SFD (9705-024)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
734.293 k3' 3031 99
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 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
�dctilbn 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.
ut.11i CH f.AM3. CtY Wf,1 6818%4015
(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 prolvisions of Sectio 3700 of the Labor
96'de, I shall forthwith comply with those provi ions
V)ate I A /SiOPPApplicant -- <
Warning: Failure to secure Worke s' Compensation coverage is unlt I and
shall subject an employer to criminal penalties and civil fines up to $104,000, 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
thhe'above-mentioned property for Innsspection►p_u✓rrp.,oses.
Signature (Owner/Agent) s�a� f //'yte1�3
■ .��DI�w ����I� PERMIT#
BUILDING (G 4
CONTROL#
5192
DATE.V2,207 VALUATION $28k3*3 �1f LOT. TRACT fit
JOB SITE
ADDRESS M
APN
761-560-1101
OWNER
CONTRACTOR / DESIGNER / ENGINEER
KS11 LAND It C10111,11.1
Dc, 14C.
C0.110
56140 PC"A BLiii)-
56140 PGA 131.,`U
LA QVINT'A (;A 92253
1.tl.QUI111r1k
x'11 92253
(760)771-3642
C ILO 4,676
USE OF PERMIT
f t1 I!W 1lA01K PLAN cit
PLAN 011AK FEE Itlill)(K R O 7"wF0R N1XJ1,1'11+ X 183UAN(% (_*' SAME'
PIAN
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`tARA000Aftt•'t)RT 58100 `I.
FST€MATED CONT O.F'CONS'T RUCfION
100643&3, eo
PERMIT FEE NUMMARV
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TOTi#1, iPERM IT 11'MS 1)UFNOW
SH.599.6a
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
7
-a-
FM
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade Iz
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap /7
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 APPROVA S
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out I
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test /7
Appliances
Final
COMMENTS:
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 12Y 1W
Utility Notice (Perm)
oll
JON TANDY
3580 Condalia Ave.
h;�� Yucca Valley, CA•92284
(619)3663.5045
REGISTERED INSPECTOR'S WEEKLY REPORT.
PE OF
SPECTION
[INRFORMED
❑ REINFORCED CONCRETE TRUCT. STEEL ASSEMBLY ❑ d
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JO ATIOREPORT
(...A- ���-�
SEQUENCE NO.
T RUCT�I/ �� �'",'� •�
1 � b-t-Sr(4ew -(-A Ge—
PERMIT NO.
D TE
_ li
DAY OF WEEK
MATER DESC RJ PTIONF e * � �
3 /b {/fO
ARCHITECT
IN CTOR,
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION. - GENERAL (� ( SUB ('
DATE CONTRACTOR J-�. (O�%V�` : CONTRACTOR"' r~S. C�wJ ("(Q 6," - ^"
(o -vl-o
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COPY SENT TO CLIENT
CONTINUED 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. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF REGISTERE NSPECTOR
DATE OF REPO T REGISTER NUMBER
*Certificate of Occupancy
'City of.*La Quinta
Building. and Safety Department. OF��°�
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Building 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:
BUILDING ADDRESS: 80-251 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9705-024
Occupancy Group: R-3 Type of Construction: VN Land Use'Zone: RL
Owner of Building: KSL LAND II Address: 56-140 PGA BLVD
City: LA. QUINTA, CA., 92253
By:.. DANIEL P. CRAWFORD JR.
1 Date: 11/21/97
Building Official
POST IN A CONSPICUOUS PLACE