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LICENSED CONTRACTOR DECLARATION
.I hereby affirm under penalty of perjury that I am licensed under provisions of
Ci%pter 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
763197 :L3 5/31/05
Date 1 r- ` _/Signature of Contractor '• * -'r-- c /
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 g'f:AICF F 2�i� Policy No. 1629263-92
(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./ r
/, `.,
-Crate:` - � � Applicant '.e"l ,Y -
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.
Sig nature (Owner/Agent) `--y' %-'/ i. ` ^ Date
BUILDING PERMIT PERMIT#
ia4f35-t?:ic?
DATE / j `4� VALUATION ( ,.` LOT 28 TRACT 28961
JOB SITTTE / APN
ADDRESS 5641,0 3ALTUSRO 775 -MO -018
OWNER
!."'1 ,I LA tdTin A 1() LP
200 F. WXr"C TON AV -71 M 00
£�.t5'Ct9"nI131i���r CA V2023
USE OF PERMIT
'Cs•IZ T?A'�3U f.9�i�1[:f..ING
CONTRACTOR/DESIGNER/
I: tWOV'A:(Ti E IiE9C)RT i:,'0MWJ14 r1Tr,,S, iNC.
200 I:, WAMMirMN AVE, 1100
ESCC23i IDO Cts. 92025
(760)€339-8238 CBS 541.3
SM •LOT 38, I'LAW 1R3p, EjR 1170:1::; NOT INCLUDE BLOCK t�'�RL.I.3,
POOL, SPA Oft Gills"JEifi AY"�t,l'PROACH. 73 % RPMUCTION TO Pi., W
CHECK IME DUE TO MULTIPLE ISSUANCE OF SAME PLAN TYPE
CIUM10M C-0143-1 RUCTION MUM SF
PORtWIPA`I IO /149.00 wit
�l.�al2AsrlaC::�12Pc712'i 6ti11.00 �1P
ES*-MA`f'ITO COS'T 0Ir i OYOMIRUG":( 0.ir3
i; .cr4D
NI7.tlr :MY
CONSTRUCTION REF
1101.000-419.1100
51;.322x1
PLF9.id CHECK F'Fa?
101--000-44.39-3118
$269.61
WCI`I.ANICAx, FTE
101-0001421-000
$143.50
ELECTRICAL F EA
101 _001"20-000
$210.21;
P1.9 M D I N 0I FF
101.-000.419.000
SIT9.23
S t'RONO MOTION PEE - RMID
10'1-000-'t241-000
$29-46
011A)al'F3:~ FEE,
101.000.433.000.
10.00
DEVELOPER IMPACT PEIM,
°�3,4Cfv.00
,rtlFt't IN PUBLIC PLAIVVV - RES11270»000-445.000
$236.50
SUB-TOTYkL C01MI? ITC11014 -AND Pf.. M CRE, CX $4,8 10, 61
0 �.%53 RRE-PAW VEW $0.00
ToAll
MAR 18 2004
ITY OF LA QUINFA
1 1—RECEIPT I DAT / r y ��/ B�^^ I DATE i71NljCEa u I INSPECT;
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs to
Forms & Footings
-Underground Ducts
Ducts
Slab Grade Q -�'
Return Air
Steel
Combustion Air
Roof Deck 6`
Exhaust Fans
O.K. to Wrap oV
F.A.U.
Framing
Compressor
Insulation p
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 z z
POOLS - SPAS
BLOCKWALL AP ROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg, Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
�/�
Water Piping 6
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection 6
Encapsulation
Gas Piping
Gas Test j41
Appliances
Final
COMMEN FOX"
C�"s'• - 7/�/�i�f�
'
Final Z
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring '
Fixtures
Main Service
Sub Panels
Exterior Receptacles d /8
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
JCM Inspections �Lm%
ER 39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
REINFORCED CONCRETE INSPECTION REPORT Date: S—.2
Project Name: Project No:
Eagle Bend @ PGA West 8117
Project Address: City:
Lots La Quinta, CA
Title 24
File #
App#
AWS 0 UBC Other:
D 1.1
D 1.4
❑ Other
Client: Sub -Contractor:
Sladden Engineering Franco Concrete Const.
General Contractor: Architect: Structural Engineer:
Innovative Resort Comm. Colbourn, Currier, Noll Inc. Schmidt
Slump (inches): (o Supplier:
Time Sampled: - 4, rh Mix Design: csc o
Time in Mixer (min.): Specified Strength (PSI): 3000
Water Added @ Jobsite (gals.): nr� Addmixture: S1
Concrete Temperature (F): gs Truck #: 3 Ticket #: 1 9
Ambient Air Temperature (F): 10n Field ID Marking: s C -LE]
Weather:
ung
Unresol ms:
None
See Below
Location of Sample:
No Samples Taken
Description of Work Inspected:
s� 4zo
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I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications _applicable building laws. Final report issued at project completion.
Inspector: Jack C. Millin ICBO Certif' a & No: 0842216-49
Contractor's Representative;
Copy 1 JCM Inspections Copy 2 Project Superintendent Copy 3 Governing Agency Page of