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RER (0003-330) + PLBG (9700)54218 Avenida Martinez 0003-330 9700 Y, LICENSED CONTRACTOR DECLARATIONt khereby 2S1irm. under,penalty of perjury that I am licensed under provlsions'of `CF Ot& 9 (commencing with Section 7000) of Division 3 of the Business and F%fessionals Code, and my License is in full force and effect. ' ' License # Lic. Class ' Exp.. Date 54£1326 13 AS.8 A FUC 0150,0/2( Date Signature of Contractor r, OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l 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+ y Code). () I am exempt under Section , B&P.C. for this reason . Date Signature of Owner 't 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 forwhich 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: Carver ARGONAUT Policy No. WC2$-614-113635 (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 shall forthwith comply with those provisions. Date: 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 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) Date t __.- BUILDING, PERMIT# PERMIT DATE VALUATION LOT "3-330 TRACT $5,500,001 JOB SITE r 1 7PN ADDRESS 54-218 ASA , A1r3.'1:1:NE7. OWNER CONTRACTOR / DESIGNER / ENGINEER' CF 'D MiAFAi0T0VAC.`I,'13TNE .R C01415TRT t':''T10AT, INC. 54-211; AVF1,,TJ1), MARTS 41905130ARDWA1 K9 UIT'F 0 , LAQU19TA. Ct, 92253 PAIM DF:$ER.T J CA 92260 (760)779=9797 i MIA 2530 USE OF PERMIT RESIVNrIAL12WOLE. - RZMODP,L -;ADDITIONAL, FIv.FCTIZICA PRIZAP PB.CNVEP PLAN, REPLAdR, EXISTH40 A/C UNIT, REPLACE WII`1'NG WINDOW AND DOOR$ PER APPROVED PLAN. - f ' r VALUATION 121 ATED C09r OF CON3°I'KUCTFOt`T 6,W,00 y' q (,ryry .t7, 1 yvyy ,It,_tST1111 .C.LIR7.vAd.i AJ E 19 JdYA11'l.lRRY PLAN CRECK PSE 101^000.439.3113 $58.$0 lv1. CONSTRUCTION FEE 201-000-418-000 $90.00 INAECRANICAL FEE 101-000.421.000 $31.50 Z1,FECTRICAL FEE 101-400-420-000 $15:75 STRONG MOTION FEL:- RESID 101.000.241.000 $.65 J'NVESTIQATION FEE 1(21-01703-423.•Of,°6) $90,00 SUB -TOTAL CONMUCM014 AND PLA14 C1.ik? K $286.40 USS PRE -PAD) • . - .S $0,00 TQTAJj 1' 14 ' 1 ''.Ii ES DUE NOW' M00 RECEIPT DATE BY DAT IN'1LE, 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 0. 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 BLOCKIAW A PROVALS 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 p 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 CONCRETE ❑ POST TENSIONED CONCRETE ❑ REINFORCED MASONRY ❑ STRUCT. STEEL ASSEMBLY ❑ ASPHALT ❑ FIRE PROOFING ❑ ❑ OTHER JOo TI – y U -n 7-n REPORT SEOUENCE NO. TVP.(JRIRE 9O PERMIT NO. DA lTi DAY OF WEEK MATERIAL DESCRIPTION ARCHITECT INSPECTOR O✓ ►° e HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL `- ;^ i CONTRACTOR ` 6 \I 4e SUB-- -, CONTRACTOR ---^ — – -- – UK aSa-P'A _ _ )I COPY SENT TO CLIENT ❑ CON ED ON NEXT PAGE ❑ 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 _ as .:.:v _c^l.lnjp THIS=W.ORK.-.TO COMPLY WITH THE APPROVED Ae' SIG TURE OF REGISTERED INSVCTOR r-' C&tyl 4 P.O. BOX 1504 N o . Building,�q 7&105 CALLE ESTADO Address 54 -Lis Martinez LA QUINTA, CALIFORNIA 92253 C4' Owner Andric `loran Address sarie City I Zip Tel. i.z Q,.uinta 32253 564--1386 Contractor Owner Budder Address Zip I Tel.: State Lic. I City & Classif. Lic. # Arch., Engr., Designer Address Tel. City( Zip ( State I Lic. # LICENSED CONTRACTOR'S DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000,0I 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 I 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, atter, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such permit to rile 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 or 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 live hundred dollars ($500). o4I, 