0306-252 (MFD5)CO
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LICENSED CONTRACTOR DECLARATION
I 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 Exp. Date
ItSS7i 13luc
Date ' .' ! -' 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'SCOMPENSATION 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 issued. My workers' compensation insurance carrier & policy no. are:
Cartier 5'" ATF•. FOND Policy No. 17).199• eft 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 Califorfiia, and agree that if I ?should become
subjecVo the workers' compensation provisions of Section/3 00 of the Labor
Code:111. hall'f�lrf�twith:c mply with tHose.provisions. "
,.Date: Applicant— 1 % + " _ ,,
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 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,.'
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nature (Owner/Agent) Date,
PERMIT #
BUILDING PERMIT
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APN Y1•� iC!'��i�.
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER�
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RECEIPT
DATE
BY
DA NADLE
INSPECT
J
/
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Stab Grade
Y
Return Air
Steel
- 7 _of
Combustion Air
Roof Deck
-
Exhaust. Fans
O.K to Wrap
S — 3 -
F.A.U.
Framing
-
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines J 01
Party Wall Firewall
Exterior Lath
- / -
Drywall - Int. Lath
-
Final177-
Final
o
POOLS - SPAS
BLOCKWALL
APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg, 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
s
Encapsulation
Gas Piping
Gas Test
Z- S
Appliances
Final
COMMENTS:
Final
44 1
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) - -
01/26/2005 08*.,44 17603401819 PAGE 04/27
1NSjJLAT jQK�CEgTjFjCATE
This Is to certify VW irmulWon has been installed in conformance with fAq curmnt energy
regulation, CalftmWAdministrative Code, Title 24, Stabs of Callfbmia, In the building at
LA QUINTA VILLAQMAPARTME BLpa2�
j LA-QUINTA CA
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TYPE, BATTS MAUNFACTURER: Certaintead
THICKNESS: R-38
TYPE: BATTS MANUFACTURER: Ca tainbed THICKNESS. R-13
GENERAL CONTRACTOR: LUCAS GENERAL CONTRAcTMGCORp LICENSE
By
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PARAGON HMID BUILDING PRODUCTS A MASCO Company LICENSE # 221517
401MUMM TITLE: ACCOUNT REPRESENTIVE DATE -
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INSULATIQN CEREEICAT
insulation.has been installed in cwkpnancewith ft;cuffent energy
�u is '0n7Zmrie1AdmlnWrddw Code, Ti*,24, suria of California, In'the bulAn"q located at
TyQWATTS whma&- I -'�N�AUNFACTURER- Certsintaagl
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WALM
TYPE: BATTS MA:UN2FAC : Certafnfleed
GENERAL CONTRACTO CASO,,P,M -Afim
BY.
R-30
THICKNESS; R-13
CORP LICENSE 0.
SCHMIDWILDING PRODUCTS AMASCO 6o-nhply LICENSE 8221517
BY. TITLE: ACCOUNT RIEEPRESENTIVE
Certificate of Occupancy
T4kf °F 4QKt«ta
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 12
;Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE I.P.
IN
Building Permit No.: 0306 252
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11/01/04