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0111-279 (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!"'''"` OWNER -BUILDER DECLARATION I hereby affirmunder 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'dwner 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 J700 of the Labor Code, for the performance of the work for which this permit.is issued. >(�) I have arid 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 STATM FUND Policy No. 07)15 � (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 fo, forthwith comply with those provisions. !L, Date: 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 form 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, 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 property for inspection purposes. Signature (Owner/Agefflr '° Date BUILDING PERMIT PERMIT# DATE VALUATION LOT �•�" 1� I xt.15 I 5220019.90 4 JOB SITE APN ADDRESS 77^805 XARFEDO CtlURt OWNER CONTRACTOR/DESIGNER/EN TRACT •,� 301215-1 ER 17-645A C:C>iYNTRY MM D_R'1V 'V1;UM,' 150 '77-645A C01,11T.W, MUB DFD. E BUTM118 50 P r:�1' m. wt��' lir C� 92260 ALY5, DIfRI E r C1; �i22 £� (7r,0;Y772n8TR USE OF PERMIT gas FAMILY MW1UJ,2N $?1D LOT 4, F1_1#W :3.V%'.. MYT DOPE NOT INC1o001r BLOCK W.•fl.i.,a, ,P001,4 OR DRNE-WAYAPPROXACH CUSTOM. CONSTRUCTION 2622 100 SIF P+~7RCHIPATIO 216.00 alt XS�17W 0"),911 OF COBMU'Un0n .l WI, YET.9EI. 1"RY CONN TRUC;TJ0,H i EVE 101400-41 S -WO $1,06 FER 101-10#00-439-318 $96 1KSC ANId:lt�L Y 101,000-421.0,00 z $102 X1.1 ZTHJCALI film 101 -OW -420.0©0 sn 1?3�'UII it NU FRIE :101-000.419.000 $172 :P{{r4;�_C�7g1�{itt Mar laN 1114E- D 101-€p00-2�g11 -/tySp 0 $2- W 101 ART ilk Pt3'SUIC PLACES - REHIL � (K 'i00-445-000 $51 101-000-439-316 • 50 t .z - x'01,= t Q � INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING, APPROVALS r MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _ Ducts Slab Grade C Retum Air / _ Steel Combustion Air Roof Deck ' % Exhaust Fans OX to Wrap : F.A.U. Framing / a Compressor Insulation S�''02 _ Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Party Wall Firewall _ Exterior Lath Drywall ; Int. Lath Final BLOCKWALL APPROVALS Set Backs Footings Bond Beam Final POOLS - SPAS Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underaround Plba. Test PLUMBING APPROVALS Gas Test , Electric Final Waste Lines Heater Final Water Piping I —• Z, — o--_ Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Pioina Final COMMENTS: Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring :,:1( L Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power i � I - s CITY OF LA QUINTA �FMOFo� BUILDING & SAFETY DEPARTMENT 777-7012 �,.. INSPECTION REQUEST LINE 777-7153 )caner SEDONA HOMES ;ontractOr CTTNROSE (URPO•RA110N 'ermit Number 0111-279 POST ON JOB IN CONSPICUOUS PLACE INSPECTOR MUST SIGN ALL APPLICABLE SPACES IOB ADDRESS 77-845 LAREDO COURT SFD - LOT 4 PLAN 3. PERMIT DOES NOT INCLUDE BLOCK WALLS, POOL, SPA OR DRIVEWAY APPROACH TYPE OF INSPECTION DATE INSP. =OUNDATION & SETBACK 7% = =' :DOTING STEEL L VAIN GROUND SYSTEM 3ROUND PLUMBING -� PRE-GUNITE DO NOT POUR CONCRETE UNTIL ALL BOVE HAS BEEN SIGNED CONCRETE SLAB JOISTS & GIRDERS ELECTRICAL GROUND WORK DO NOT POUR CONCREjkNj9TI ROUGH ELECTRIC W ALL ABOVE -HAS BEEN SIGNED 2,9 =v2 - ROUGH PLUMBING - v , ROUGH GAS & GAS TEST/, HEATING & VENT - A/C FIREPLACE ROOF BOND BEAM O.K..TO WRAP GROUT ❑ 4' ❑ 8' FRAMING INSULATION PRE -ROOF COVER NO WOR14 UNTIL ABOVE HAS BEEN SIGNED DRYWALL INTERIOR EXTERIOR LATH POOL PRE PLASTER POOL FENCE & GATE SEWER SE@B9TXNK f �' — FINALS. ELECTRICAL PLUMBING FINAL GAS TEST HEATING - A/C HOUSE NUMBERS JOB COMPLETED TEMP POWER ABOVE APPROVALS DO NOT INCLUDE RIGHT TO TURN ON UTILITIES OR OCCUPY BUILDING r. r 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: 77-845 LAREDO COURT Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 0111-279 Occupancy Group: R-3 Type of Construction: VN Land Use Zone: RL Owner of Building: SEDONA HOMES. 11- 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 iSPECIAL INSPECTION SERVICE, 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 O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE O ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ (/OTHER /' y JOB LOCATION REPORT SE UENCE NO. TY P OF STRUCTURE r w�uS PERMIT N0. - DATE i DAv OF WEEK MATERIAL DESCRIPTION ARC ITE INSRECTOR NRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL SUB CONTRACTOR CONTRACTOR ' PAck ao n S 0 All oJ6CQ/nz4- S'n `fl ��t4ftw COPY SENT TO CLIENT O CONTINUED 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 F REGISTERED INSPECTOR y IU'Qd �'Czs7 [-7 —�� DATE OF REPORT REGISTER NUMRFR