9907-176 (SFD)LICENSED CONTRACTOR DECLARATION
F,'Vreby affirm under penalty of perjury that I am licensed under provisions of
Chgj ter 4 (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 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).
( )v.) I, as owner of the property,.am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code ,
I() K m exempt under Section B&P C for this reason.-
ate ASignature 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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(X) 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,370 0 of the Labor
Code, I shall forthwith comply with those provisions.
►ate:,., �.� - jApplicant of
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 Ouinta, 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-Jor inspection purposes.
tSignature (Owner/Agent) o .fir �_� Date
BUILDING PERMIT PERMT#
y.-
DATE j� /P VALUATION ti� Iy �•w =�1�� LOT <� TRACT
JOB SITE q
ADDRESS:�.d •=;,i s'_4�1:`�1 �'JA�fIi1 �;�;�dK����l�-�s�f>�t"r�.�
APN
ry
OWNER
CONTRACTOR / DESIGNER / ENGINEER
! I(M rlC,
C
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01,-901 RAMON .Y>OMD
USE OF PERMIT
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G;1M �`f:).l �bA ro t° 4•:f j rf $• L:3�-�?�-ti0(j ��i0 {Ii0
X332 �' IN styU sLIC PILAC.IL S I�t.F>Tf, `: ?�. 000-:2153-M
+I il{•, a °i' 1,t, r�Ci�ti rit �R`'i'tE iu ANOTA"N►= , i'
A AF",-',
PR'NIP 1"
�13�i Pjf;i
;y
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
Set Backs
APPROVALS
MECHANICAL APPROVALS
Underground Ducts
Forms & Footings
i
Ducts
Slab Grade
Return Air
Steel
, I b -
Combustion Air
Roof DeckQ
O.K. to Wrap
0�
�- `u
Exhaust Fans
F.A.U.
Framing
- -00
Compressor '
Insulation
—9:;w
'�7_0
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
..ap
Drywall - Int. Lath
O& 0400 3wsd4l
Final
Final o
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
(/ _ 00 SV
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
.PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
Zr �' Q ��
Heater Final
Plumbing Final
.Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test0
Appliances
Final
COMMENTS:
_
M i9 6�1 �`�` 3 - ov S7
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
W14 Notice (Perm) Z 2 M .-p
R4-.�.,-�f-: •,--•...�i'�y^+'sr�.�C1a-4..y �Mr.� 1�•-.�s�iY--�".:.�+'*'ti:...--� _.,�.. ... .—-•�---'S--r-�^�1•,:: , •-,_
�. tIG1%n,�CV
,� ` . �� V P.O. BOX 1504
Building d / I vI"
78-495 CALLS 1504 O APPLICATION ONLY 1
Address T1V O!V �Zl/MP�OUINTA, CALIFORNIA 92253
Owner_
wneer
Mailing
Address
City Zip Tel
ailicto°,rJ�i/_ l`i� r) 2��. 7,'-0-3?_2-'�'.7
Contractor
Address
City lZip I Tel.
State Lic.I City
& Classif. Lic. #
Arch., Engr.,
Designer
Address I Tel
CityI Zip I State I
Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
_SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that 1 am exempt from the Contractor's License Law -for the following
reason: (Sec. 7031.5,BusinesS and Professions Code: Any city or county, which requires a
Permit to construct, after, improve, demolish, or repair any structure, prior to '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 (5500).
C-1 1, 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 Law 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.)
1'1 I, 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. B. 8 P.C. for this reason
Date Owner
f
WORKERS' COMPENSATION DECLARATION
I hereby 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
(7 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 ($700) 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.
k A
CONSTRUCTION LENDING AGENCY
I hereby 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 if work thereunder is suspended for 180 days.
I certify that 1 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 abover
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
BUILDING: TYPE'CONST. OCC. GRP.
A.P. Number ! 7 ? • 1,!f :? —e7,-5, /
Legal Description G 4 7' /A." 9 / L✓./ti i 7"
Project Description 4: '� rt l� JC" l? .
