SFD (9705-018)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 DATE
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
Da a Signature of Contractor�14
f / 1
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
erformance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
S ctl n 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:.
Cartier Policy No.
4121W'11 IN*. CO. VIA' tki?e't�ti1f`+
(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' compensatioh..provisions of Section 3700 of the Labor
Code-1.'shall forthwith comply with those provisions.
ie' v Applicant .%4P f a i.
Warningng: Fasecure Wor�kbrs' Compensation coverage is un[4411 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.
JOB SITE
ADDRESS
BUILDING PERMIT
VALUATION SZ24,�M-)t) LOT
OWNER
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LA QTfiNTA
USE OF PERMIT
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PERMIT #
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CONTROL#
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CONTRACTOR/DESIGNER/ENGINEER
56140NA 131M.)
('A 92253 1 A01.11NMA ('A 427-5
(700)771 wV)42 MY 4676
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OAR, tlCOU .'Afd)(_ . 0' i 1;3.641 S!'
41 V NtYIE'M`.I'I I) COST OF (IO1Nn/'it, IJI(ITICIN 224.315.90
FI f: 101_(KA11--41HAR)o S1.077JO
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ARTIN
701 di(N -255,()6(1
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, indemnity
& 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 propertyfor inspection-pur, oses.
RECEIPT
-Slg ure. (Owner/Agent)i. N Date�r�-�/
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TA.'sS. PRIIII xs: ID I?"E i:.w ri.tfd)
DATE —A
R)TAJ, PER NI i' 1+P)EN 01111+; NOW I . $7,705.73
BY I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
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 14 1Z
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
�JL
Final
Final -POOLS-SPAS
BLOCKWALL AP ROVALS
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 7
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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
n:
JUN3® J�TANDY
r
av/tNvo - 3 b Condalia Ave.
®ap�Valley,
CA 92284
(64*i65-5045
REGISTERED INSPECTOR'S WEEKLY REPORJ
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE AkTRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING�(tm�k
jc-
iosl:5�IONREPORT
-�;" M e 4t. o N' L.A. t v\ TA
SEQUENCE NO.
TV PECT�RE
45
,,,,/
PERMIT NO.
DAJE �
DAY OF WEEK
MATERIA ESCYY���_RJ\J\L0.LAfy�
� �
ARCHITECT
INSPECTOR�
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL I % �' ` - SUB
CONTRACTOR ` CONTRACTOR
(.�U=I_(6 ( IN
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c,� AS
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COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PACE OF
r� CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT IHAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
•-_-•�-o.....a�_ r. I-- A A-- A I IM.U.MU C.A.DPD()\/F. ii
NATURE OF REGISTERED I PECTOR
,.
r ific�ate of OccupancC t �1 N11 c
City of La.. Quinta F
Building and Safety Department OF
This. Certificate issued pursuant to the requirements of Section 109 of the Uniform Bu#ding 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: 80-335 MERION
Use Classification: . SFD Bldg. Permit No.: 9705-018'
.Occupancy Group: R 1 -Type of Construction: VN Land Use Zone: RL : .
Owner of Building: KSL LAND IL Address: '56-140 PGA BLVD. -
City: LA QUINTA, CA 92253 By: STEVE TRAXEL
Date: 4-24-98
Building Official
` POST IN A CONSPICUOUS PLACE ".