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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. Da
jDate�- 1' -Signature of Contractor—
OWNER-BUILDER
ontractor
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 A 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.
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
„e,'rmit
is, iss ee�� N! orkers' compensation insurance c er & po I no. are:
Cagier �'C'1':Policy No. �`�la�:;�-ati
(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, 8 d agree that if I should become
subject //the yvorkers' compensation provitions of Section 37®b of the Labor
Code, o f�, hvu comply with those prgvt. ision_S.
•pale: /Cr ApplicantLL'✓° ' L-
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 Quints, 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 160 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, tfiat•the above information is
correct. I agree to comply with all City, and State laws'relating to the building
construction, and hereby authori a representativeS.of,this City tole er ulpon
the above-mentioned property f inspection purjpps S. O
Dat
Signature (Owner/Agent)
BUILDING PERMIT PERM ��wpl,19,
DATE VALUATION M21141.4i30100 LOT F•A,R.3!4. TRACT M 0,Q2I
JOB SITE 4&WJ i �i� I EIiIN�4 liIUTYF�
JAPN
ADDRESS
„
OWNER CONTRACTOR/DESIGNER/EN INEER
APAIMIAENYJ A1,11 1-k QUUMA. Vff-T.,AC:tR, L;[ LUCAS c KIKER.Ai., C0H1 ' Aj7.i i14 ' :,.:IRP.
310 5 QUAD, U� 217 11 i ) Q11m], � T. n.T
tz1"rL i?;j3tT,1 E91,114 CA :�,266i 1+51?VPr.3N'3;1?.':a,ALM C: P, 9291'6
(949)474-0121 IAq 11156
USE OF PERMIT
it CL4 IM B1{)C1 FI LL!1310p, twooi.,,, "ki v J 9. Pw'i4kr I F.Eb,
y 7" .41L)IiiDI?30�
POM YPA'17IU I,417d:iv :w
C01 T' ',AC -T AN ?!JW X74,100+ 1. 41 LS
�;1�'!/[ATED (1109 (Ar �'.OF'�ta".�". UC 110110
42.3j=.06
7� 1 y�; a
PTR NQlllIVEIllw'
rO?^3"RUC`.' ]IM 11d? 101.000.410.000 t1,773,50
PLX4 f •.'i EC*.X FF4 bei
MI;fSsRIANICA.!; M'.I:'; A 01-000-i6`1 -OVI :t84,00
1134 I3..4TIUCAI.•�q&g: [12-4CJ 10-.OfYI q�tit=t6G
PLLIMii'[NO FO l 0 ). • Z1h3•�l l c•U00 SG67,f)U
S R.(, ;fl? MOVON FEE , RZZID 101'-000-141.000 "1�i1.35
KI[t�4':�I't�1Ci 'f?I?� 1 C+1 •t10�J�`?3 •QC0 32 �,Ot�
DE EWPER II1 PAG7
ART sN PIMAC PLAiCE3 - RE911C 270. 000-44 5 -000
OTAL 0102r` VRU.(_n1 0P P.hYD
I �F'k,i 1°.[E•i�'l i'?Ifi3
$;?.C3C�
JU
I�
[RECEIPT
DATE
By
DATE INALED
INSPECTO
INSPECTION RECORD
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
2L.,
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
ELOCKWALL
APPROVALS
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
_ 7
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS: A
!�
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) —
!16
Certificate of Occupancy
Titr 4 4 a"
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 13
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP:
Bui ding Official
Building Permit No-: 0306-219
Land Use Zone: V -C _.
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11/01/04
A CONSPICUOUS .PLACE