Sq. Ft. No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑' I Repair ❑ Demolition ❑
Ca�.l�rr4c-r : �JauG Mc+ta ttlE (4314 -512 - 7073
Estimated Valuation
PERMIT j AMOUNT
Plan Chk. Dep. _��• co
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
R Side Setback from Property Line
INSPECTOR
i f
Validated by: t U _
5
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
Permit
Desert,Sands Unified School District
47-950 Dune Palms Road .
Notice:. La. Quinta; CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE 'OF COMPLIANCE
Date 10/25/99 APN # 773-213-001
No. 19509F
_ .Jurisdiction La Quinta • .
Owner NameDouglas & Joyce McHattie Permit #9907-176
No. 51520 Street Avenida Montezuma Log #
City La Quinta - Zip 92253 Study Area
Tract # 1321, U12 Lot # '15 Square Footage 2144
Type of Development Single Family Residence No. of Units 1
Comments
At the present time, the Desert Sands Unified School District does not' dollect fees on garages/carports; covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes.' It
has been determined the above-named owner is exempt from paying school, fees at this time due to the following reason:: "
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code,53080 in the amount of
1.93. X 2,144 or $ 4,137.92 the property listed above and that buildtn
permits and/or Certificates of Occupancy for this square footage in this proposed project may now�lie issued''
Fees Paid By cc/Wells Fargo s Telephone y328 3587,
Name on the checker .r
By . Dr. Doris Wilson
Superintendent
Fee collected /exempted by' Juanita GreenPayment Received $4,137.92
Check No. 0762001670
Signature '
NOTICE: Pursuant ofembty Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to ru from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on theDistrict('s)(s') behalf, whichever is earlier. -
Collector: Attach a copy of county or cityplan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy; Accounting .
s
Recording R6quested `By 1U8094 _
CHICAGO TITLE COMPANY
RECORDING REQUESTED BY: RECEIVED FOR RECORD
AT .8:00AM O'CLOCK
-CHICAGO TITLE COMPANY ' COMPANY
.
99.8552KC 91055561 PAID
EN E II p q� Doc. Transfer Tax MAR 16 1999
WHUNLRE 00 R R �CI(+FL� CTu��unH+O D EFLOW, D'
1'V1LA/11 E1'IGNV • RI1/, co, R@Cbr Recorded m Official Records
of Riverside county. California
DOUGLAS K. "MCHATTIE Recorder
and JOYCE G. MCHATTIE Fess $
27550 LONGHILL DRIVE
' RANCHO PALOS VERDES, CA 90275 SPACE ABOVE THIS .LINE FOR'RECORDER'S USEAPN: 773-123-001
.
GRANT DEED EjSL
0�-0/7
The undersigned,grantor(s) declare(s)
Documentary transfer tax is $55.00 I-
(XXX) Computed on full value of property conveyed, orv
4 (
'),.Computed on full value less liens'and encumbrances remaining at time of sale.
).Unincorporated area: ( ) City of and U_
\ FOR A VALUABLE.CONSIDERATION, receipt of which is'hereby acknowledged,
Y
WILLIAM THOMAS•BUFFIN, AN UNMARRIED WOMAN
�^ hereby..GRANT(S) to'
QS1 DOUGLAS K. MCHATTIE and JOYCE G. MCHATTIE, husband and wife as joint tenants'' "
the real property in the City of LA QUINTA,._County of Riverside, State of California,*
described "as:
• LOT 15, BLOCK 21 OF SANTA CARMELITA AT VALE LA QUINTA, UNIT NO_2, AS PER MAP'
RECORDED IN BOOK 18, PAGES 55-56 OF MAPS RECVORDS OF RIVERSIDE COUNTY,
`CALIFORNIA
Dated March 8, 1999 '
...State bf California .
