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LICENSED CONTRACTOR DECLARATION
k*ereby affirm under penalty of perjury that I am licensed under provisions of
Ctaapter 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 f EkR Date
5C1 3 }311.1c J % ` WD5
Signature of Contractor�kj ' �•
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.
(\) 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:
Carrier 'RTATE FIM ► Policy No. I%1Q9 ;1Z -2t'1 3
(This section need not be completed if the permit valuation is for $100.00 or less),
O I certify that in 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
subject tt9� the'wot/kers' compensate rprovisions of Section 3700 of the Labor
Codp fiyhjill tortKwiffi domply with ose provisio
ea"te: Applicant a,"fe' '
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 a6thprize representativesvof this City to enter ypon
the above-mentioned prop rty for inspection purposes.
Signature (Owner/Agent) - I Dat
27
BUILDING PERMIT PERM 0.'
2A $3
DATE VALUATION W401115'i.�.° LOT PAR 314 TRACT Y 30721
JOB SITEa1F..C',f l3 .:,'; 3 :'moi V{ -')I''' rL`.R D.Rr� 1I.
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
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l i::'I' AS 4sE;Nf a_, L OMP.
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(9Kf)/I74-Q2b1 C1''Si
USE OF PERMIT
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PEPWIT DOES, f)T ihtt:1'iA1M ItOJWfiU"S OR`Ir;,
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d.r -00 SI?
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MECHA NIC.41., J r'.. 10.1-.000•421,(NJ0 &' AM
JFLZ T'R_►r'A1., FEE, , r, J -000-M-0"" —0"" . $ f& 13
STRC NC'.r MOTX44 -11U ' : -..E:7JD / (! -000 $1.5,02
ORADIWO RE i `;4J 000-423-000$14.Qal
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USS ' • +`li�.fYs)
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RECEIPT
DATE
BY
DATE FINALED
INSPECTO
{_',
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
Return Air
Steel
-A2- t
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
J
F.A.U.
Framing
— -
Compressor
Insulation
— p
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 — --
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
_ 2
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
—
Encapsulation
Gas Piping
Gas Test
►/
Appliances
Final
Final
Utility Notice (Gas) oc
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 08:44 176.03401819 PAGE 07/27
INSULATION CE811FIg"T
This is to certify thatinsulaWn has been inshilled In contmItanca with the cunwd energy
regulation, CalOomia Administrative Code, TW 24, State of Calffbmla, In 1119,building at
LA CAJINTA VILLAGE APARTME", "LA QUINTA CA
TYPE:SATTS MAUNFACTURER: Certainteed THICKNESS: R-38
WALLS:
TYPE: BATTS MANUFACTURER: Certaintsed THICKNESS: R-13
GENERAL CONTRACTOR: LUCAS QZNERALCONTRACTING CORP LICENSE *2sKw-.S—
BY' TITLE:
PARAGON SdHMID BUILDING PRODUCTS A MASCO, Company LICENSE #221817
TITLIEACCOUNT'REPRESENTIVEDATE-
-4WO
01
INSULATION CERTIFICATE
This that Insuteftn has been 'installed in confbrmam* With the ourrent energy
regulation. mIB AdmlfflsftatfftCode, TIM 24, Store of cauornig, In the building located
op
CEILINGS;
TYPE: BATTS MAUN Cerigintsed KNESS' R-30
TYPE: BATTS MAUNFACTUR THICKNESS: R-13
T
*4
LI,
GENERAL CONTRACTOR: GENMAL CONTRACTI
RPP LICENSE 0
Sy.
TITLE:-
7AOON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE # 17
BY:TITLE-. ACCOUNT REPRESENTIVE DATE.-
Certificate of Occupancy
may' °F:W 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.
Use classification: ARD.
BUILDING ADDRESS: 50-660 EISENHOWER DRIVE # 27
Building Permit No.: 0305-248
Occupancy Group: B-1 Type of Construction: B-1 SPRINKED Land Use Zone: V -C
Owner of Building: LUCAS GENERAL CONTRACTING CORP Address: 1111 -QUAIL STREET
Building Official
A
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 02/23/05
FEB- 7-0.5 MON 1:14 PM RIV, C'0, FIRE PU INDIO FAX YO, 1 760 863 7072 P. 1
Crafo E. Anthony
Fire Chief
Proudly serving 1110
unincorporated
areas of ltiversWe
County'and the
rides or:
Banning
4
Beaumont
4
Calimesa
Canyon Lake
fi
Coachella
Ps
Dcsert Hot spaings
a
Indian Wells
0
Tndio
4
Lake Elsinore
4
La Quinta
.Moreno Valley
Palrn Desett
4
Perris
Rancho Mirage
a
San Jacinto
4
Tcimcula
Board of Supervisors
Doh BU q1 x,
NOW I
John'ravaglianc.
uimict.2
klT stone,
Di4tiiiat3
Roy Wilson,
l..)istriout 4
Marlon MINIev,
Dietrict 5
'RIVERSIDE (]OUNTY
FIRE DEPAF:TMENT
�1
82-675 Highway 111 • Indio, California 82201 • (.'60) 8638886 • Fax (760;863-7072
i
February 7, 2005
'lye
City of La Quinta
Building Department'
Re: LAQ-05-BP-044
C'
Buildings 19 thru 25 and.27
i
The Riverside County Fire Department is granting the clearance for a building
permit for the following project located at, 50-oF—Eisenhower Drive. La Quinta.
Please call if you should have Questions. W
Respa-dfully
FRANK KAWASAKI
Battflion Chief / Fire Marshall
By •fitORS
-O�'`t -
Tarry De oucy
Fire System Inspectors