0306-223 (MFD5)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
04 Uj Professionals Code, and my License is in full force and effect.
:5 C) License # Lic. Class Exp. Date
754t78i .1 . 11U
CY
LLJ
Z ir 'Pate-/ ignature of Contractor
1.— 0 OWNER -BUILDER DECLARATION
b CID
UJ W I hereby affirm under penalty of perjury that I am:exempt from the Contractor's
C0 License Law for the following reason:
z 1, 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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct. the project (Sec. 7044, Business & Professionals
cr) I am exempt under Section B&P.C. for this reason
LO
04 Date Signature of Owner
IL < WORKER'S COMPENSATION DECLARATION
CD cc I hereby affirm under penalty of perjury one of the following declarations:
FZ 0 1 have and will maintain a certificate of consent to self -insure for workers'
X LU !�: compensation, as provided for by Section 3700 of the Labor Code,, for the
0 _J _J performance of the work for which this permit is issued.
< L) have and Will maintain workers' compensation insurance, as required by
d Se n 3700 of the Labor Code, for the performance of the work for which this
0) %, rkers' compensation insurance carrier & no. are:
z Carrier Policy No.
< (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 b6come subject to the
workers' compensation laws of CalifomiV-ind agree thal il- I should become
subject to toe wp�kers' compensatio7 pfovisions of Sectioln 1 1700 of the Labor
e: L"'Annficant 11f,1(
Warnini: Failure to secure Workers' Compensation coJerage 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
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 Quintai 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 applicatipn.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 authoriA represen6tives of this City to enter upon
the above-mentioned property f inspection p6rp6ses.
.'Signature (Owner/Agantl
BUILDING PERMIT
DATE VALUATION S423;5YJ= LOT, 11"P.R*'W".1 TRACT
ADDRESS
OWNER CONTRACTOR / DESIGNER EN&NEER
USE OF PERMIT
PORMIlikTIO IV
SPRINr-LER. 3F.
4131153010)
STRCV0 MOTION, FEE PMJD 101-000-241-006 $4135
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs.
Underground Ducts
Forms & Footings
(-f _119 — —,-s
Ducts
Slab Grade
—) -
Return Air
Steel
Combustion Air
Roof Deck
— C) --
Exhaust Fans
O.K to Wrap
— -T
F.A.U.
Framing
3— v
Compressor
Insulation
3 — -
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
-
/o
a
Final /
Final ,t! o
BLOCKWALL APPROVALS
POOLS SPAS
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 Cz
-/73-
Heater Final
Water Piping
—Z, .y
Plumbing Final
Plumbing Top Out
r/ 5
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
p
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
.. d...�'
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
Temp: Power Pole
Underground Conduit
Rough Wiring y
Low Voltage Wiring
Fixtures
Main. Service
Sub Panels
Exterior Receptacles /
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm) JZ&AZZ�IZ71 ay'
COMMENTS: P�,....v -F•� �+r/it4 J-7
-
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.
BUILDING ADDRESS: 50-660 EISENHOWER DR. BLDG 18
Use classification: A3
Occupancy Group: MFD
Type of Construction: V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Auilding •
191
Building Permit No.: 0306-223
Land Use Zone: V -C
Address: 1105 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER
Date: 12/21/04