn�+pIrL�j:'��if1rr,�'[t�S'
y} yt
1 y�- y /]/�t -t�1 ryil.� /�ii p I�
1Y.^u L�.LIO .l A.L:-i eye CA 9.d,�i 611 l!iC�f7 �7 � ,1': �:..i Al- t l CA 926,'60
USE OF PERMIT
Jo
'rf", \ L• r' =,i rn yp �• •
• _ .� ... — �-Y _5 H.
...y
�
10"LJDBLOA: W,1€.9 OR Pool., Ell V.)d w13J1�)y::,l?IcrN'Ii1t,
�'P },3tJII,��ltd0¢
sr'RZINK z.SR. k:{ .60 Sig
►P 11 ft, f;'P. ?G`I:N"I' 374,'iwoo 1..'9
:ia r' I%',r!IATE D 00,17 ' OF
W2',",:4X,(A1
ITM 1''d' PEE 9('6JiMA1n,,'
a`CN'I-7'Yi^i CT40Ai ,rte
PLAN >~t'#iEOK NNX: j.f11-fltav 4:3'� 31 k �rF_n 5f
M,FOHAIIIi'EaLEr?
rl.frX8V.KCl r"Hi;``►Aih3t:=a a n ) � � t
31P.i:),yt3 hIOT FaF, - F 1' i1D
GRADMO ME '19" -W304',3-001
I7L^f�1.C3F'ffi.1A8�°:��L'F Dttt.Sr- 911,',. ' .�:•
ART M 4'il613C `"LACIES - RESSIE
MI.''.I'MA.t:.,ONSTAlsC'iK)t '6 AWPLAN MECi�
1t',.`-'':
:C ":3
S61 Ori
JUL3q d ��.
- I
J�
71
RECEIPT
DATE
BY
DATE FINALED
IN$P OR
r
� ?A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel C- —2 Z —
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap —
FA.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
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Alain Drain
Bond Beam
Approval to Cover
Equipment Location, -
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Unes G
Heater Final
Water Piping
Plumbing Final,
Plumbing Top Out z .- +
Equipment Enclosure
Shower Parts
O:K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: YX I -,<z,4 • �• e� -12
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.1'
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
01/26/2005 08:44 17603481819
PAGE 17/27
INSULATION CERTIFICATE
been installed in coftmwce with me current enemy
This is to certify that Insulation her
regulation, Califbmia Administratilve Code, Title 24, Stft of California, in the building at
LA QUINTA MAGE APARTMewrf*,, 66 , LA QuinTA CA
TYPE:BATTS MAUNFACTURER: Certainteed THICKNESS-.: R-30
TYPE: BATTS MANUFACTURER: Owens Coming THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICF-NSE#-7<'-rr'-79-f--
BY' TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE V 221617
Ry- 01" TITLE: ACCOUNT REPRESENTIVE DATE.
INSULATIOEIDEMIEICATE.
This Is to ce at insulation hes been Ifttalled In coriftmance with the � current
regulation,
"ulawfim Caft dminishative Code, Title 24, State of Calfflomla, In the bold
.9E-
Tyj
P �BA-6
THICKNESS: Rpt)
TYPE: BATTS JREk THICKNESS: RA
GENERAL CO CTOR: (,..UCAS GENERAL CO NG 'CORP LICENSES
BY: TITLE'
�RAGON SCHMID -BUILDING PRODUCTS A,MASCO C,orhpany L NSE V221517
BY:. . TITLE:.ACCOUNT REPRESENTIVE DATE.
FSA
Certificate of Occupancy
T...Mf °F xP agma
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 10
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.: 0306-217
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: I NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 12/10/04