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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
dkvtee 9 (commencing with Section 7000) of Division 3 of the Business and
Pf6ffessionals Code, and my License is in full force and effect.
License # Lic. Class - Exp. Date
/-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 issued. My workers' compensation insurance carrier &.poli no. are:
Cartier . "; .°2�la Policy No. ;'114%1�t 1
(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 Califomia, ,and agree that if I'•should become
subject tp t wor ers' compensation provisions of Section 31700)of the Labor
Code, lr ha .forth ith cern ly with those piovislons. 1
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Warning: Failure to secure Workers' Compensation coverage hi - nlawful 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 authorize, iepresentatives_of..this City to enter up n
the above-mentioned property f' r inspection purposes.)
Signature (Owner/Agent) f ! 'rt -'� = - Date — 1' t ?
BUILDING PERMIT PERMIT# _
DATE VALUATION "2_3,;.530.00 LOT 'n, }`�,�a>{f TRACT % i ;S�i'� 1
JOB SITE r sAi� �kX�'�li�i�.�1�j}�lA�.
APN
ADDRESS
OWNER CONTRACTOR / DESIGNER / EN INEER
CORP.
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USE OF PERMIT
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A .ft ^iy - J " .E JI'J, . Film, .. ar...�ffi .. _
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POI =1
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Ct:t'1JUN`f x'r1,lEl;°. ;'01.51
1a' MNITATI1 D £:0911
COAM1.10s 't'IOt13 FEE 1'31. 100.418-00 31111':AJJP
F%L,1w Ul.;la;{;r. fm"F, I r Z _000 -*135► -318
HEC4'IKNIC,AL Ff,,: 1011. -000-421 •00n, $114,00
KI,: ;C:'i itkCA,L..FnC'' 1:47_000-A20-00AD 0131116
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a7 Fs;k�aGi Adi'r t iC7; :+'�� • I�L*:31P� Y G -�{�-;fid 1 ••aQiy `�a,3t
i^!7�'el!'+yitE1flKQJ TY. 101-100.0 -000 )f,ltik:
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ART TO PUBLIC rN Ci<P, - REV': VO -000445-00101
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RECEIPT
DATE
BY
DATE FINALED
JNSPECTO
INSPECTION RECORD
�. OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
— /
Ducts
Slab Grade
— 9 — 3
Return Air
Steel
_ /
Combustion Air
Roof Deck
73
Exhaust Fans
O.K to Wrap
— zii- 25F.A.U.
Framing
i 7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
2 -�
Drywall - Int. Lath
Q —p
Final —
Final _ 4
SLOCKWALL 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
Equipment Enclosure
Shower Pans
OX for Finish Plaster
SevMPLaterM
—
Pool Cover
Sewer ConnectionEncapsulation
Gas Piping
Gas Test
Appliances
Final
--
Final4�2
Utility Notice (Gas) V/ I
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
COMMENTS: Pv&7,r/,;P. x",
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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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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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Certificate of Occupancy
oF�° Building 8 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 32
Use classification: A3
Occupancy Group: MFD
Type of Construction:; V -N
Owner of Building: APARTMENTS AT LA QUINTA VILLAGE LP.
Building Oflfcial
Building Permit No.: 0306-232
Land Use Zone: V -C
Address: 11.05 QUAIL STREET
City, ST, ZIP: NEWPORT BEACH CA 92660 .
By: G.SH"OWALTER
Date: 11/01/04