0306-221 (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. Oat
Date `' �A 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.
(\, j+ 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' i orkers' compensation insurance � II no. are:
Carrier ,j,T 'a Policy No. � tit! 1 9
(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
subjectg l e w rkers' compensation provisions of Section 3,700 of the Labor
Code,,r hblhfo hwith comply with those provisions. e„
Deter.. .� i�,'Applicant rot*, %tw . _ _,?l
' Warnin : Failure to secure Workers' Com' ensation 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, indemnity
& 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 al'LCity, and State laws relating to the building
construction, and hereby authonie represeni�66s of this City to enter,upon
the above-mentioned property dor inspection puyi`ses.
Signature (Owner/Agent)�,''.,1 : �I /h Dte �• -�
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BUILDING PERMIT PERMITO#�g a�
DATE VALUATION 5423, 5:!C? ) LOT ' �,1','.;:`�i• TRACT K;. "�5 ; 21i
JOB SITE °5+''1-MI)!USZK'Y 0AV RSJ.CV_.,N.
APN 173-3'dV411)t
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN (NEER
.., AR1'1Vt2 hS'rS AX i:,,k. C;'UNTA';iI i3j'ac., :t T.,E:jf �f�Y v3 b' :� i' #+.i.. comp. f `,)ln),
110 5 4 UAM. Uif<YF 1' 1 1 QTTJQI sn?:1 7
ateAca k7 is 92660 KA-'XV01ZT I~Vl MIR CA 92,660
USE OF PERMIT
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CNS' It;yt'.)tai HE I I 811 $j;773 0
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KU-'iiAFICiV, uU, ] 1,11 -OV0-4 21 ^000 $184,00
SL &=RACril., e t`ll? 10,1-000-4210-000
PLUHI3113#:if�,k -0';1_000-111•'1:9»066') j'$b7,R11
.S7N.01,10 MOTION IF—H - fii+.,�I6 M1 -000.241-ON V.3.35
GR4,1A4101 F& F 101.600`423.0U^ 315.110
£1VII&OPEEP IMPACT
.�.1�"i' 1� lir.}�F�,1C 1�L�i�C.1E:! • szCLU�?. ��T;�'•(/CtS�{5�J04� �":*9�.�i�
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JUL 0
RECEIPT
DATE
BY
DATE FINALED
INSPECT R.�,
e
t -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
AA
Underground Ducts
Forms & Footings
Ducts
Slab Grade
19-sS- 3,
Return Air
Steel
, 3
Combustion Air
Roof Deck
- Q • O
Exhaust Fans
O.K to Wrap
Framing
F.A.U.
Compressor
Insulation
-J? -
Vents 1-49
Fireplace P.L.
j
Grills
Fireplace T.O.
zo
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final 22—
Final —
BLOCKWALL APPROVALS
POOLS - SPAS
sleet
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
- - 3
Heater Final
Water Piping
- // - 3
Plumbing Final
Plumbing Top Out
/1 '
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Q _ fj -
Pool Cover
Sewer Connection
rj —
Encapsulation
Gas Piping
Gas Test
mw p
Appliances
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 08:44 17603401019
yr•Iw!�.n•nw�+ytie•A'1YfL41N'i��whRM'AN7r)►J7/»„�.• _
INSU Ia'C N CERIWIgATE
This is to certify that Insuiadon has been Inatatled in fiance with the current energy
regulation, California.Adminlstrative,Code, Tile 24, Stabs of Caftnis, to ft building at
LA Qt1KNTA ViLLAGr. APAmENTS DCd-75.A A QUINTA CA
TYPC
E S MAUNFACTURER: Cortaintaed. THICKNESS: R-30
WALLS:
TYPE: BATTS MANUFACTURER; Cert* teed THICKNESS: R-13
PAGE 24/27
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE # 7��5
PARAGON SCH WD'BUILDING' R- ODUCTS A,MASCO Company LMME #221517
WAS T nE: ACCOUNT REPRESENTIVE DATE.,,/,- 7
INSULATION CERTIFICATE
This Is to c ert'ty that insulation has been installed in conformance with the current energy
regulation, Cailfomia Administrative Code, Tice 24, Stam of California, in the building located at
LA QUIMTA VILLAGE APARTMENTt " QUINTA CA
EILINGS:
TYPE: BAITS MAUNFACTIIRER; Cortainteed THICKNESS: R-30
WALLS:
TYPE BATTS MAUNPACTURER: Certainteed THICKNES&A-1$
GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE # =-7
SY TiTLE_01
s�LO
PARAGON tD BUILDING PRODUCTS A MASCO Company LICENSE# 221517
BY: TITLE: ACCOUNT REPRt:SENTIVE DATE:
/ r
Certificate of Occupancy
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.
Use classification: A3
BUILDING ADDRESS: 50-660 EISENHOWER DR. BLDG 15
Building Permit No.: 0306-221
Occupancy Group: MFD Type of Construction: V -N Land Use Zone: V -C
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP. Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 11 /06/04
Building Officia