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LICENSED CONTRACTOR DECLARATION
1 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
Dates Signature of Contractor ,*:. A ;�
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 Policy No.
(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 provision
Date: `J r-' ` Applicant +! . �� ' . -
'I V,
Warning: Failure to secure Workers' CompensKtion 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 As
application. .— —I -
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. I
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 i
correct. I agree to comply with all City, and.State laws relating to'the buildin
construction, and hereby •authorize representatives of this City to enter upo
the above-mentioned property ftor inspection purposes.
r'? 3
tSignature (Owner/Agent) Daterfr_
BUILDING PERMIT PERMT#
DATE VALUATION LOT �35.�j, TR CT
yg Q�py (9
�iil�3dse�C4?'U ;5n/
JOB SITE
APN
ADDRESS
79-,Z503 DAVA
OWNER
CONTRACTOR/DESIpNER/EN INEER
M5 -,0% -TX ,. (101W TRITMm
cpam.?inuAFowq A. mn (1''Cke W" col,
1335 'I 11.1.)° U'1`RUTYME, 0,200
747.25 J02,1I DAM% MIM #A
BAN DEMARDWO CIA MIN
PAP::l I M"T CA 92260
(?6q1340-9000 C�'10 1155
USE OF PERMIT
POOL AY+,"I OR SPA..
PlXXJS,A. fiiJtF'. JI rF�AS�x1 f 4� ;Ffh�: ,k�Ft rTi+!' +k,t1C E37'Pi3k�• v `iFS
11HOPE+ TWT, 20 LY, OF 4' BLOCK NNALL CITY ST.A.HD ARD,
11'00L AN Di0k SPA
q If 11— W.P.11L A.1100 LH'
cogir 030' CONI ..1111R:OMC3XN
PLAN CHECK FED, 101 -0 00-439-,7 S10-40
-40
C".OR� U0.. T10Yd 2, 101-000-418-000 $2.16.00
MEt"1' A'010'.A a RE -- POOL 1012-000-421-000 $24.110
1?tLMTRICAL f+'EE, — POOL 101-000-4.20-000 $,$5.00-
PJAIMM10 FEE -- P001, 101n000-419.000
%0 11 �TOT'I, C:014_011 a"°,1'1.O114 AWD PLM CM=
$452.40
LIM P-PA1:DFD1
w0,00
.`@C'T`6`1
APR ' 4 2001 i
RECEIPT FINANCE DET LIIUU
E op P
/ J F..r
BY
111-0.
D FI ALED
INSPECTOR
INSPECTION RECORD
F4: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 & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs _
Footings �14/d/ ��
steel
Electric Bond
Main Drain
Bond BeamW6�
Approval to Cover
Equipment Location
Underground Electric
_
Final %�%/pJ �'�
Underground PIN. Test
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
Sewer Connection
Pool Cover
Encapsulation
/
Gas Piping
Gas Test
Appliances
Final
_
/
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main ervice
Sub Panels
Exterior Receptacles
G.F:f.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY ❑ S]+ O
❑ POST TENSIONED CONCRETE ❑ ASPHALT r -OTHER I�
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION ry ' _!S�„ S (?�
REPORT SEQUENCE N0.
TYPE OF STgf U fi -
PERMIT NO.
D �To►''��
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INlISPE T R
HRS. CHARGED
U)
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR ` ua o
SUB
CONTRACTOR �.
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S Rdd.l�s S -Tu cls -I'o :.r
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE
OF
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.
ISANATURE OF 0_0REGISTERED
D TE OF PORT REGISTER NUMBER
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 #: 2B Phase: 2
Lot No.: 50 Job Address: 79-595 Baya Street
Ceiling Area: R-38 Blown Insulation
Exterior Walls: R-13 Unfaced Batts
Signed.
Garage Ceiling:
With Living Above
Overhangs:
With Living Above
Non Access:
& Sloping Areas
Access Attic:
Interior Walls: R-11 Unfaced Batts Between Floor:
Subcontractor.. OJ Insulation -Co., Inc.
42620
Ca
Tom Berry, .General Manager- Ter,"la Branch
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, this certificate should be passed on to the buyer.