0011-268 (SFD)LICENSED CONTRACTOR,DECLARATION
U) 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 Busiriess. a'n'd
WProfessionals Code, and my License is in full force and effect.
C) Z) M Li c nse # Lic. Class ' Exp. Date
F-_CYLO
1`LLJ
71163#} i,'v 10f3t2t
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).
O I am exempt under Section B&PC 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.
Y� 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:
CarrierGOLDEN SAME INS.' Policy No; • . 'IfWC .A4069-02
(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
sufiiect to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with, os provisions.
ate: r^_'fd ,�°a� Applicant "P;k _ '1�Li.-I (r %stc✓
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 10 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. /
.ry
Signature (Owner/Agent) Date �� �•+
BUILDING PERMIT PERMIT#
/ F
DATE t fi � 9'� �.&LUATION LOT "� TRACT
JOB SITE
ADDRESS 7.0-6m BA YA
APN
. 7d'9a 47?"22
OWNER
CONTRACTOR / DESIGNER /ENGINEER
C7YgC2 7kwml, cVlY"grfliPs.
CYdW{l MWELL C0h*1nU.19
1535 oo. PD" n -mm, am 42oo
) 535 30, V ZMEW, € IX A900
RAW URNARDWO CA 0U08'
Skg BERHARDWO CA 92408
(909 , 81.60orl CB14 2120
USE OF PERMIT
LOT S1, PLA14 3CR; Spin - PFIR,M1T 11OVVfg0;T 13=rl: DZ 3).,0 _K'W.A1,L.%
POOL, OR DiLCG' EW.A T APPR.0.4.CK P601 CHECK FEE it.EDUM 75% FOR
MIULTIPL,E iSSUANCF..OF SAME PWI TYPE.
t IXITOM CONSTRUC'110N 28151/00 3F
F3E3P/I104157.00 SP
GA1ppOUCARAT (Of) pRyWAD
llt;1'"s!'MA:tL' P COST OF C4tiN&C,RUO`L71ON
x32' :ao .
CONSTRUCi'IM M .'101-000-418- 000 11s101.5R
PLAN CHECK FrZ 101.000-4.'^s94 9 $222.47
M EC1 NAICT., FEE 103-000-421-M $98,50
ELECTCt1C�,#1L. V.F.F.. 101-000-420-000 $142.21
PL UMSIF3O NE 1011000-'b19-000 S16915b
STRONG MOTION YZE a RESID 101-000-241.000 $23.14
C41dAM10 FEE 101.000-423.000 $20,00, .
DEVELOPER 3MPA.f;�'?Zs $1,907.00
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WAIIXOXmT�affol�' r7'l�i��.°! l,'�1,J!9�i1 vmmc
'78 DUE, HOW
lu. r
RECEIPT
DATE
,
BY
DAT FI ALED
INSPECTOR
�.
G/
V
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
J
Underground Ducts
Forms & Footings
/�
Ducts
,
Slab Grade
-; a
Return Air
Steel
Combustion Air
Roof Deck
I Q/
Exhaust Fans
O.K. to Wrap
p
F.A.U.
Framing
Insulation
_
_
_ _ �
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall - Int. Lath
S
Final
- —
Final
POOLS - PAS
BLOCKWALL
A PROVALS
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
/Z–Z8 a a
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
/
/
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final _L02,
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
_
Fixtures
Main Service
Sub Panels
Exterior Receptacles oe
G.F.I.
Smoke Detectors
Temp. Use of Power
/
Final
Utility Notice (Perm)
6WEEK-PA,
Certificate of Insulation
Your. Home has been insulated with CertainTeed Fiberglass Insulation products, which are designed.
for today's safety standards and tomorrow's energy requirements..
Fiberglass is inorganic and therefore.permanently noncombustible, so it does not have to be treated
with fire -retardant chemicals that will likely lose their effectiveness over time. It has not been treated
with chemicals that can corrode wiring or metal. Fiberglass will not absorb moisture nor will it
settle over time as may other insulation materials.
This also certifies that CertainTeed Fiber Glass Insulation has been professionally installed in this home
to provide the following thermal performance..
Job Name: Mandarina Tract: '28719 Plan #: 3C.R Phase: 2
Lot No.: 51 Job Address: 79-605 Baya Street
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Signed
Garage Ceiling: Non Access: _
With Living Above & Sloping Areas
Overhangs: Access Attic:
With Living Above
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJInsulation Co., Inc.
42620 Ri
a, Ca
Tom Berry, General Manager- Tem5cWq Branch
v
R- means resistance to heat flow. The higher the R- value; the greater the 'insulating power.
Ask your builder for the. fact sheet on R- values. Keep this certificate - with your other
valued papers. If you ever sell this home, ibis certificate should be passed on to the buyer.
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 '*VQSTRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE /❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
O S 0 (�
OTHER LOCL-OC46,
JOB LOCATION yo) �'
v
REPORT SEQUENCE NO.
TYPE OF STR WRE� ��
PERMIT N0.
DtTE/� `�,�
v
DAY OF WEEK
MATERIAL DESCRIPTION �� O
ARCHITECT
INSP CTORV
MRS. CHARGED
�`i I1-1 •C � Lo
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPL
DATE ECTION GENECONTRACTOR C(�,�TV172 tjO NAC -S
SUB
CONTRACTOR LJ 'i t Tes ,570E2,
7- S-- X 3
A
11-4
CAD&A
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AkM O .C -Z,
EA on -f + -C.-
COPY SENT TO CLIENT O
COPY
CONTINUED ON NEXT PAGE ❑
PAGE OF
O
CERTIFICATION OF COMPLIANCE
'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.
IGNATURE OF REGISTERED IN CTOR o-1
v� fl 6
D TE OF EPO IT REGISTER NUMBER