SFD (0301-005)LICENSED CONTRACTOR DECLARATION
11ereby-;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
674004 t T3%(
Date,-- f A + K Signature of Contractor f
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
Code). ,
( ) I am exempt under Section ,B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I heieby 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.
Se(' )' I have and will maintain workers' compensation insurance, as required by
tion 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 idTA1,: inIlD Policy No. 04 6-7 38-200'
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance of tii .%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' comp nsation provisions ofpSecUon 3700 of t� Labor
Code, l shall forthwith comply with those IS ions. r
pate: - ro r< Y s Applicant f
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
Si nature (Owner/A ent) d Date -2</% �~ F
9 9 ,
BUILDING PERMIT.PERMIT #.
�Jµ��
DATE VALUATION vt�.� LOT TRACTJOB
SITE
ADDRESS tir41�,dA�3
APN ��.C'e•253
OWNER
CONTRACTOR / DESIGNER / EN &NEER
'1,D a�� ���i � i 3k"�S �.,C►k""T1h1'k,
�` �+��3�f.: f���I�"� Jt7 �t��7
LA Q'�.+'.l�Q'E % CA 9..2253
1,At.t UINITA CA. 92M.
(760)'771.3941 C;gl3 * 2:1196
USE OF PERMIT k
SED . Iffr 75.!P')",7�f 1UR, F'iWAPT iDOR.S 4, Urt' INC,LUDZ PLC) K'
W,A1AAMtCKi4SP'A OR DR1Vk1VAYAJ_1PR,0. W4.
Ci3SFOM. C ON27RUCTION 2924.0 01F
Prti6YE.OHIMTIO "a35.m S41••
CA3ft.E4,M'w`'0A.]Y.T.at.9RT S11'
ESMU-11M) (10 -yr OF C0.119MUC.1110H
240,117.10
CO),49!'RUCT101 ,F8', 1 q1.O£i1l 41 8-000s j.,13'4.00
...
PLA:14 CHM-9. ME 101.000-439-318 - . 028,97
meG'nANw,r�:,.Fep 101.000.423-000
F,&,E5”! 9fCAL t T11r# i f1l-fl�lG1-� t-fXf3E3 $169.24
VWW'fiS31' O.Mrs SM.6
STR(YNQ A1li0`i 1014 'e ms - :�'.ESiD 101 -000 $24.0
VeVH-WPL?x)M,PAvT pm
ART IN PUBLIC P..40tMe ^ RESIL 27(}',tl00m44:, -000 SJOA29
' C�1t+1"i2cYC"1C?3t?'kr� r�I�f�tJ'i:k11L=t"tid•
®
`.�",t3tl.Ici
1X3. M,41AUDMMO
$01,00
JAN 2 2003 TOW � rRwm' `�NDU .HOS
CITY OF LAQUIFIl'A
FINAN CE PJFP�;
-
RECEIPT
DATE
BY
DATE FINALED
5-
INSPECTO
;4
-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
,Foirris & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
=_�
F.A.U.
Framing
Compressor
Insulation
- 3
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
L,
Final
Final —
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
3 9 3
Encapsulation
Gas Piping
Gas Test
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 Rower
Final
Utility Notice (Perm)
COMMENTS:
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 ❑ STRUCT. STEEL ASSEMBLY Q� /�-
❑ POST TENSIONED CONCRETE ❑ ASPHALT j� .ER
❑ REINFORCED MASONRY ❑ FIRE PROOFING �/ �� (/r
JOB LOCAqNq
n M`
`L
REPORT SEQUENCE NO.
TYPE OF j.�R
v\
Q_J` J`
oT .�, ^ r
PERMIT N0.
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSP O
MRS. CHARGED
O25d
1p� 8 ()
ENGINEER /�� �(.J 4
(`�%.,.
ASSISTANTS
HRS. CHARGED
INSPECTIO
DATE
ENLL
CONTRACTORi
SUB
,..,_-CONTRACTOR-.,
Poo-
iI
W O�
lry1 a� �h-► �Se-
a v QTS
1
COPY SENT TO CLIENT ❑
CONTIN DON 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
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS, SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
ATU F REGISTERED I CTORCA 4' '
03. .3zs� v 01
DAT OF R PORT . REGISTER NUMRFR
A
f
t
a- - _ - -
^f r e
-L 11M1�`N
/ Q! ry.
�-a- � Certificate,of Odcupanqy
,
jpICpWYAIID �� J -.'f - - , .., . • t J t • h , -t -
n
- =y De rtment
''OF �-Building&Safety
-This 'Certificate,_is issued pursuant to the requirements' of Section 109 of the California Builaling
r_
Code; _certifying that,~.. at -the . time , of issuance, this structure was:= in ` compliance with the
' " = provisions ; of `the Buildin Code and the.; various'- ordinances .of. the Ci re ` ulatin buildin
A 9 tY 9►. g g .
_ -
construction and/or,use.
BUILDING ADDRESS: •79=982 MISSION DR. EAST
• *=p' -_T t`.. '+ • � - A.. ` ' 'n4. ti - - -, . f � J .k ^tea - •; i . • •�-- •;`'-.
4Use classification: SINGLE FAMILY DWELLING r Building Permit'No.: 0301=005 '
Occupancy Group. R-3* - Type,of Construction. V -N '- ; ± 'Land Use Zone: R -L
Owner of Building: TD DESERT DEVELOPMENT ; Address:,,PO'BOX 1716 - t -
' City, ,ST; ZIP: LA' QUINTA CA 92253
`By: GARY SHOWALTER • .. _.
Date: 11/25/2003 _
:* Building Offic'
'POST IN A CONSPICUOUS PLACE -
`�
I