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0111-043 (GRES)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 Professionals Code, and my License is in full force and effect. License # Lic. Class_ Exp. Date OAS 5? B)U,t" Dateff /106( Signature of Contractor � � r,3� � !✓^' 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 Seciion 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 Policy No. k�C31e21� INS CO. WC.1•407M (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 C"$$lifornia, and agree that if I should become subjecgo th workers' compens5fi n°Ppr�ovi! ns of Section 3700 of the Labor 'Cod I forthwith comply with diose p� visions, Da el . d Applicants " l'"'""".a�Q v 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 forwhose 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 epresentatives of this City to intel upon e above-mentioned prop{ for, s ' `tion purpoes. / / Gignature (Owner/,gent): �� rll /� Dad/ t f .BUILDING PERMIT PERMITk DATE VALUATION LOT 0t 11_O43 TRACT JOB SITE . - • ADDRESS APN OWNN.E�Ry7 CONTRACTOR / EN 1N�ETE[R+� il.J...Lt\7+.CSP'• 7/yDESIGNER /yy BOB.r: O]ED div ARDS CU 6> b�l.'�i.�.�'.r L,1' 014 �t5-:505'hi'�' M, '"/ ✓-5320 FTMA DI2 E 'LA,Q CIA. 92253 1A Q17.19TA CA 92253 USE OF PERMIT GARAGE OF. CARPORT 184 V GOLF CA.kT rAi:A09 l483i7]'i 1014 0A7ZA0Es1 'F"0RT 1900 -OF BMM. ATM) �C>r;f Ole 4<ON�`,lRm'C" ON 3,5€36,40 7, �3�� +�y gct•yy�. (yp,[�7�q�g?. Ie"hld) ASM, 1. 4YJ.l�Tl.47/J.�bR 111M.1 CINFICK Mes 101<000-439.315 $40,95 Ce NSTRUC '1101 PRE, -101-000-418-OW, U3.00 ELECTRICAL FE E ' 101-000-420-000 S2?9, 50 N'1'RU.M'IJIsEtt7'i'iow viers gnmy;D 1Q1-o"eo-244-QOtb �.SE ORADNO FFF, 101-00 0-423-000 NUV 16 2001 C9itf OF LA ,Ofl91A RN 49,95 1Jx,.&�? ,ycy,X-I. iFMS $0.00 i I.'MAL MMdITr 1,AMS DUE NOW r r• _ RECEIPT DATE DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings�a/ Slab Grade 0� �` ' Ducts Return Air Steel _ Roof Deck � Combustion Air Exhaust Fans O.K. to Wrap !Q_�j/b/ 6N F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath Drywall - Int. Lath _ Final t{/����r(,L �jJ BLOCKWALL APPROVALS Final POOLS -SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final - Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) T4bf 04" P.O. BOX 1504 Building 78-495 CALLE TAMPICO Address 4,�4 �D�v rGf►O'� LA OUINTA, CALIFORNIA 92253 Uwnere `V7 �©T WfE_ Mailing Address Cit Zip Tel. G �VilJr Cj2zS� %�S 79$� Address L & Classif. I Lic. # Desi frCDSt4(0 Te f Tet' E0 _ 265 a Cit Z Z� O State O� Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 70D0) of Division 3 o1 the Business and Professions Code, and my license is in full force and effect. SIGNATURE DATE OWNER -BUILDER DECLARATION I hereby affirm that I am exempt from the Contractoes License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a permit to construct, atter, Improve, demolish, or repair any structure, prior fo'its Issuance also requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (8500). I: 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, Buisness and Professions Code:The Contractor's License Caw does not apply to an owner of property who builds or improves thereon and who does such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he did not build or improve for the purpose of sale.) "1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) 1-1 1 am exempt under Sec. S. 8 P.C. for this reason Date Owner WORKERS' COMPENSATION DECLARATION Ihereby affirm that I have a certificate of consent to self -insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company r7 Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed if the permit is for one hundred dollars ($100) valuation or less.) I certify that in the performance of thg 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. Date Owner NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. CONSTRUCTION LENDING AGENCY Ihereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lender's Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration it work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives -of this city to enter the above- mentioned property for inspection purposes. Signature of applicant —Date— Mailing ateMailing Address City, State, Zip c� iii- oN3 APPLICATION ONLY ILDING: TYPE"CONST. OCC. GRP P. Number Legal Description �+/�. Project Description�C7� C46M.i— !S3 .'I1 Sq. Ft./ No. No. Dw. Size Stories Units New ❑ Add O Alter ❑ Repair ❑ Demolition ❑ imated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing S.M.I. Grading Driveway Enc. Infrastructure TOTAL REMARKS ZONE: BY: Minimum Setback Distances: Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from Property Line FINAL DATE INSPECTOR Issued by: Date Permit Validated by: Validation: WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 6,, ; 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY k- CPOw-'f ❑ POST TENSIONED CONCRETE ❑ ASPHALT O OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATION- __ \5G--!565 —R� v; Eki4 1 LQ 0LA11— ICE REPORT SEOUENCE NO. TYPE OF STRUCTUREPERMIT SFirt►in��CC ((ES PGI¢ �I�Sj N0. bl (l .- o c43 DATE 1112-.910 DAV OF WEEK MATERIAL DESCRIPTION Sine. so" SE7 - £foX- ARCHITECT P, -e%>I r- INSPECTOR -?• 7% HRS. CHARGED EN NEER G-, 57'2uC-*1A1ti4t- ASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE CONTRACTOR _BOB e►".�R-d.s - CONTRACTOR. _ 0 b s -e 9,v eo( or & 4 mol 2 E,A- .�► h ��.c,e.� A -L(, ® oC >c CAKT h.c c1 D w T e4 # S' Z 7 /�G C, GB-f'� l� S ,�,�a.r �� � � N /� to w✓ G /-e � ru le r COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE ( OF ' CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. 0. ?. 'INQ2� IGNATURE OF REGISTEIDD INSPECTOR It 29 ®1 Zcr80 l I l (32,(,.- y4 DA OF REPORT REGISTER NUMBFR