9705-023 (SFD)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
X
ft
{,Date %Signature of Contn
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
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.
'lt).RIC U INS;. CO. WC 6W%505
(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 rovisions of Section 3700 of the Labor
Code, I s all forthwith comply with those),provisio
Da%te:: f Applicant -- ' r
t�Warning: Failure to secure Workers' Compensation coverage is unlawfful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit ;subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.,/� ,
Sg� nature (Owner/Agerit); �1 � JDat 7, 47
V
BUILDING PERMIT PERMIT# CONTROL#
0%1OW 5191
DATE VM97 VALUATION SQ41,83
4,N) LOT TRACT
JOB SITEr[7•�.�y'tL� APN
ADDRESS
OWNER f CONTRACTOR / DESIGNER / ENGINEER
/ ] t
t4Ll1i
LAIN".) Al � U,ui, �1-��.� \�.{i M'�i�.f�.I �,^•�`..�i{�Y �` l.i�ilt t�
.�o14011 i 1 UV0 5t)1du 11GA BIND
1.A(:AIflti1A. CA 92253 LA01ANT'A CA 9225,1
474i0)774 -N;42 0111 4676
USE OF PERMIT
41.1.1
`ut'.0 - f.tl.ldt f AOA. t.%AN SAIe
I'.t,AN C'IV,( K- W:H KI:!i1.RXJ) 7-5t; Ff * MI113JPLH ISSUANCE* OP SAM
I'I,AN
( J,%T'0i6 CG1gSTR.IJ0'Ivl4 21187100 SV
364.00 SF
0A1iAfIJ;tCAR1)0RT 677.118 SI+
INT INIATED CM OF COINSTRUCTION
11*14 NMI11' Ir'CE$l NIMA;RY
CX)NS'r RI fC"f I ON C%'
m, I m'..t
PI ANt',l41rr.Kx .T.:
10;1..()flf —4377>r?IR
�2- .1Z
NIi CIyiA141M.1r X
1101-000-421-00'0
$8.5,50
�'�#�.•.1.'1{�,�.: iltlr'�'jcf:' -
�'V1Wti�^�ic�.��'WW
�6'�a. ��?
IAJM)31tvt:.r M
101-000-419-000
179. Zi
,�`1'I?.ONG, �. ITION I�1�f1- RVS+17
!01- (IfV-24) -(W
01G\D.t NCf ME
101.000-423.000
[1NV tA:.%TK Ji::t'URB FHE
225-000-443-3-f2
P:1"3:R.146
KRT IN PLt43I.It;; P1. ACES - Rli14ll) 7701-77)1X)-255-000
$:354.60
" f i-"ft.1 'r1t, CC�f�I ;IIiUC; "I� i?v A �3f1 TSI. Alt .`If?CK 4.
LIESS P 12.1;^1frZi' l i I?F;
TOTAL I'I~;iZI If T F E;I S .TY fE NOW
RECEIPT I DATE I BY I DATE FINALED
241,8.
Z 391C
INSPECTOR
$7,5)4 47
57,534.47
C
e.l J
INSPECTOR
$7,5)4 47
57,534.47
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPR VALS
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
Exte '
ryvjaIL- Int.
Age
lz*_1407
Final
Final —mss—
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING AP VALS
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
AA
Appliances
Final
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)
COMMENTS:
• _ .. "Yi'y' - - '�.. .��, .r.;^..r�t..-.. �r,..a.-xe -���-...,.y..-; _^e-�....,.v.-w.vnw,,. r^-n.�-+-•-+�.-.p...�-......,r,.�,r•....-.+�.. a•.y�,_K..:-..".�..;�.r�..: -�
ciry
JON TAN DY
VlCdr� RFV 3580 Condalia Ave.
40 :��� Yucca Valley, CA 92284
SPECIAL INSPECTION SERVICE.-��Y (619) 365-5045
REGISTERED INSPECTOR'S WEEKLY REPORT
S•"
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE AlgiRUCT.STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ')i'_�OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB .L N
REPORT SEOUENCE NO.
_TUR n `��
:YJ`!i � •C
PERMIT NO.
DQTEE
DAY OF WEEK
MATE ALL DJ CR PTION pa�ARCHITECT
L -.Q
-
IINLv� TOR
HRS. CHARGED
ENGINEER
AgSISTANTSI
HRS. CHARGED
INSPECTION GENERAL C / ", ' ;/1� v 'l
DATE CONTRACTOR J 1 y�/
CONTRACTOR C
�����( (� lj-
01
_D6S�
`��... � � '� le-• �} S
(ISI G-- O _ 1'- _
S S y - t OK
�.DIJNeG� (o(J ��A-iE:S.
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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 SIGNATURE Of R ISTERED INSPECT�TR
KNOWLEDGE ALL OF THF. ABOVE REPORTED WORK UNLESS OTHERWISE `I� ^ ��
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED /v Ll/ .�1-+/-�,'✓X
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. DATE OF REPORT REGISTER NUMBER