9908-132 (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 f Exp. Date
z743013 .8
ate / 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
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.
(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 hot employ any person in any manlier so as' to become subject to the
workers.', laws of California; and agree that if I should become
subj�Ct to the workers' compensatio�n�pirovisions/of Section 9700 of the Labor
Cole, I shall forthwith comply with those p oIr slp. .
(Date: � 1� Applicant or!r- G f6
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
constryction, and hereby authorizea4epreseniatives of this City to enter upon
the Bove -mentioned property for inspection purposes.
rSignature (Owner/Agent) Date
PERMIT k
BUILDING PERMIT
",.t>843Z
DATE VALUATION $,j94.1T1111. 0 LOT�� TRACT f �. y� 97 15
A &lq
JOB SITE '
ADDRESS �J IIr:Y u i��tlQ.
APN 14•CPZS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
'1-3/4.�.i6.�' t3ERM1 I) AS, wi�i..f.
i-tafs(3l .1�1�.1cE l.wePl9i 11').!? 1}1
LA cjUIN-I';ta• CA V2253
LA. Q01i`!TA CA 922.' 3
(760)77!-2%,7 C1',f A 5107
USE OF PERMIT
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Ul.i931 rkylvlr 00 4&IM AXT +111 4,0,.. SW
PERMIT FEE, "WiMMARV
0JI43TRUCT10114 FIX '101-000-419-wo t,67100
,Yt.. r> Sd G'KM Fr� IF, 101 •a)t O-43.91.18 $1, iq9. %s
{is:� EPwt�2lCr�3.. ,t"�k"s (� � �4�1�•�','..l �Ui�a �.t•M0.�'t
1014.0('1-42C000
PLUMBA'NU FEE
rfk0t,)(4 ?:. ol"ioN Ftesla - RFsm 10 1 -Mtn --241- )0' SI -9.45
%t FRAS tRUt;"i UE FIE 225.00 f- 43-3.12
ART HWPUBLIC Pf.M,2I - RLS1 c 701 -000- l 55.000 S73Ci. 0
' � a
a
SU13-7MIT I, r;ONIM�€0,7iv"T C ' AND 3'j,t11+1 3HEY
LEW PH-PAl;'t PEES
$0.00
j
CEIP�T
DATE
BYE 'g
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
_.; MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
G !,�Y'
Ducts
Slab Grade
z
Return Air
Steel
Combustion Air
Roof Deck
_ - .
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing2
C(J
Compressor
Insulationf,
_
�•cl
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 Hacks
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
Water Piping
f�7Y.
Heater Final
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
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:
JON TANDY
37630 Medjool Ave.
C � Palm Desert, CA 92211
tOC Office (760) 772-7192
�SPECIAL INSPECTIONFax (760) 772-7193
~,. -Pa■a_ger (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT ' t•
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
O
❑ OTHER
JOB LOCATION�' �' �� L A Q-2
REPORT SEQUENCE N0.
TVp,�OF STRUCTUREC)
PERMIT NO.
DATE, /�
(/
DAY OF WEEK
MATERIAL D CRIPT N
/
ARCHITECT
INSPECTOR
MRS. CHARGED
ENGINEER
ASSISTANTS
NRS. CHARGED
INSPECTION GENERALSUB
DATE CONTRACTOR
(VA 137 C --s CONTRACTOR µ STL-C J�-
v..
LSA k�S
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COPY SENT TO CLIENT ❑
CONTINUED ON 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.
y1 � NA URE TI �F REGIST D I lzq�PECTQR
ATE O REPORT REGISTER NUMBER JJJ