0111-278 (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
Date • , �� "'_ Signature of Contractor .gL— "'
i..
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 S'4°A'.1'E F1)ND Policy No. 0 1-5M
(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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Z�h 'Applicant
_Warning: Failure to secure orkers' 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 permitto 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.
� k
Signature (Owner/Agent)^'`'+ Date �•
BUILDING PERMIT PERMT#
DATE VALUATION LOT TRACT
..Al2,RAU $2047XI .'A3 :3 30125-1
JOB SITE
AP�INEER
ADDRESS id°- f935 LAY.w.•KD0 C��;S�;f"RT
2l,' .1
�
OWNER
CONTRACTOR / DESIGNER / EN
77-645AC7 i'UN'K`RY CLUB DRNT. WT 11,150
J7.645A.C.C1M.IRY CLUB ?,1 WE SUITkC 150
P.r IMDlEiSl'�P...k�'.I' CA 92260
.1 z+,LM3 .SERF iW'A 9,22fent 3
CMt3YM-8224. C.BL# 1137
USE OF PERMIT
WAI��..1s`Yx�T:�1 LY].)WE, LLT -140
`� 1 1..��'T f ►a7MFi;d tilt, w'I BAIT VORS NOT INCIAIDE SLOC.K_• W'Aa�.LIZ,
CUSTOM i:.0W*'1':"1Y TXft4 UK Do 0
PORCWPt3TIO 12` 00.'�'s F'
fyARAG +�tt;:f%RPOR I• 3>ITt1 .3±
W C067 OF c'o.1+n.a1'1:;2ilarloR
207,61.22.70
�yWIrIK
1
RZ 301.000.418.000 Sr110171.49
PLAV CHECK IaZYt' w1: -01b0 -43q-3 tt: 9�ttT�:20
ta��,pp�eU��.`w:€3, .�,,T,13?+�WE 101-000-421-0000 9�4t
t'.n'f*�pla day
•A ?, RR1CAL FM 101-0004W-00 $014.56
1~i,'% ME41,90 FRE 101 -COO -419-000 $165.00
STA.0140 M:OTAOR FF - LD 1101-000•241-700 3 3 D. A
/R1M40 fET& SAW
V!.1!9 ZL0P .,1A+ ACT VER, P1907.00
ART IN PUBLIC PI ACT.40, .. R,x^,M V")0-445^000 319.56
,
FIT, MPOSIT G1 �000-439-3) 18 4500,110
` p. Uk-T(YrJVL Ccb3 gTi1,,f\.. fT0W AND PLA?C1EtR
$4,2211.80
nidJPQE-jJM � .1
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4500.0
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tA.ds�a.n�J;r.�i!1,t.?d�711 I�ai IS .Ri Ad�; �rW+YV
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SOV . 2 9 2001...
RE IPT ---[DATE
BY
DATE FINALED
INSPECTOR
!!ee
h�-1
INSPECTION RECORD
OPEIRATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs _ew _�j
Underground Ducts
Forms & Footings L
Ducts
Slab Grade
Return Air
Steel
Roof Deck �t jj_�
Combustion Air
Exhaust•Fans
O.K. to Wrap e
F.A.U.
Framing
Compressor
Insulation Z —sr
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
Encapsulation
Gas Piping
Gas Test
Appliances
..
Final
Final
Utility Notice (Gas) '
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fodures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
a
,
s : CITY OF LA QUINTA
BUILDING& SAFETY DEPARTMENT
141PEETION REQUEST LINE
777-7153
Ov, nes --- SEDONA HOMES
Contractor SlTNRnSTi C0RPQRATl0N
Permit Number 0111-278
POST ON JOB IN CONSPICUOUS PLACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 77-835 LAREDO COURT
SFD - LOT 3 PLAN 2R PERMIT DOES NOT
INCLUDE BLOCK WALLS, POOL, SPA OR
DRIVEWAY APPROACH
TYPE OF INSPECTION DATE INSP.
FOUNDATION & SETBACK%�-
FOOTING STEEL
MAIN GROUND SYSTEM
GROUND PLUMBING U O
PR&GUNITE
DO NOT POUR CONCRETE UNTIL A ABOVE HAS BEEN SIGNED
CONCRETE;,SLAB
JOISTS & GIRDERS
ELECTRICAL GROUND WORK
DO NOT POUR CONCRETt Utq#IL ALL ABOVE HAS BEEN SJPNED
ROUGH ELECTRIC
ROUGH PLUMBING / - / 15 -
ROUGH
ROUGH GAS & GAS TES 7' 2
HEATING 8 VENT- A/C
FIREPLACE
ROOF 7 -
BOND BEAM
O.K. TO WRAP
GROUT ❑ 4' ❑ 8'
FRAMING
INSULATION — t�
PRE -ROOF
i
COVER NO WOl#AK UNTIL ABOVE HAS BEEN SIGNED
DRYWALL INTERIOR d
EXTERIOR LATH It'
POOL PRE PLASTER
POOL FENCE & GAT
SEWER 8ffTiel7dlfC
FINALS
ELECTRICAL
PLUMBING
FINAL GAS TE T
HEATING -A/C
HOUSE NUMBER
JOB COMPLETED
TEMP 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:
77-835 LAREDO COURT
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group: R-3 Type of Construction:
Owner of Building: SEDONA HOMES
Building Official
Bldg. Permit No.:
VN Land Use Zone:
0111-278
RL
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
❑ POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY ❑
❑ ASPHALT /OTHER L_10CX'
❑ FIRE PROOFING '1
JOB LOCATIONii
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
d
PERWT
NO.
DA ! E
DAY OF WEEK
MATE,%AL DESCRIPTION
c�rM S lC�io S2
ARCHITECT
IN$ CTO
HRS. CHARGED
ENGINEER
JASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
CONTRACTOR
er a
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int
oM e 51
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lotsx
C1Ar,, - or
¢1�1 6)a a
IA„ aon &j
APON
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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
4t6 Z
IGNATURE F REGISTERED INSPECTOR (! )CdO 0 77?� 7-R7
DATE OF REPORT REGISTER NUMRFR