0011-265 (SFD)LICENSED CONTRACTOR DECLARATION
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 Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
714A Be B �� I(01/2c
Date 1,azd 110Signature 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 l Signature of Owner
WORKER'S COMPENSATION DECLARATION '
I hereby affirm under penalty of perjury one of the following declarations-.-
I
eclarations: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..
(j 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 Caq 11DEN RAM. WS, Policy No. HWC-M406842'
(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
yt
, I shallforthwith comply wit'ect to the workers' compensation provisions of Section 3700 of the Labor
h those provisions.
: A - r, Applicant ;-,Y)t° =�
Warning: Failure to secure Workers' Compensation coverage isunlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. -
IMPORTANT Application is hereby made to the Director of Building and Safety g,
for a permit subject to the conditions and restrictions set forth, on his '
application. r,
1. Each person upon whose behalf this application is made ,& each person.at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, &.shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building t'
con truction, and hereby authorize representatives of this City to enter upon
th above-mentioned property for inspection purposes:
ignature (Owner/Agent) 4� ' Date -t
BUILDING PERMIT PERMIT#
DATE 1311, ,'"'1 VALUATION LOT 0011-265 TRACT
�►�1:i,Rlit.I1W 423 a$�
JOB SITE
APN
ADDRESS 9-575 PAYS
9-470.022
OWNER
CONTRACTOR / DESIGNER / ENGINEER
CMM T€1TIW CRO"Gi all CC?MMM13 TIM
C1114I 1`1 URY OKOWIML Ci3Mt+A.1.1MT Ei.3
133 so, D. koo
1335 SO. "L)' ,9'. ,1<;'i', kx #2ot3 ,
"14k3E1'tHA:R171AiO OA. Q2408
SAN B-HAN.A,:R]IJ:ENO (A, 5+:404
USE OF PERMIT
MGLE r-PMJ 'Y D` .1J1 0
!,,C`T 49, PLAN 2C11; aVO,z• PERM17 POFZ tIOT INCLUDE, HLOCK gJALL.S,
P00t, OR DR.fEIl tat+'AY APPROACH, PtAW tri' ECK FEE REDUCED 75% FOR
Mu",'PLE ISSfI',t.A1•ICE OIC iauRINIl KAU 7'y?& .
CUSTOM CONEENR JCTION' 1,597,00 SP
ROPCi'INATIb 212.00 sy,
OARAGE/CA tk'ORT (OF) 11,S:ti '00
KS' dATV) CWT Wr CONS" .`�.iG`'l�Jt01a1
216W 9D
FRE guhEM Y
CONSTRUCTION FEE. 101-000-418-000 $ 4,049.00
PLAN ('.iF FCK FRE 101-000-439-318 $212,26.
MECHANICAL L VEti 1.01.00OV-4.21 „000 $91.00
ErLECTRIC .AJ,, .1rER. 1101-600.420-000 $ I44.08
PLU1> BY0 FEE 101.000»419.000 SIASR
S RONO M F1014 FEE - 6i'EMID 101 -00-241 -000 $21,70
ORA DINO ME. 101.000.923.000 $20,.00
I;II?V1��f" IPAP..kCT It $1,Kr.00
.ART N PUbLJC I'�i.,A. !F•,8 - RF.SIE TOI—iit3ta-255.000 $42,46
s � •
.ESS 1'1ZFs.-,P 1 :Wt
$0.00
i
DEC 1 IL'. � TAL.±�#:�t:'� ' D NOW
Vos
✓�� 1 QUI
RECEIPT
DATE
Byf
ATFI LED
INSPECTOR
)
'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings .
_
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
j . 7 -p
Exhaust Fans
O.K to Wrap
l
F.A.U.
Framing
p d
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
7z_45P- w 6
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Sewer Connection
�
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
N N
a�
Certificate of Insulation
— — Your Home has been Insulated with CtninTeed FibmAasa hmzlathmpu&wM whtcfi m.desl
for toda — --
grmd—
yb sttR�r atendand9 and tsIItoirow's energy t�equiremont9.
Fibagla is irtorW& and tlterefors pantaoertlly nromeembumft1k so it dons not have to be tmted
wig.fie-tt�cdeatchanlc$ts_that Mmmly_lose-tbeixoffeefiveness-aver-tiime Xhss not-beett-Uaeted ---- -- -----
wgtt clemtiseb that can caarode wiring err tmetal. Fib9ass will mot atiserb ntokhm iter win it
— ---- ----settle-opt--lhnast-may ath�iasalatiaammt�� --.— - . --- ---
..
CE
tn
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N
N
0
11
Interior Wallic R -i 1 Umfaoed Salts BAweaSn Floor:
Subcost OC1Vr OJ Insuhdo" Coy., Ina
� neaoy, c_7a
Sighed
Tons Merry, Gegen d tanager- T ala Bmach
R- mteatt, resistance to heat now. The higher the R- valm the greaser the imuloting power.
Ask your builder for lite fact sheet on R- values. Keep this certificate with your other
valued paper,, f f you cvcr acil this home, this certificate should be passed of to the buyer.
T116sibo certii-res thut Certaizf ted Fiber Glees Insulation boa been prof sdonally
iss� in d& hotrte
t-0
to provide rho fo WA tg thcrMd per6na EUIM.
Q,
Job Name: Msndarina Tract; 28719 Ph b.- 2CR-
Phase: 2
4111Job A 79�5?S iHa�a ■ -
-- — — -- ---
-R-
Ceiling Area: R-38 Braved Insulation . Garage Cemov
Non Accem
... _
& �opMg Areas .._..._ ...
g
Esterlor Waft R -l3 Unfaced Bath
Overft
�.
With ildving Above
CE
tn
O
N
N
0
11
Interior Wallic R -i 1 Umfaoed Salts BAweaSn Floor:
Subcost OC1Vr OJ Insuhdo" Coy., Ina
� neaoy, c_7a
Sighed
Tons Merry, Gegen d tanager- T ala Bmach
R- mteatt, resistance to heat now. The higher the R- valm the greaser the imuloting power.
Ask your builder for lite fact sheet on R- values. Keep this certificate with your other
valued paper,, f f you cvcr acil this home, this certificate should be passed of 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
PERFORMED71
O REINFORCED CONCRETERUCT. STEEL ASSEMBLY O C Ll 0
O POST TENSIONED CONCRETE _rASPHALT MOTHER
O REINFORCED MASONRY ❑ FIRE PROOFING'-C)LP`�l7
JOB LOCATION
9-
e7
AAA St
REPORT SEQUENCE NO.
TVP OF STRUCTUR4��� A
F0 L
PERMIT NO.
DATE
410-1)
DAY OF WEEK
MATERIAL DESCRIPTION
,T-3 �,��
ARCHITECT
PE
IN TOR
HRS. CHARGED
_
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR (fte_*ouk w' s CONTRACTOR
1-� L ZL-
S
ISS S • �s 'ic .
.,S . � g �
(.3, cC3
wL l
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Md
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.
SIGNATURE OF REGISTERED INFWTOR
9 v a 7�
ATE qF REPORT REGISTER NUMBER