County,of Riverside ).S.S. WI IAM THO OF N
On March 11, 1999
before me, Kelly Collier
personally -,appeared
William Thomas BuffIn
personally known tome (or proved'to me on
the basis of satisfactory eiridence) to be ,
the person(s) whose name(s) is/are subscribed
:to the -within, instrument and acknowledged to .. „ KELLY "
me that he/she/they executed the same in 1 lER
Q COMm. 10Y (011IER
his/her/their autho 'zed capacity(ies)', and a:� �NOTAR? [ME �pRNA
that by his/her/the r signatures) on the 4
instrument the pers n (s) , or the entity upon " p"' comm. Expires n 1999
behalf of whic th per on(s) acted, executed .
the instrumen .-
-WITNESS my h fic 1 eal.
Signatur (This area for official notarial seal)
MAIL TAX S TEMENTS T SAME AS ABOVE
a�-
RC District - Planning Review Form
This form is to be used by CDD staff .for review - of single family dwellings in the RC (Cove
Residential) .District, in order to determine'the applicability of compatibility issues or need
to -require the filing of Master Design Guidelines by the applicant. It shall.be transmitted to .
Building & Safety as your correction list.. Please attach additional explanations as necessary.
APPLICANT: DOUG MC HATTIE
PROJECT Lot' 15 Avenida Montezuma
ADDRESS:
APN:. 773-123-001
LEGAL: LOT 15 BLOCK ?11 , UNIT 2 , S.C. @ V.L.Q.
CK'D BY: Fred Baker.
BIN NO: CASE NO. 99-105 CHECK -DATE:
-:`-Inform'. the assigned -Building -plan checker .up.on: your assignment to this case. The CDD
Executive Secretary maintains a log book to track- applications and assign case numbers.
The zoning code, architectural and landscaping manuals, :and/or assigned inspector should
be consulted where uncertainties arise. The completed checklist shall be -maintained in the
Building .& Safety .address`•file:
i
.. CITY OF LA QUINTA SUB -CONTRACTOR LIST
JAB ADIJriESS `5 /,-j —(2 AI1-1 A z;1/LZL/'�4 PERMIT NUMBER OWNER i % IL. BUILDER
This form shall be posted on the job with the Building Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result ina stoppage /of work and/or the voidance
of hidlriinn'nprmit Fnr Parh annlirable trade. all information requested below must be comDleted by applicant. "On File" is not an acceptable response.
Trade I Classification
Contractor
State'Contiacfor's License
Workers Compensation Insurance
Company Name
. Classification
le.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xxlxx/xx)
Carrier Name
le.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xxlxx/xx)
EARTHWORK (C-12)
— c G ,I / J.
.I
'CO'NCRETE IC -81
)CsiG /2/ G i T<� /�/'"�C'!?/L
13
1 i O.
7- 1 /-ao M112 C uicLuL A)5i,'q-
10 10 Ej- dric1- `7 7
07-0/-00
FRAMING IC- 5)c�j!-10K
(""w
7777&
9'30-0
`,>7/1((. l' J 117
044 -)94Q7 --r-)9
'0 I OQ
STRUCT. STEEL IC -61)
N6,y L
MASONRY IC -29)
Rq r IC_
<I �'G (%/ C u/ /�/� I) y
� 2 %
/o Z 13 (o
9J 3 01r, 1
G.) I /1 i C= l" I: Irl iD
I � C c C G
PLUMBING (C-36)
iILp i/n/c> %LJ Lr
L
6 7'
1401
=LA1.��)�-' 61AT.Itl5
OII-�I2,JCI';Cl.h2
t21ZI 99
LATH,.PLASTER iC-361
%�EiNL
DRYWALL.IC-91
HVAC IC 201`
13�c� zG . (('
v, 10c f r
y Ci 7 18-0-17-1-00
I
ELECTRICAL (C-101
ROOFING (Cr39) `
pi, rj, e_
L'c �i 1 > >OOF (
C'3 `
G
FS— , W
�
�/�' S
- Ll
SHEET METAL.IC 431
= _ - Al 0,2 Can ;
CLO
l c
! 'S /�7 1 1/`). Cv. '} f� fNc Ind':' "
50 /h [" -02
FLOORING IC 161
GLAZING 10171" '
0< <J!k/�.
