9705-013 (SFD)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
Date r 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).
( ) 1, 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
Pec 'on 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:
mer tvy Policy No.
y
(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„California, and agree that if I should become
subject to the workers' compensation provisions of 'Section 3700 of the Labor
Code, I sha `fo bwi comply with those provisions.
Dater S -Applicant -J r���
,'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, 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 comp.ly,.with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned pr) e[rtty for inspection
}purposes. s�
Sig ture (Owner/Agent "1 �' .r�1�,! tf•'� 1iC Date
... , c U
PERMIT# CONTROL#
IV=1 PERMIT
BUILDINGPERMIT
'
y'�w� 5181
DATE VALUATION LOT TRACT
: l22i 7 z tr>,J1 119
. 3.40 1 S18
JOB SITE g
ADDRESS
APN
761-560-013
OWNER —
CONTRACTOR / DESIGNER / ENGINEER
K'SL LAIND I1 C 01.P
81,1Df' VI:1,OPMENTCEAP
56140 IUA BIND
.56140 PCA BIND
LA Q1, IMI'A ("A 92253
1, A, t3f 1IKFA CA 02253
(7CA177 1 .:km 2 CRIX 4676
USE OF PERMIT
;.^+).0
.Si,l) - fftAl1 A06 i'LAN :iAR
i i? '1.'c:a iC;t?f�:3'I3<lif;'1it)ty 3,441A0 3F
i'frlsc'flf 'A`.t'tia 519.00 SF
0Al3A1!1(,'jkK140R'1' M1.041 1,91"
10M'it1iSMD (u(%ST OF CONSTRUCTION
286,393.40
(70NfSrRtI( r10N 1, U)i 1014XV-41€i-{)Cil)
N1„AN ril ..._47+. yrirl, 1.01-009-433-31
MLi:1 ANICA1., Vh% 101-WO141-000 r:1ul.00
r.1 LC"1'.121(:A1�1 ia1 ifll�tlliti-'i2i1-U00 Sl:l 0
PLUN04WC31' iZ 1Gl-C313(1-413-C)i10 8213.25
I`�_
ST110 NO MOMON fT?f.? -. REZIRD 101.01)0.2414."D $28,64
�
ORrYIANG 171.8 101-000-423410`—
fN1 KX`YrkkJ0t1Jk1 FEE 22S -WG -443-312 $6,4E1><I.IiO
ART iN 1 UB1,1f: PLAVAr'E S - ft.1i`i(T, 701 -OW -255 -WOO
Cq
a
8'( 1)3-T(Y1AI C'0N:�1IRI!CI'ION A N n PI A,N C11F.CK
°°" S9,3«TY1,
LESS 111d, -PAID FEES
$0.00..
7'4'►'3'AL PE32NOT MEN 1 11W, NOW
59,:342.37
RECEIPT
DATE
By
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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
of W7
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final 15— — -POOLS-SPAS
BLOCKWALL APPROVALS
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
1111171
Encapsulation
Gas Piping
Gas Test
A - j
Appliances
Final
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)
COMMENTS:
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10 10
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HALL ,le;'� 1,� r
DINING IIA
—
ROOM _1
-
BEDROOM L-1 ,
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OH^rf 11
BAT' 2
t� � � � � r- � � 11 �r�ap� �.�: .'. •.'. •,.r:.. '..�1�--•--....-.._._._ . _ .......: 1
JON TANDY
r 3580 Condalia Ave.
Y- cca Valley, CA 92284
L,INSPECTION* SERVICE,
(619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ?X:�TRUCT. STEEL ASSEMBLY ❑ S14 -o R
O POST TENSIONED CONCRETE ❑ ASPHALT OTiER
❑ REINFORCED MASONRY O FIRE PROOFING
v L P.�v `��
REPORTSEQUENCE N0.
T 0`�STp/ FJUUCTURE R '
l ifs L. �J
PERMIT NO.
7-Q
/_ 1
DAY OF WEEK
MAT RIAL DPT ON ^ `
ARCHITECT
INSPEC'ZTA�
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL `— d ' SUB j ., ,;—,.,/� •�
DATE CONTRACTOR, S �(/ ` CONTRACTOR �(iL KJ iN
�-
O -gse' 2 =1n u.��t�t �� -� �A-S'-� PL A
x1 o x
ucZ
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COPY SENT TO CLIEN C'
CO INUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
SIGNATURE OF REGIST:PtD I SPEV2* _
0 co ;t -
DATE OF REPOR REGISTER NUMBER
d
P.O Box 1504
78-495 CALLE TAMPICO
1.A `QUINTA, CALIFORNIA 92253
July 13, 2001
v
(760).777-7000
.FAX (760) 777-7101
Mr. Bruce Lindell
57-395 Riviera
La Quinta, CA 92253
Dear Mr. Lindell:
Please be advised of address changes for the following structures. The structures
formerly "addressed as: �a7=395-Riviera, 'Lot 18-APN#761-560-010
57-411 Riviera, Lot 17-APN#761-560-01.1
57-427 Riviera, Lot 16-APN#761-560-012
57-443 Riviera, Lot 15-APN#761-560-013
67-459 Riviera, Lot 14-APN#761-560-014, the construction for..
which building permits 9705-016, 9710-168, 9705-015, 9804-098, 9803-010, 9809-258,
9902-101, 9705-014,:9712-068,.9811-134, 9705-013, 9711-075, 9712-025,'9708-072
and 9712-017 were .issued, will now, be addressed as follows;
(80=425 -Riviera, Lot 18 - Lindell
.80-455 Riviera, Lot 17 - Soderling
80-475 Riviera, Lot 16 - Gould.
80-485 Riviera, Lot 15 - Westergaard
80-505 Riviera, Lot 14 - Schweizer
Please note this change and contact me directly at (760) 777-7019 if I.may be of further
assistance.
Thank you.
Sincerely;
Diane Aaker ,
Senior Secretary
Building & Safety -Department
J