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GRES (0309-076)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 684857 B Ric ! . 03%31/2( Date`'! i f C� Signature of Contractor v 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&RC. 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. Sfi�( ) I have and will maintain workers' compensation insurance, as required by ction 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 PERFK.ItRRI) FLPLC,�Y Policy No. WY.11-109040-2 (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 !'r Paieai ,— ,Applicant 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 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 - BUILDING PERMIT PERMIT# cW.�-0116 DATE VALUATION LOT TRACT $4,194A0 � JOB SITE ADDRESS ��(j APN 767-11V-1-031 OWNER CONTRACTOR / DESIGNER / EN 1NEER M & M DON MADDOX BOB EDWARDS C J149MUMON 56.105 MMION 79-920FTMADRWE LA QUDITA CA 92253 LA QUDT A CA 92253 (1;760)775.7933 CBL# 3212 USE OF PERMIT OARAGE OR CARPORT 214 3F' 001.F CART OAR. OR, t3ARACIMARPORTi 214.00 SF ESTMAZED COST' OF' CONsTRxic. oN 4,194.40 I'YJtMIT FEZ SmN:AI2Y CONTMUCTION FEE 101.000-418.000 V2.00 PLAN CHECK FHE 101-000-439-318 '$'55.18 ELECTR.1CAL'FEE 101.000.420.000 $26,78 STRONO t5OTION FEE - RE= 101-000-241-000 t so MM -TOTAL CONMUC TION'AMD PLAN+",,,RFCK $137.46 tM PRE PAID FES 10.00 e �IY7rAL i��1'tMJff nicKs .Duu .Now S1.a+7.�iki OCT 2 3 2003 CITY OF LA QUINTA FWANCE DEPT. RECEIPT DATE BY` D FINpLED� 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 17 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 BLOCKWALL APPROVALS 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 - .r. Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: INSPECTION GENERAL SUB DATE CONTRACTOR CONTRAC ML - `UA t� f ' 1 II COPY SENT TO CLIENT O 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. HAVEWITH THE PLANS. I S ECIFIOCATIONS. UND AND A PLITHIS WORK TOICCABLE MPLY SECTIONS POFOVED THE GOVERNING BUILDING AWS. CONTINUED ON NEXT PAGE O 1 PAGE OF SIVATURE OF REGISTE D INSPECTOR DA OF REPORT REGISTER NUMBER JON TANDY 78-194 Elenbrook Ct., Palm Desert, CA 9221'1 Office (760) 772-7192 x • Fax (760) 772-7193 Pager (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY ��1C� INSPECTION O POST TENSIONED CONCRETE O ASPHALT ❑ OTHE PERFORMED ❑ REINFORCED_ MASONRY O FIRE PROOFING JOB LOCATION REPORT SEQUENCE NO. TYp� 0 CT RE ^ ( (Q NVr�I PER( MIT NO. ^ ITE ,4 DAY OF WEEK MAT LfiDJ\ESCRIP!lITIWOrrrN1` ARCHITECT N. INSPECTOR MRS. CHARGED ENGINEER JASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE CONTRACTOR CONTRAC ML - `UA t� f ' 1 II COPY SENT TO CLIENT O 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. HAVEWITH THE PLANS. I S ECIFIOCATIONS. UND AND A PLITHIS WORK TOICCABLE MPLY SECTIONS POFOVED THE GOVERNING BUILDING AWS. CONTINUED ON NEXT PAGE O 1 PAGE OF SIVATURE OF REGISTE D INSPECTOR DA OF REPORT REGISTER NUMBER Building Address 56-805 Herion Owner Sunri se Comm P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Mailing Address 42-600 Cook Street Suite 200 City Zip Tel. Palm Desert 922€0 1 566-'2028 tional Hortgage 6 Land Same City Zip I Tela State Lic.I City & Classif. 288330 Lic. # 398 Designer Address Tel. City ( Zip( State 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 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, alter, improve, demolish, or repair any structure, prior to its issuance also requires the appicant for such permit to Me 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 cowl penahy of not more than Ove hundred dollars ($500). ❑ 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 Law does not apply to an owner of property who builds or improves thereon and who roes such work himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or lnprovmnent is sold within one year of completion, the owner -builder will have the burden of proving Mat he did not build or improve for the purpose of sale.) O 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 contractors) licensed pursuant to the Contractor's License Law.) ❑ 1 am exempt under Sec B. & P.C. for this reason Date Owner 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 ❑ Copy is filed with the city. ❑ Certified copy is hereby furnished. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (Ibis section need not be completed N the permit is for one hundred dollars ($100) valuation or less.) 1 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 Cali omia Date owner NOTICE TO APPLICANT: ft, 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 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 ise 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•I have read this application and state that the above information is correct. 1 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 Yq No. 07242 1 � /o/- BUILDING: TYPE CONST. OCC: GRP. A.P. Number PGA Legal Description Traci 24WI Project Description Phase 4H - Plan 113A Sq. Ft. 2899 No. No. Dw. Size Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $234,923 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. i.3S.. Const. �. Mech. - uo Electrical 132.71 Plumbing jbb, 50 S.M.I. 1b.05 Grading Driveway Enc. Infrastructure �4*U3 @ss Gredir. L: Infra We �i TOTAL REMARKS it•_,�zi'.•s►'.i'i' )" t•+t-lir%'- X'•-ri.vm . _ 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 2/28/90 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SQ. FT. @ $ UNITS SLAB GRADE ROUGH PLUMB. BONDING YARD SPKLR SYSTEM 2ND FL SQ. FT. FORMS i EWER OR B�Py� ROUGH WIRING. MOBILEHOME SVC. BAR SINK POR. SQ. FT. ® AS (ROUGH f A,,qd METER LOOP GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS GAS (FINAL) TEMP. POLE DRAINAGE PIPING CAR P. SQ. FT. GROUT WATER HEATER WALL SQ. FT. FINAL INSP. DRINKING FOUNTAIN. BOND BEAM WATER SYSTEM URINAL SQ FT ® _$ LUMBER GR. ESTIMATED CONSTRUCTION VALUATION $ FINAL INSP. f(} 0 WATER PIPING NOTE Not to be used as property tax valuation FLOOR DRAIN MECHANICAL FEES ZiV WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER VENTILATION GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED FIRE ZONE ROOFING: LAUNDRYTRAY AIR HANDLING UNIT CFM FIREPLACE 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. SQ. FT. ® c BATH TUB SQ. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SQ. FT. RESID ® 11/. c SEWAGE DISPOSAL SQ.FT.GAR ® Vic HOUSE SEWER GAS PIPING PERMIT FEE PERMIT FEE PERMIT FEE DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST. FEE ELECT. FEE SMI FEE PLUMB. FEE STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR SETBACK ROUND PLUM�6 -7 UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS i EWER OR B�Py� ROUGH WIRING. DUCT WORK ROCK STORAGE �OUND. REINF.Y G.,0' 11 �V AS (ROUGH f A,,qd METER LOOP HEATING (FINAL) OTHER APPJEQUIP. 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. f(} 0 G&RAMING—/j� FINAL INSP. OOFING(—l� LjV �— ZiV REMARKS: VENTILATION FIRE ZONE ROOFING: FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING �`lIJ O MESH �SULATIONISOUND6-0 z�" FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL