0306-231 (MFD5)LICENSED CONTRACTOR DECLARATION
U) . % I hereby affirm under penalty of perjury that I am licensed under provisions of
c,4 ;,Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
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C,
Professionals Code, and my License is in full force and effect.
O 5 M License # Lic. Class Exp. Date,
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1� CY Lo JIC
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Z r- Date > Signature of Contractor
(D OWNER -BUILDER DECLARATION
LLI W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
coo 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
Code).
C05 I am exempt under Section B&P.C. for this reason
0
0J Date ----Signature of Owner
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d< WORKER'S,COMPENSATION DECLARATION
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Z
Er I hereby affirm under penalty of perjury one of the following declarations:
LID <
, iZ 0O 1 have and will maintain a -certificate of consent to self -insure for workers'
X uj u- compensation, as provided for by Section 3700 of the Labor Code, for the
0 _J _J
_J < performance of the work for which this permit is issued.
<I have and will maintain workers' compensation insurance, as required by
S 9
q ion 3700 of the Labor Code, for the performance of the work for which this
LO
F_ permit is issued. My workers' compensation insurance carrier & policy no. are:
Z carrier Policy No: il'7119,`,IMCVi
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(This section need not be completed if the permit valuation is for $100Z0 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 Califomia(and agree that if I should become
subject tion prdvisions of Section 3700,'of the Labor
Code
o thos 0� provisions.
Date:.
L_ i. L
Da
Warning: Failure to secure Workers' Compensation coverage is unlaMUI- 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
ofthe 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 it
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;
� C ' ity, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope I for inspection purposes
13Y
1,.Signature (Owner/Agent)
PERMIT#,
BUILDING PERMIT
a3fYi-1111
DATE VALUATION '"231MIX? LOT TRACT
JOB SITEAPN
ADDRESS 9q -&k F NHOYMR DIUVE
OWNER
CONTRACTOR DESIGNER EN61NEER
QUIMA VIU-M-3E, Lf
-cu'."'AS G1,Smkac-
11
MINVII.)IFU EMM"P., CA 92660
NEWPO PIT 0A 9266()
(944)474-0-A1?1 COLO 17 5
USE OF PERMIT
nWF_1Z__.W0
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1WFO, , V 151111 3 2; 10aw7' V 17=71C. FES 7y -11- toff.017it-
Ip CLU'DE BLOCK WALL. ! OR POOL.. RI V-14
Lrzoo i'�Y
10 � 10 0 i3 F
AK! RVIZIMMIA), 1,2n,oe "n
r4,jorwc- LS
:16 17a"I'ED COW Or, CON STRUC.37011\1
PXRNIF� YMW-qAFrft'
CONSTOYC'MYN 101-000-418tOOD Jl.r_'L�oo
P'LA'.N CH1174!X MY 10; i�.
MECRA1W,CW YZE I C41 -f)()0-42) . ()0Q 52!1441
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PLUUP-1 41e,.A FEE ID I
;si,r,mqeV.VTI&N "Et - PLUSID 1101-000-241.006
ORADWi'l ("89
ARX IN MWIC KAC!K' - RESH: 2'70-000-445-000,
AW)Pl.,M CB M,Z
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TkYr10z:0,HTMYf T"W1 DUE P0141
V6,.t 34.90
ID L
RECEIPT
DATE
BY
DATE FINAI,ED
INSPECTO
0 -
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Y . 2
Ducts
Slab Grade
-
Return Air
Steel
_ Z --
Combustion Air
Roof Deck
U
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
-. Q
Compressor
Insulation
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
Steel
POOLS -SPAS,
Set Backs
ElectriaBond
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
— 3
Heater Final
Water Piping
1j 1d&5
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
Sem ZzJg 0_,_1!,
/ .. ^� %-CZj
Pool Cover
Sewer Connection
_" 1v dy
Encapsulation
Gas Piping
Gas Test
-
Appliances
Final
Final
I ELECTRICAL APPROVALS I
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: r ��
/OJT AGF/,ZHa
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 30
Building Permit No.; 0306-231
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
INA
City, ST,. ZIP: NEWPORT BEACH CA 92660
By: G.SHOWALTER -
Date: 11 /01 /04
01/26/2005 06:44 17603401819 PACE 25/27
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} INSULATION CERTIFIC
This is to cww ow insulation has been Installed in conformance with the current energy
regulation, Caftmia Adminisbative Code, lift 24, State of California, in the building at
LA QUINTA VILLAGE APARTMEN74ADG_9&1A QU{NTA CA
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TYPCE L BA MAUNFACTURER: Certainieed THICKNESS: R-W
x TTS MANUFACTURt,R: Cerlalntsed THICKNESS: R-13
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GENERAL CONTRACTOR: LUCAS GENERAL CONTIiACTWG CORP LICENSEV7!� 7 '5-
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PARAGON SCfiNitD BUILDING PRODUCTS A MASCO Company LiCEN3E P 221517 F
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INSULATION CgMFI ME
This Is to certify that insulation has bow Installed in conformance wdh the aurent energy
regulation, Caftnia AdminWeetNe Code, Title 24. State of Cautamia, in the building loceoed.at
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LA QUINTA VILLAGE APAR71i1ENTli3LD00` LA QUINTA CA
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TYP7TSS MAUNFACTURER: Certainte'ea THICKNESS; R-30
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WALLS..
TYPE: BATTS MAUNFACTURER; Certain%% THICKNESS: R-13 r
s GENERAL CONTRACTOR: LUCAS GENERAL CONTRACTING CORP LICENSE 9'75
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J6PARAGON SCHMID BUILDING PRODUCTS A MASCO, Company LICENSE 0 221517
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BY: UTITLE: ACCOUNT REPRESENTIVE DATE: j3hd a
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