0307-310 (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-BUILDERALLARATION
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 IE-:�;EWI T Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
( I I certify that in the performance of the work for which this permit is issued,
I hall 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 Sec)jn 3
o700 of the Labor
Code,•I shall forthwith comply with thos provisions.._,v
D"ate: � � % '0';/Annlicant � �''i �
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 suchD
permit, or cessation of work for 180 days will subject permit to cancellation
nformation .
I certify that I have read this application and state that the above iis
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/Agent) f l `•'/y/'��= "r ' Dates
BUILDING PERMIT
DATE VALUATION S:F& .8 -; II LOT
JOB SITE
ADDRESS
OWNER
81 •Q'7R) C4'IA?ML'L &R.
L.t t }i f1ld'i int k'% 97"M
USE OF PERMIT
M. CiLE1?l'ihM11Y. DW..F.L1J1:K+
PERMIT #
C 4t I_31,0
25
APN
TRACT at');4-
CONTRACTOR / DESIGNER / ENGINEER 4-
CONTRACTOR/DESIGNER/ENGINEER
.78-070 CADIZ
C.A. 922,53
(7hC1>564-IS32 cffi.;� 32717
3ri,a - A.AJ•i caq r"tum TJ: rlx71/. 41O. iz"a
WALL, P001,, 3PA OR 1J RIN FWA Y APPROACH
C. STO'M CONSTRUCT.WN 4,3$4,.00 V
FOft.GblP ATIG W42.40 St"
0PARAMUCARPQR11 8)5.04D SF
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SEP 03 2003.
CITY OF _L_A _Q_USN_TA
CEIPTYtl6`�'�r"' ` .OAT BY DATE NED/ INSPECTOR
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SEP 03 2003.
CITY OF _L_A _Q_USN_TA
CEIPTYtl6`�'�r"' ` .OAT BY DATE NED/ 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
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath —
D II - 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
Fixtures ,-
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Feb 07 04 04:29p RRYMOND FRRNGIE 760 936 0956 pr2
RAYMOND FRANGIE STRUCTURAL CONSULTANTS, INC.
44-100 MONTEREY AVE. SUITE 201-C, PALM DESERT, CA. 92260
PHONE (750) 836-1000 FAX (760) 836-0956
E-MAIL R.FRANC3IE@VERIZON.NET
FEBRUARY 6, 2004
SOUTHERN HILLS DEVELOPMENT
51-070 CHANTICLEER DRIVE
LA QUINTA, CA. 92253
Attn.: JIM EVANDELL
Re.: THE SUMMIT, LOT # 25, PLAN # 4 OR "A"
57-570 BALL.YBUNION
LA QUINTA, CA. 92253
FOLLOW-UP TO WALK THROUGH
JOB NO.: 4034
DEAR JIM
THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL
REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF
OUR SITE VISIT.
WE BELIEVE THAT THE AS -BUILT CONSTRUCTION AT THE TIME OF OUR VISIT IS
IN GENERAL CONFORMANCE WITH OUR STRUCTURAL PLANS AND RELEVANT
CORRESPONDENCE ISSUED BY OUR OFFICE.
WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PRIOR TO
INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVED THE VISUAL AND
ACCESSIBLE STRUCTURAL REQUIREMENTS. ( EXCLUSIONS ARE ITEMS SUCH AS:
FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING,
AND ANY STRAPS ABOVE THE ROOF SHEATHING.).
RESPECTFULLY SUBMITTED
;zii)-i;:
NICHOLAS ABOU FADEL
PAGE:2
FEB -7-2004 SAT 03:14PM ID:
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 14TRUCT. STEEL ASSEMBLY O�
❑ POST TENSIONED CONCRETE ❑ ASPHALT TWHER ����� (�
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATIO n' 600 8 , ( LA
VN {V Q1��
REPORT SEQUENCE NO.
TYgE�O� $TaUCTUR1E( O� dr
PERMIT NO.
D/� E
DAV OF WEEK
MATERIAL DESCRIPTI N_� A �.,p.:.�
ARCHITECT
I/JP.•
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION CONTRACTO M+iG GOA H iAi 0 Q -u • CONTRACTOR
DATE
a
-SA ASS W ar si c-6
s Wet4-
�l8
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.
SI �.ATU E OF REGISTERE
Id- 3 �-
INSP T
DATE OF REPORT REGISTER NUMBER