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0011-261 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter g (commencing with Section 7000) of Division 3 of the Business and i�Profe Dnals Code, and my License is in full force and effect. Licens # Lic. Class Exp. Date `i 1/41$ 1i y i 1%►dry1,`Z ate- 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: ( ) 1, 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.Q. for this reason- Date easonDate 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 Sec on 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 Policy No. 0OLDEN ZA01:9IMS. NWC44408-02 (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 subj ct to the workers' compensation provisions of Section 3700 of the Labor Canfle, I shall forthwith comply with those provisions: ate: %:.J,�. > 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 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 personrat r 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 employeesµ 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 co struction, and hereby authorize representatives of this City to enter upon th above-mentioned property for inspection purposes. ' ��ff � VSignature (Owner/Agent) '� - ' � Z 4", Datef BUILDING PERMIT PERMITN DATE %h, VALUATION LOT0�I•61 TRACT � J/fr r.4 2X19 JOB SITE ADDRESS •79-4WO 33AY A APN • OWNER CONTRACTOR/DESIGNER / ENGINEER :Kwmy, MJmL w vr6bO CL•a4rIlYAY CR,0TYJUdy pVn111 1 X35 so, aDs syrr, r, via #290 1:535 00, "7 =KFI '; =4 #200 SAN BF.RbIARDIX0 CA 9240'a ��� ,S A3J BTMMAT�l'.11,1•TO ; r• /Lf�9'2R' 09 5.6007 �' Wt, 2120 USE OF PERMIT R,OT 14, PLAN AJ; 5111) �e ZaFRMIT DORS NOT INC1.401! Bt.'CK WALL% POOL, OR DRIVEWAY APPROACH. 111." C34940K FES? PXDUC.ZD 75`,, FOR MUTAIPIX,1'S i004VE OF is ML? PLAN 7`1CP& CUSTOM CONSTRIK'1 014 ;L,197.00 SP PORC"81PATIO 213.00 By CIARAA4sE9wrora (sn;+ 11.$140 .t@QS.2,L%18'tdT.M+I C`IIAY,f 6 %, F CadN.6J4.Khh8.1G,-MO - - 216,50W3 FERMMrye SuMbLIM i CONSTRUC-TION .7Z 101►000-419 R3 -(*0 $1,04.9100 3?LA34 C1'iEVK FEC 1014100-439-318 $212.26 M1WHANICTAL PEE 101.000`421.000 591.0. SR.IrCTRICAJ, RZE 10.1440.420-000 $144.00 PLq.Ttv3Rl1NG F99 .101-000-419-000 00-X319.000 $143.58 STRONG Y"A.C3Ji'ION FEE.' d R 10 1, O i -N104A $ -000 ORADIRO ti' E 101.000 -be -000-4A -ON $20.08. . i3ZV11i OPER.) IMPACT "X $1,907.fig ART tH PUBLIC PIALA. - PLE.9.11r 701-000.255.00.0 X42,46 '.. S1.T-lC}°1`4~112.1C'1?eA111?1r�1�A��g1�y'��TF9`.q'tys, $3,�i�5{,�5y.��,��y �y 110 Z'.nb�:r".G`d�i.,1� 1 ' 7 $0, 00 DEC 12 2000 OTAL 14.MMIDIT-i- NOW DATE B 6 DAT F ALE7RECEIPT 3 INSPECTOROr 0 INSPECTION RECORD .. OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR k BUILDING APPROVALS MECHANICAL APPROVALS Set Backs j'(�— (� Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck 6�yzm Exhaust Fans O.K. to Wrap _ _ F.A.U. Framing Compressor Insulation _ ���� �j Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath 6 Drywall - Int. Lath Final �l Final _'3/a �— 77 POOt.S -SPAS BLOCKWALL APPROVALS 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 �ZB-6a 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 COMMENTS: Final 0-r Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbitures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors _ v' Temp. Use of Power Final Utility Notice (Perm) 05/24/01 THU 13:21 FAI 760 7727183 JON TANDY REGImmm INSPECTOR'S NImI.Y REPORT Z 013 JON �Y e 37630 aea1001: Palm, Desert, CAM-1-1 Office (760) T72-7192 Fax (760) 772-7193 P"W (760) i76-3338 TYPE OF INSPECTION PlRFORMED 0 RONFORM CONCRETEBTRUCT: MELASSEM%'f O POST TENSIONED CONCRETE O ABPNALT 0 REINPORC90 MASONRY O NRI PIIOOPINO O St{c �OTMER'- I w PAZ- )% ID. LOGTKf11r7 +d $ A A S*r- LA a0 i 0TA age" su1,mme. OMSe' _ sM4 ar Of VJUK . WATERM GFSCIBFDWY R 3 G At -Wow, ! NRS. CAARGED s ICK kL,-) • Hft c+l►IwED CON>� 01 H a..o co" SENT TO "I"T 0 COMTMI tl OY Ww Fif 0 ME OF CERTIFICATION OF COMPLIANCE I MEREBY 0:1110tt THAT I NAVE INSPECTtb TO THE BEST Of Mil KNUMEDGE ALL OFTHE AWK WORM VIIORX UNLESS OTHEYWISE NOTED. I HAVE FOUND THIS WORK TO CWPLT VM THE APPRDIIED PLANS•rSPECIFICATIOW AND APPLICABLE CWTIONS OF THE �mKrw war n1Y/i • 11yR - l G �yi MAI.— DF 1 U V RIGISTEM rapier" scscabW-17,50 r / 7 - (�j 7,50 ti lli VA%v". Fp NI smRFR I IPA M09911..,,.__ _ ....r..._ ... __ (N W 0 Certi*ficate of Insulation -- -- -- Vour�lomahas-bean-in�ulatad-withGe�4�rT�d-FibergJa�-InsulatEonpmdrr6ich�re-de��ted-- - - — - . for today's satiny standards and tomorr+ Ws energy requEmon rts. Fibergaass is itosganic artd dieretbre permanently a mambustib* so it docs not hwe to be treated ----— with chemicals that can corrode wiring or metal. Mcrglass will not abmb moisture nor wilt it _ -- - ..- ------ settle aver-titrfe�i��bt�>trsulatwa tna�et, ia7s-------- --- ® This alts certifies that Cett dfiTeed Fiber Ori ss laauliitioa h�a beex profmioaaliy irtsta ' is this home ui to provide the following ihomal p61orumce,. r, (n Job Pisan Mat<dsNarl Trete 028719 Phut q: 28 Phase; 2 - - a: 14 Job Addren: 79-649 Maya Shoat Ceding Ann: R-38 Btowa hnuladan Garage Ceiling: 1Wa Aceem With Living Above d< Slopleg Areaq D - Lrattlor Walla: R 13 MA ced Batts - - --- - ------------- - -- - - - --- - - - LU --- -- w - - With Living Above -- r - o Interior Wath: R-11 Unikeed Balls Between Fluor: Q SUbCVntrQCter.. OJ IDDM air CO., Ing U) ? Nedoy Temeea , Ca 9990 o to Signed Tom terry, General ger- Temecula Branch N m Q� R- means resis ancc to beat now. ?'Ire higher the R -value, .the greater the iEoulating power. Ask your builder for the fact sheet on R- values. Kecp this certificate with your other valved papers. [fyou ever sell this home, this certifnata stsould be passed on to the buyer. m N R N 0