0005-066 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby_affil'm under penalty of perjury that I am licensed under provisions of
CKdpter 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
11,41 ftI3 1 I t�lS 1124
Date �j f� Signature of Contractor,'
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 001ID&I EAOL 3I113. Policy No. NWC-544008.02
(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
de, I shall forthwith comply with; those provisions
i.
Ate, r� /A17 -%.Applicant F
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 subjectpermit to cancellation.
I certify that I have read this application and state thatahe above information is
correct. I agree to comply. with all City, and State.lawi'relating to the building
con,struction, and hereby authorize rep resentatives';.of;this City to enter upon
th above-mentioned property for inspection purposes r !
Signature (Owner/Agent)' r'��� ? Datea'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT M)54" TRACT
$202AM-10 19 A,8719
JOB SITE
APN
ADDRESS 7"go m ,/•m
769-490-042,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
C ENT[JRY CRO'Vd1%LL COUMUNrM
CU ITIR.Y CROW..C� L CEyNMri .V1
1535 SO, "Do MGM, STX 4200
1535 $0. '17' ,2Kr y Y, S'F 0200
ANBY10TARDMO CA 924i3S
S� �F�1�2C+1�1C! CA 92408
(809)381.6007 C131* 2120
USE OF PERMIT
X31'GM VAMMY DWE a.1140
�fCLN LOT 19 PL 18R PERMIT DOM NOT INCLUDE BLOCK: WAL&S O.K'.
P00f,14OK P AN CHECK FIE t3.:.L+1"ii.TCT ION FOR MULTIPLE I3;113ANC9 OF
SAME FLAN, T`rrPX
t _
CUSTOM CONSTRUCTIM 2,419.00 OF
PORCH/PATIO • 200.00 SF
GARAMCARPORT (51� 11,358.00
FITHAM CORT OF CONYSM'LTCHON
202.4 .10
k'ERWI'•i+'1M S hn"R'Y
"CC -INSTRUCTION FEE 101.000.418.000 $1,000.00
PLAN CHECK. FEF 101-000-439-31 b 1102.1-0
Iy O.M NICAL FEE 101-000-421-000 S". s4
EUCTRICALFEE 101-0410.4241-000 $129.77
PLUMBR40 + 101-000.419.000 $142.50
`_
STRONG MOTION M- RESID : 101-000-241-000 $2f3: 23
" :' . .
GRADING FEE 101.000-423.000 $20.00
DEVELOPER IMP.QCT FEE $1,90q.00
.ART IN PUBLIC: PLAC'F.S - R.ESIL 101-000.255.000 $20.00
• f`i :. _'
-X`Ok . CCi%,d'�";t`�'-LIMON AND PLAN ME=
$3,546.32
L= PRS PAID FM
$0.00
TMA L PLVMr SNS ME NOW
S? r5i6r-3;t
RECEIPT "
DATE
ABY f ..
B?yrE FIDNAL�DINSPECTOR
! fZ
.�. INSPECTION RECORD
Al OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs gk Underground Ducts
Forms & Footings �O� Ducts
Slab Grade Return Air
Steel Combustion Air
Roof Deck �/ _ 4b ��— Exhaust Fans
O.K to Wrap F.A.U.
Framing gyp— Z , Compressor
Insulation 1_4/ ®Zj Vents
Fireplace P.L. Grills
Fireplace T.O. Fans & Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall _
Exterior Lath
Drywall - Int. Lath
•� Final
Final1-51A
- O POOL SPAS
BLOCKWA_PPROVALS Steel
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final Gas Piping
PLUMBING APPROVALS Gas Test
Electric Final
Waste Lines - _� 3� G2� �C Heater Final
Water Piping , Plumbing Final
Plumbing Top Out Equipment Enclosure
Shower Pans O.K. for Finish Plaster
Sewer Lateral _ / Pool Cover
Sewer Connection r f//� Encapsulation
Gas Piping A 00-1
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICA► - PPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I. _
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
.J,
09/ 14/20@0 13: 2e
s
=714978992E
VANDORPE CHOU AQSOVATES, INC,
OONSUL*IN0 ENGINEERS
295 N. Rampart Streel, Su1te .A
OrAngo, CA 92868
Tel; (714) 978.9780 Fax (714) 978-9326
Attc. Jack Fisher
Centun' C:rcwell Commuluties
1335 South D Street, Ste. 200
San .BfF rnardino. CA- 92408
Subje(;t: Ma.ndarina ;La Quints, Ca.)
.Plan 1, Lo( 19 (Tract 2,9719)
Dear Sack,
PAGE D!