INSULATION IC -21
1.0
SEWAGE. DIS, P (C-42)::
nnom/
!"�Gc�i,!•�.> l
L �D
U
ulAl2Lr11)I)0141(-1T,IIJS•
011 12001 L•1 Z
W211q9I
?HINTING (Cr331
L`)!
CERAMIC TILE JC* 54)
CABINETS IC 6Y'
FENCING IC 131 '
0 LN L 12
I...NDSCAPING fC 271,'i
: j7G 51,: /Z % (/ 7/43/1/6 /�C 4"'
/3
64) /J C% S
l "3 -
%,> /' : l in<s�! ' ,�! _
/! U. /O f C^^9 7
POOL (C-531
License Number Exp. Date
(xxxx) I (xx/xx/xx)
00 -7c) 0 1-11"/0011✓
114(n / 1"412510
D`i3q-0151
U -/: LO ,✓
59o5- l0 2�0o II
C"ry
OF LA
�N 2 9 RECD
P.O. Box 1504 �IeiQy
78-495 CALLE TAMPICO (760) 777 000
LA QUINTA, CALIFORNIA 92253 (TDD) (760) 777-1227
June 28, 1999
Mr. Douglas McHattie _
69801 Ramon Road #242
Cathedral City, CA 92234
SUBJECT:. MINOR ADJUSTMENT 99-473
LOCATION: LOT 15, BLOCK 21, UNIT 2; AVENIDA MONTEZUMA
APN: 773-123-001
This letter is to report that the Community Development Department has reviewed
your Minor Adjustment application, pursuant to Section 9.210.040 of the City of La
Quinta Planning and Zoning regulations.
-MINOR-ADJUSTMENT. REQUEST:
To reduce the side entry garage setback from 15 feet to 13.5 feet, along the
Montezuma street side yard area.
DECISION:
Approval is granted for the requested reduction, based on the following findings:
• Minor Adjustment 99-473 is consistent with, the La Quinta General Plan, in that
the reduction proposed does not alter the. approved land use for the property,
or affect land use on surrounding similar properties.
Minor Adjustment 99-473 Js consistent with the La Quinta Zoning Code, in that
the requested adjustment does not reduce the required street side yard setback
along Avenida Montezuma below.the 10 -foot minimum.
• Processing and approval of Minor Adjustment 99-473 is in compliance with the
California .Environmental. Quality Act. The adjustment requested falls under
CEQA Guidelines Section 15305(a), which allows minor setback and parcel
adjustments as Categorically Exempt under this Section.
• Approval of -Minor Adjustment 99-473 is not detrimental to the public health,
safety and general welfare, nor. injurious or incompatible with other properties
and land use in the vicinity. The adjustment has no impact on health or safety
issues, and will not affect physical land use characteristics in the vicinity. • ,
CAWrkgrp\Letters\ma99473.wpd �(,
Please .be advised that this approval relates only to allowance of a "reduced setback ;
as stated above, and does not imply any entitlement or;approval of'a building permit
for any structures shown on the..plans on file. All other setback provisions and
development standards of the La Guinta Zoning ' Code are applicable and, shall be
adhered to in preparing plans for building plan check. One stamped original exhibit is
attached for submittal with. your building plans.
If you have any questions; please contact me at 760-777-7069:
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
Wallace. Nesbit.