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 or 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 am exempt under Sec. B. & P.C. for this reason Date OwnerY _ Y � t WORKERS,' COMPENSATION DECLARATION keI hereby affirm that I have a certificate of consent to self -insure, or a certificate of Worr's Compensation Insurance; ora certified copy thereof. (Sec. 3800, Labor Code.) Policy No. Company ' O .Copy is filed with the city. ❑ Certified copy is hereby furnished_ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section need not be completed N the permit is for one hundred dollars (E100) valuation or less.) I certify that in the performance of thg work for which this permit is issued, 1 shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of California. Date Owner ` % 4--a"^ NOTICE TO APPLICANT: I�fer' making this Certificate of Exemption you should become subject to the Workers' eompensadon provisions of the Labor Code, you must forthwith comply with such provisions or this permit, shall be deemed revoked. \,, .4 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 tit 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 Address City, State, Zip 9700 (BUILDING: TYPE CONST. OCC: GRP. A.P. Number ,Legal Description Project Description Sewer Hook UP Sq. Ft. No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ 'Demolition ❑ Estimated Valuation PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. Const. Mech. Electrical Plumbing 30. U0 S.M.I. Grading Driveway Enc. Infrastructure TOTAL - D . 0 U REMARKS A�" ft5 `kf$��F1rS� X4 a Ulf 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: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FES 1ST FL SO. FT. ® $ 2ND FL SO. FT. POR. SO. FT. ® GAR. SO. FT. ® CAR P. SO. FT. WALL SO. FT. 0 SO FT ® ESTIMATED CONSTRUCTION VALUATION $ UNITS MOBILEHOME SVC. POWER OUTLET YARD SPKLR SYSTEM BAR SINK ROOF DRAINS DRAINAGE PIPING DRINKING FOUNTAIN. URINAL WATER PIPING NOTE Not to be used as property tax valuation ROUGH PLUMB. FLOOR DRAIN MECHANICAL FEES HEATING (ROUGH) WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER DUCT WORK GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED GAS (ROUGH) LAUNDRYTRAY AIR HANDLING UNIT CFM HEATING (FINAL) KITCHEN SINK ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET' COMPRESSOR HP POLE,TEM/PERM LAVATORY HEATING SYSTEM- FORCED GRAVITY AMPERES SERV ENT SHOWER BOILER. B.T.U. SO. FT. ® c BATH TUB BOND BEAM SO. FT. ® c WATER HEATER MAX HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL LUMBER GR. SO.FT.GAR ® 3Ac HOUSE SEWER FRAMING FINAL INSP. GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PLCK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK GROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APPJEOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM $ GRADING cu. yd. plus x$ =$ LUMBER GR. FINAL INSP. FRAMING FINAL INSP. ROOFING RAP �� �j AV REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING MESH INSULATIONISOUND FINISH GRADING FINAL INSPECTION - CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURES/INITIALS GARDEN WALL FINAL Received From:Date: Address: COACHELLA VALLEY WATER DISTRICT CASH RECEIPT DETAIL 13 4 1 R9 Jt�Tract Account No. Lot (s) Service Address G.A. Code 0 Meter(s) $ 0 Service(s) 0 Backflow(s) 0 House Lateral (s) 0 Detector Check(s) 0 Meter Surcharge "VSanitation Capacity Charge 0 W.S.B.F.C. 0 Temporary Construction Meter 0 Turn on Charge 0 Uncollected Account - Name 0 Inspection Fee - Tract - Fee - 0 Plan Check Fees Water I Sewer - Tract - • Bond Payment - A.D. --Bond Assmt. • Customer Deposit • Other TOTAL Remarks: OCOPY to: Cash Check Money Order Water Service N ) , 4'. , i Cashier CVWD-438 (11/89'