�:ince 1979:
Facifty Planng(r•
Cole Cor,$Utants
S!r")cmal Engineers
Fire Protection Engineers
September 14. 2000
We have received and reviewed the sketch sent to us regarding the 14D5A at rear o.f'dining for
plan 1. A .5/8" x 1.2" anchor bolt may be installed in lieu of SSTB anchor belt as shown on the:
attached Figure No. 1.
If you have any questions, please contact Steve Trieu of our office.
Very truiv yours,
VANDORPE CHOU .ASSOCIATES:
llkz
Robert Chou, S.E. r#�;% �y
ST 4' Plo. S-OOab18 c
Art: Figure 1. a E*
�
1-Alohl-i1cSl2000'%t.'C'(' 16921FieldV (P14n I kDSA).wpd ,rj+JprrRUCTV� � �`?
F 01 CN
N
1
09/14!2090 1:-�:20 17149729926
VC.4 PAG_ 02
VCA ENGINEERS
Joe
296-A Rampart Street
ehM-T N°' OF
Orange, Womia 92M
araouuuoef_ __ DATE
714 978-9780
cw9cklc By DATE
s0,r6 A-1.1
5 -5r -A'3 'IYV-C 9
ioo1 r'
/ ! S-4
of ze
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p
N
EN
&W
Certificate of Insulation
Your Home has been insulated with CertainTeed i:<berglasa insulation praiuolsr wh{cb an designed
for tachy§ safety standards and tomorraWs www requirements. --------- -
Fiberglass is inorganic and therebre perwmneatly nonearrd ustlble. so it does not have to ba treated
tha wil! IdCc3.r ion thtir eiibativ+euress over tine: It ho nat bean treatod
with chemimb that can eorrade -sviriir g or metal. Fiilgsa will met absorb moistm not will it
-_---- _-- _--
settle _oveUime.a2MWather_boulshm material& . --
m
1%is also csrti&s that. CertainTeod.Fiber.Gi aesknOstion has baa pan1essiona8y installed.ialhis home
r- to prwAde the &Ilowhng thermal pefarrnance__
m.
N Job Namm Mm&rim - Tmet.- — 25M Plan ft 1� —�
T L-otfiia: -151•—deb �lddreae: 7�6090-Baya3'Iraet,�-¢�fa-E - - - - -
U t
Z- ._... .
Ceiling Area: R-38 LlnfaoW Botts Garage CeElimg: Non Access:
With staving Abure ... _ .. & .Sbwing Areas .- -- ...
-� Eatenar Walbc R-13 Unlaced >Esat-,
Ove<hanga: Aeeesm Attica _ -- -
E
w
►- Between Floor:
Z tnterior.Walb: R-11 Unbe dBatts
o _ -
CE
SubeenlWe+eter.. ®d ,1MUkdOOO Ctk, lfeeb
in 42UO Rio Nelgo TemsgjK Ca 92 0
0
0
a
m
N
kD
N
N
Trim Berry, Gewrol Mgmgee6 TemeOffa Drnnc8t
R- paeans resistance to heat flow. The higher the tt value, the greater the insulating power.
Ask your builder for the fact sheet on R- values. Keep this ecrti%mte -with your other
valued papem If you ever salt this horse, this certificate skould be passed an to the buyer.
_ __-._........_...Y......_�..r-..+hN..n-rr--w...-..._.....----__. ..�_�.-..+.�.A--air - ..,►�. �... _,_�... �. ....y,
C
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
O POST TENSIONED CONCRETE tE3 ASPHALT
O REINFORCED MASONRY O FIRE PROOFING
O SH O P
OTHER i
W e-LDW&
JOB LOCATION
fSPIA -C LA .oOTA
REPORT SEQUENCE NO
QE�RUCT C3T � 1 LAG
PERMRN0.
pAxE
/C!7�A
DAV Of WEER
MATERIAL DESCRIPTION A 3� A `K)�b_
'F}•..
CHITECT
_
MRS. CHARGED
L
ENGINEER
ASSISTANTS
HIS. CHARGED
INSPECTION
DATE
GENERAL
JMo=oRaMTo&_v
sue
O •w Q.s CONTRACTOR 1A txe5S
PJ0
COPY SENT TO CLIENT O
CONT[NUEO ON NEXT PAGE O
PAGE -OF
CERTIFICATION OF COMPLIANCE
1 HEREBY CERTIFY THAT 1 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
(JY�. (ta.A►L
L-AGNATURE OF REGISTERED PECTOR �� ��