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LICENSED CONTRACTOR DECLARATION
hereby affirm under penalty of perjury that I am licensed under provisions of
Ikapter 9 (commencing with Section 7000) of Division 3 of the Business and
PrCfessionals Code, and my License is in full force and effect.
License # Lic. Class Exp, IDate
Dated I Signature of Contractor + �I
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 & I',V no. are:
Cartier �'3 ?a7i: ;'+ ;�iL'` Policy No. 1,71493 -60s
(This section need not be completed if the permit valuation is:for$100.00 or less).
( ) I certify that in'theperformance 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 Califomi7; and agree that if' I sho ,ld become
subject topihe Workers' compensation provisions of Section 379k6f the Labor
Code;'l splfo/tjlwith omplywith th'sip'provisions.
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, 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 all City, and State laws relating to the building
construction, and hereby authorize representatives of tFiis City to enter upon
the above-mentioned property,for inspection purposes,.,'
Signature (Owner/Agent) 1., Date
BUILDING PERMIT PERMIT 0306 249
DATE VALUATION ?-, ;),F �1),dCi 'LOT !PAR04 TRACT %';. .01Z 1
JOB SITE SO -154.0 b1iSoop"! �IR.aWKR My.r1rY.I.,
APN 41,01;
ADDRESS
OWNER CONTRACTOR/DESIGNER/EN 1NEER
At:i?;x i lli�i`3".fS.�1': ,F� ::{1:3>m .•, VTi. LMYLE,1J' 1a'X'AS G�'sh]±= .'A 0016.1.
QU,#dT, xru,.w T i i 31 QUAIL •IL t5IRM."r
"A A660 �IIHWP .9JRT'DEluN CA 926'.0
(.7SLO 1756
USE OF PERMIT
31
PRAMIT POES ir'Ur Mr:.'.i.t.'D OR 1100v",
ilifo-I-Y ,'rf, aam s)vaKK'4,.• i11jLi.m05
A/C OF
CO'N9'P4k+ 0 ii',A—Sd 0_i`, ,` L,3
EUIVI!'.3•?IM C:caISTx 11 CMr#VIRUt•`.H:kow
C.Or i'RT,IRUOTTOH.FEE, 101.000.418.00JO $AI3,Fa91
,
RL,A�N C;ha'W-K FFV, M-1.100-439-318 $119.01
m izo;to1larll1. F-'1.1111 1.01-0001-4-21 _00"). MOO
&,E -'Z i`R1CA.•L, FF.. i01--000-420-00 $246.19
P:,1 amst,P+/trill 11,9 101 -000-419-000 ^:.' 9.000 VOJ,',10
STROW0MOT1014 -m300-2411.000 $1..02
0Rtkt9tN0 FFE s 01-;10)-41.+•000 tt.5100
UL�•b' E?z,,t�c. Y1b1)'}�ta".i'• 1�1�L? 9;3,9i+8.r30
'
S1JTI3-'tt?7'x. Aki'l) mg, f'i .K
f
RECEIPT
DATEBY
DATE FINALED
INSPE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
/—
Ducts
Slab Grade
Return Air
Steel
_ Q-
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final ^
Final I Z- 21 -
BLOCKWALL APPROVALS
POOLS a SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater F'mal
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
Sewer ConnectionEncapsulation
_
Gas Piping
Gas Test
Appliances
Final
Final
LM14 Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
01/2612005 08:44 17603481819 PAGE 02127
INSULATION r-F01n1:Ir-AT8;
This 19 to Certify ftt Insulafm has been kWWW in Q0nf0rn1ar= With the cunWft energy
regubtbn' Cal'fbmia Adm'nMmdm Code, TNIO 24- StW8 Of Calif0miR. In the building at
LA QUINTA VILLAGE APAJqTMENT�"—
41�LAQU,NTACA
CFJLING-S.,
TYPE:SATTS MAUNFACTURER: Certaintaed
THICKNESS: R-311
WALLS:
TYPE- BATTS MANUFACTURER: Owens Coming THICKNESS: R-13
GENERAL CONTRACTOR. LUCA$ GENERAL CONTRACTING CORP LICENSE A -7S
By, TITLE:
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE 0 221517
IlAt A W1
PT 7.11,121111151NEW
TITLE:- ACCOUNT REPRESENTPM DAM-
INSULATIQN CERTIFICATE
This it #W,insulation has been installed in conformance with the cuffentenergy
rnia AdmInIWvMve Code, Tft 24, Shft of CMffomia, In ft building
�vlgjjz -.,
MW
-411'�Am
WALLM
TYPE. BATTS
GENERAL
THICKNESS: R.3o
Certaintew
LUCAS GENERAL CONTRACTING
By---�.�
LICENSE #
PARAGON SCHMID BUILDING PRODUCTS A MASCO Company LICENSE #
BY. TITLE; ACCOUNT REPRESENTIVE DATE-
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: M.F.D.
BUILDING ADDRESS: 50-660 EISENHOWER DRIVE # 31
Building Permit No.: 0304249
Occupancy Group: 134 Type of Construction: B-1 SPRINKED Land Use Zone: V -C
Owner of Building: LUCAS GENERAL CONTRACTING CORP Address: 1111 -QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660
By: G. SHOWALTER
Date: 02/23/05.
Building Off ial
POST IN A