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0112-165 (RPL)LICENSED CONTRACTOR DECLARATION I hereby,sffirm under penalty of perjury that I am licensed under provisions of Chpnter 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 490M B t'l?;ftdi //Date tee %/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 pjury one of the following declarations: ( ) I have and will maintain a certif ate of consent to self -insure for workers' compensation, as provided for by ection 3700 of the Labor Code, for the performance of the work for which thi permit is issued. k) 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 MAtlMON Taw,, CC Policy No. 03fCR0016704 (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 sh aI . fort.with comply with those provisions. , Date: 12121 dry Applicant 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 hiss, 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�oid if work is not commenced within 180 days from date of issuance o 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 relatingto the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) - `,- Date/. G BUILDING PERMIT PERMIT# 8?11 163 DATE VALUATION LOT TRACT JOB SITE ADDRESS $ ,}.rJf �I&yf:=AMr, 7� Q rA. APN OWNER CONTRACTOR / DESIGNER / EN (NEER ROR.ERT & S'A]UTIVEAHOW sTm13mY CC')N2 t'.U=ON ti 1..;,2CHtvUNT ;ri? " LA tA/�1.���ry.TiiGGli�f'A CA 3 . a ��Iyq yy��9,22,,5 �F 1) c;6T)776-825.0 C.:.,3.* C7457 USE OF PERMIT , )N)OL AIAWOR SPF a 814AU., OR M F7SACE r'i' .R RE:-Al„r4.Si'RR rNSPECTfON. D`Oi,.L `L;C,1C IPI- -14T :POOL ,f4NWOR SPA EVRIN 1.TEA COS' O,3_' C:O>'1STRUC CIM 3113019M.00 ]?MWl.' FFT �'i�P.r�1Lti RY PLAN C11=9 FV? 103rvc)cxa-439-038 $415.6 CONSTRUCTION TION ME' 101•00"18-000 $639M 1C L •�2(1j�f{ld(J S d5,0O •ryr�i'yf, r�Llp-RiC.� ��j`�rit py��}}Igaj��i�A e0y (XO1101.410042Q-000 PLUMMO F9F-^ I 606 1011.1700-419.000 $27.00 nor. 9."7 2001 . C.CSNMETC:!70HAN1pC1y:►����,,tA•��� ry'�F3yEC7K ,s...�---��� � *; l.ALw.,67 .i'�1eZb'S5('rtlr+�'�i.i5A7 td:�ll. VS.• 'TafAl, IYE:ixtl4f.1',VKC Y DUE NOW ��1 DAyTE � / BY \ DATE FINALED INSPECTOR 0 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 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 Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond A,er Footings Main Drain2 Bond Beam Approval to Cover Equipment Location Underground Electric — G 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: 1_1z L/ © 2— t!J(lr 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) 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 CONCRETETRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB L = ^ Ue� ` FIIi wn rA 1 `/-/ ^ u`wIA REPORT SEQUENCE NO. TVP i:AU E Plt)T�NC. _ t6 / DATE DAV OF WEEK MATERIAL DESCRIPTION p ILT\ _ ARCHITECT TORT-- NRS. CHARGED ENGINEVO O V A ASSISTANTS NRS. CHARGED INSPECTION DATE CONTRACTOR GENERAL a CONTRACTOR W ( E5. S agsmum RA a vs r A of i -A DIE7 I C ,,A Q •P. To f • p • 9241( leelo �1 COPY SENT TO CLIENT ❑ CONTINUED N NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MN KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE OTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS 5fGNATURE OF REGISTERIb INSPECTOR , O 7/ �S �q7S ATE dF REPORT REGISTER NUMRFR G 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 ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB LV../ . t n N -re^ ok � LPfa(i REPORT SEQUENCE N0. TVP UCTURE 0 Q l j10'� pVJI 16V1J D AV OF WEEK MATERIAL DESCRIPTION ARCHITECT / I - j� _ HRS. CHARGED 1 ENGINEER0Uh, ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR S �� SUB (� CONTRACTOR G Q, ��_ CfV+Gbi-�� N ceA v V e COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE of CERTIFICATION OF COMPLIANCE 0 -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. s�1 4-1 'ffGNATUR OF REGISTERED I ECTOR v r -l'? l 7� D TE Ct REPORT REGISTER NUMRFR 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 CONCRETETRUCT. STEEL ASSEMBLY ❑ ❑ POST TENSIONED CONCRETE O ASPHALT THER ❑ REINFORCED MASONRY ❑ FIRE PROOFING S JOB 0 N 3� �v� � ,. iz�Z „ V REPORT SEQUENCE NO. TV 9iRRJdtTURE ,D`/`E—SCRIPTIO'N}Y'r1l~J. ' 1 � Re's. . PERMIT NO. 1 t �y DISE I DAV OF WEEK MATERIAL _w w ^� S(, /K, ARCHITECT r L/� INP]CPFI. _ HAS.CHARGED ,,^^ (^ r' J ENGINE ASJSISTATTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR S VCI. CONT CTORW 4A '— Co L -s Sk�o «► C.� (� cb v1, J3 IBJ S i /ISS li'jcy -eLCc>t,, W9,(-4 le k RC.(4Ak1- j9ReSe,,rQ SAWN -S hi s (0 COPY SENT TO CLIENT O TINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE ? 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 /S;NI�TUPE� 0 F REGIST p --o _ 11 TE OF EPORT REGISTER NUMRFR