Associate. Planner
W N/wn
Attachments CITY OF LA OUINTA
JUN 2 9* RECD
c: Bolton Engineering Corporation
BUILDING Aii3 SA7Y
G -reg --Butler,: Building &,-Safety_Dgpartment,
File, MA 99-473
C:\Wrkgrp\Letters\ma99473.wpd
z®r
SPECIAL INSPECTION'SERVICC
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
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 A--
O POST TENSIONED CONCRETE ❑ ASPHALT ❑ O ER ////
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION ISEE5z0 - V� /' Z ' .,j y / ^ �u��
H IV Y' L-7
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
jr M cka`�-�-i e.014107-1
PERMIT NO. -
"i
DAT
!e
l'� o 0
DAY OF WEEK
MATERIAL DESCRIPTION
ox,Bd
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
po 4o,>
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB _
DATE CONTRACTOR CONTRACTOR
y oe
Qb5-nevod olQ ceme^4 o i 5 E„Ar-5/8” A I/ ,een-
f .
r..
COPY SENT TO CLIENT p
CONTINUED ON NEXT PAGE p
PAGE ' OF ,
I ..
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTEDRTED TO Tlj� BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPOWORK UN ESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TC COMPLY WIT• THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS, OF THE
GOVERNING BUILDING LAWS.
IGNATURE OF REGISTER INSPECTOR
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DAYE OF REPORT REGISTER NUMBER
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INSPECTIONS
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211
Phone: 760-345-5554 - Fax: 760-772-3895
Proj ct Name:
Project No:
Date: .
Project Address:
UBC yr Title 24 Other:
Client:
Sub -Contractor:
oe ree Cts rP u 0 ce C,�..
Weather:
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General Cont actor:
Architect: c - �l�
Structu ra6dAngineer:r� y� %4111 r
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Locatio1 of Samples:
CQ S +1 .• Ca CAL- �0"
C. _ c U rn r"1 0— 111 n a S
Welding Process / Electrodes:
ft
Slump (inches): :3, • 0.1�3
Time Sampled: 9 •� �M
Time in Mixer: (min.)
Water Added @ Jobsite: (gals.)
Concrete Temperature: (T) �
Ambient Air Temperature: T 3
Supplier. % tJ
Mix Design: r�W!7@2
Specified Strength: (PSI) _
Admixture:V-0. 1r�.r v,rCtS�
Truck #: Ticket#:
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Field I.D. Marking: a a (o KC � N�
Welders:
Unresolved Items: None
See below ❑
Description of Work Inspected:
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I hereby certify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this r '
work to comply with the approved plans, specifications & applicable building laws. Final report issued at project completion. Page / '"• of
Insp. ctor'�`\ �.,1 1" i1 \��
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Contractor's Representative:/
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- JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency
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JON TANDY
37630 Medjool Ave,
Palm Desert, CA 92211
REGISTERED INSPECTOR'S WEEKLY REPORT
Office (760) 772-7192
Fax (760) 772-7193
Pager .(760) 776-3338 : "•!
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL -ASSEMBLY ,LA.px�
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OT ER /
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION _ 1 `
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REPORT SEQUENCE N0.
TYPE OF STRUCTURE
Srmtka-4R
PERMIT NO.
.0'- 1-7 4p
DZ
100DAY
OF WEEK
MATERIAL DESCRIPTION p
ARCHITECT
INSPECTOR
MRS. CHARGED
.,
ENGINEER
ASSISTANTS
HRS. CHARGED
9 SUB !
INSPECTION GENERAL CONTRACTOR } 0, �L �•
DATE CONTRACTOR ' t
I
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE + . OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 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 CAWS.
SIGNATURE OF REGISTERED INSPECTOR
44
DA E OF REPORT REGISTER NUMBER
A
Certificate of Occupancy
City of La, Quinta
Building and Safety Department �MoFti°
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding. Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or' use. For. the following: 4
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BUILDING ADDRESS: 51-520.AVENIDA MONTEZUMA
Use Classification: SFD Bldg. Permit No.: 9907-176
Occupancy Group: R 3 Type of Construction: 1 & VN Land Use Zone: RC
Owner of Building: DOUGLAS & JOYCE McHATTIE
Building Official
Address: 67-801 RAMON ROAD
City: CATHEDRAL CITY,, CA 92234
By: STEVE TRAXEL
Date: 04-24-0.1
POST IN A CONSPICUOUS PLACE