0111-277 (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
521;00 A 31ic _ f` rIVO
Date* ' —e Signature of Contract C111 '
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 9aI'.A•TF; WND - -I Policy No, 07152
(This section need not be completed if the permit valuation is for $100.00 oir 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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 1 1 Applicant-~"- -.
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.
Signature (Owner/Age Date®
BUILDING PERMIT PERMIT#
DATE VALUATION LOT L���r'� I TRACT
30125.9
JOB SITE
APN
ADDRESS 7.7-25
��%.773-022-W.3OWNER
CONTRACTOR / DESIGNER / EN (NEER
alis i ,R xiCrJ r t
RiR3ROSE CO. 3i1?'ORA.1109
77-645-A CO TAMP CLUB DRIVE aUi'11,a 15 C
77 ^ 64 A COLTJq f Y C -LU % 1 ML? Uf.' p, 150
PALM DES Rl',�T CA 92260
MIA DESEV CA, 92260
(760)172-8224 MA 'I 13'7
USE
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RECEIPT
DATE r
BY ' I f
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
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 r
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS ,
BLOCKWALL AP. PROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to. Cover
Equipmenf 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
Encapsulation
Gas Piping
Gas Test
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
Utility Notice (Perm)
2
s CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT, j
. yOF :,Vjl .1 °1?1--11 �' .777-7012 : .
INSPECTION REQUEST LINE s
777-7153
weer SEDONA HOMES
ontractor SIINRO)NE (Y)11NUKA 1'1(/N
ermit Number 0111-277
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
OB ADDRESS 77-825'LAREDO COURT
SFD — LOT 2 PLAN 1R. PERMIT DOES NOT
INCLUDE BLOCI{ WALLS, POOL, SPA/OR
DRIVEWAY APPROACH I
TYPE OF INSPECTION DATE INSP.
DUNDATION & SETBACK
DOTING STEEL
AIN GROUND SYSTEM
ROUND PLUMBING �J
RE—GUNITE
O NOT POUR CONCRETE UNTIL ALL A OVE HAS BEEN SIGNED
ONCRETE SLAB
)ISTS & GIRDERS
LECTRICAL GROUND WORK
0 NOT POUR CONCRETE UNTIL 4CL ABOVE HAS BEEN WNED
OUGH ELECTRIC
OUGH PLUMBING
OUGH GAS & GAS TE
EATING & VENT -A/C
'REPLACE
OOF
OND BEAM
X. TO WRAP —
ROUT ❑ 4' ❑ 8'
RAMING
ISULATION
RE -ROOF
COVER NO WORK UIPTIL ABOVE HAS BEEN SIGNEEDY
lRYWALL INTERIOR
XTERIOR LATH
OOL PRE PLASTER
OOL FENCE & GATE
EWER SE2141A"* 17.._ j n �)
FINALS
:LECTRICAL
'LUMBING
'I NAL GAS TEST
IEATI NG - A/C
(OUSE NUMBERS
OB COMPLETED
'EMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
Certificate of Occupancy
City of La Quinta . -
Building and Safety Department
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:
Use Classification: SINGLE FAMILY DWELLING
77-825 LAREDO COURT
Bldg. Permit No.: 0111-277
Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL
Owner of Building: SEDONA HOMES
Building Official
Address: 77-564 COUNTRY CLUB DRIVE STE. 137
City: PALM DESERT, CA 92211
By: BILL GORDON
Date: MARCH 27, 2002
POST IN A CONSPICUOUS PLACE
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 O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
O REINFORCED MASONRY ❑ FIRE PROOFING
❑
O OTHER )p/
JOB LOCATION `7 7 ^^T 5 / � � _ J is J V'
O C`�'+�"�4-
L -A -Go v-4-1wv-4-1wREPORT
SEOUENCE NO.
TYPE jW$,58rli
�PEDTIT
x
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPE'CTO�
1j
HRS. CHARGED
ENGINES
�::5t�V o lS
ASSISTANTS
NRS. CHARGED
INSPECTION
DATE
GENERAL�Q s�SUB
C:ONTRACTO 1\ t1�`�
CONTRACTOR
v (1
us,
)
�
COPY SENT TO CLIENT O
C HUED 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. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
SIGNATURE OF RE S EREDoSPE R�-
DATE OF REPORT REGISTER NUMRFR