0007-109 (RER)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
r Professionals Code, and my License is -in full force and effect.
License # Lic. Class Exp. Date
532631 ,73 C33 ( OW0e2(
Date'? 3� t,1 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.
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 CLARENDON NA T'L Policy No.DI KROD20306
(This section need not be completed if the permit valuation is for $100.00 or less).
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 California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply withthose provisions.
Date: n. i t_ ,. Applicant—
Warning:
pplicant Warning: Failure to secure Worke%s''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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) 1-,i,C , .. 4 _0, 7 Q Date 'Z • 3 Zlu
•
BUILDING PERMIT PERMIT#
DATE/ IQr 1 VALUATION LOT p 00011-109 TRACT
7r
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JOB SITE
APN
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ADDRESS �-4,57 OAX E=
- -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
(§•AIZY llOLEAT(3A
BRENDAN J 01:3�I.P—A
18133 WML Y POND COURT
46460 DE, =ZT LILA DR.
WOItT04 LYE 11#11 49167
PALM DESERT CA
92260
('760)862.1931 C13LO
5831,
USE OF PERMIT
REMENIIAL TiEIAODM
RESIDENTIAL !21,MODEL (MORNING ROOM) & INSTALL WINDOWS & (1)
SLIDING DOOR, OPEN THE AREA BETWEEN KITCHEN & LIVING ROOM,
PER APPROVED PLANS ONLY.
VALUATION 4000.00 LS
ERMIA.TM CONT OF CONiNMUCI10IH
t3 ,(3130.(713
PERW17 .FEF 8LTMAARY
PLAN CHECK • I ? 101.000.439-•318 S37I.30
CONSTRUCTION FEE 101-000-418-000 $372.00
MECHANICAL FEE 101-000-121.000 $21,30
ELMCTR1C,AL PER 101-000420-000
SUB-1U'rAL COXFi'RUCT'IOAI AN -D PLAN Ck:D iCK
83.30
a. LESS PRR-PAID FM
$0.00 ,.
TOTS: PIMMUTT MMS DIDE NOW
15 3
RECEIPT
DATE
B.YI _ `
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
F.A.U.
Framing oe
Compressor
Insulation Q
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 Ll
POOLS - SPAS
BLOCKWALL APPROVAL6
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
Neater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
,
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole '
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
,tJOUTANDY
37630 Medjool Ave.
y.
Palm 'gDesert,',, CA 92211
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Office£ (760)• 772-7192
iSPECIAL INSPECTIONFax,
(760) 772-7193
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Pager,,. (760)' 776-3338
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REGISTERED-INSPECTOWS WEEKLY REPORT
-
TYPE OF
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY ❑
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i HEREBY CERTIFY THAT, 4 HAVE. INSPECTED TO•THEIBEST•OF my;, "�.•
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AT RE OF REGISTERE INSPECTOR
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PLANS. SPECIFICATIONS. AND 'APPLICABLE SECTIONS. OF' THE'
GOVERNING BUILDING LAWS. �, • �, F.'I)Atj
OF EPORT' � REGISTER.NUMBER
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{_ ? 37630i4Ai djool -Ave.
- _ 'Palm. Desert, GA 92211
'fr Offices (760) x.772-7192
INSPECTIONSPECIAL +` Faz'(760) 7.72-7193
+, . Pager. ' (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT -
TYPE
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PAGE OF
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CERTIFICATION, OF COMPLIANCE+
I HEREBY CER7IFY THAT I HAVE INSPECTED ;TOJHE.BEST- OF, MY-
KNOWLEDGE ALL OFTHE ABOVE REPORTED WORK UNLESS OTHERWISE• �' �+ ISIG NA URE OF REGISTE INSPECTOR ,
NOTED. I HAVE FOUND THIS WORK TO COMPLY. WITH THE APPROVED f r k`� v a 6a o.
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GOVERNING BUILDING LAWS. i +t•. ATECIF REPORT REGISTER NUMBER
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''. Palm Desert,• CA` 92211
' Office ;' (760) 772-7192
INSPECTIONSPECIAL , { ; Fax (760) 772-7193
Y •
Pager (760). 776-3338
REGISTERED INSPECTOWSWEEKLY REPORT
TYPE OF �'• ' t;
•O REINFORCED CONCRETE,, w O STRUCT. STEEL ASSEMBLY
} O ,
INSPECTION •
•OPOST TENSIONED CONCRETE+. '' O'ASPHALT t i '
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CERTIFICATION OF COMPLIANCE •, x
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HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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KNOWLEDGE ALL OF THE;ASOVE REPORTED WORK UNLESS OTHERWISE e;
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