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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
nate �— Signature of Contractor s� ^
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
,ji 'c ion 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.
04606162
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 thA provisions. fi 7 Jp r
Date:
te: 4 Cl' df Applicant e9C
a
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 Saf1.ety
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 oftsuch
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.f61 inspection purposes.
Signature (Owner/Agent)ys-,�'���'�' Datete
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BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0, �i.�°1 TRACT
52.011.20)
JOB SITE APN
ADDRESS
OWNER
CONTRACTOR DESIGNER //�yE,N` 1N�pEERR
gq�p}aq�Y py�y };y�� �Ap rygyq�j�+q�
�.ltiL`i .1 Wlk I.wCY`�'9�/�C`�1.L CFt�.N3iKt1..i.'1�7.➢,d.I. S
,�/gy`y,�(; �y a1 5��•�q� 1
lwC'tf.(A,& 4+'A•CXm.i �T'OOLS & S.Td'Y.'D (A4�.A. A1!3l'1J\I col'
1-535 so11Y r�..REF13.'e ISM #200
747 2 5 JOXI r 1XIM? #A
SAREMMARDINO CA MOO
P )ALM DEMT CA 92,260
(161[�)340-PNO CUR 355
USE OF PERMIT
POOL AADfOR SPA
POOF..I«SPA. ,AARTYISISARPMR a SHM,,t...BI'7 [N PLACE AT PRYoPWA &R.
PdONT-TIabt. 7L V. OF 4' HIGH 9WIl .-K WALL CITY S`E'A.l^tDMD,
POOL, AM OR SPA 1.9
4 P°r. eMAIA. ?..Qo IX
LOMMTED COST OF CORMUC710P
P yrr= &T3t"ir i�tf"RY
PLAN b:HM119r"I' '' e01-000.439.318 St�t3,At3
xf,
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y yi�yy 4lott-S+3y00-1AbeY�8-000
.S fS„'i'da:•%,kd�dl^P1�,4.A), C'FE-- J"a.%t r'i.e YW%S'^000-4 R.4"0�.00 •A3�.i+b+
r7,LZC'MV,.g L YEI -,, PW. . L 102-000-41,20-000 x+33.00
PL!,Jm.sralo ME POOL 01-000-449-000 2217, 90
(rs jp� �h +�;.�(�'ryry(,'g` +��q' �; �y'�''�'\ �,y `pp ,.`�{'j
W'A,AL �iNb�M J,Anll9+«y i.l:CV ,fa1��D PU�OX,�1 �d .h✓3M.
j�d,Q �j l� fi/�
A7F4 2.40
10", FREAMID FM
I
APR 4 2001
$0100
CITY OF I.A OUTNTA
RE _._-
1A Er j BY
DAT F LED p
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
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
steel
Set Backs / _
Footings 5 9 Y� C�
Bond Beam _ -D (
Electric Bond
Main Drain
Approval to Cover
i
DHV)
Equipment Location
_
Underground Electric
Underground Plbg. TestFinal
Gas Piping
Gas Test
G 6 �7
K_kFF,
PLUMBING'PROVALS
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
Unde`ground 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)
Your-Home-has-been-insutat+o"d-withPasi-Tecd-Fiberstass-Imutadmrpmduct' wilctram dpsigood - -
for Ways safety standards and tomomtw%eneaFy naqUh+vmemts.
Fibetglriss is iisargmtic atad t6erefor� pe �:aomoetobustibi� se it docs not have to be trcatcd
r - with chemkals *Mean coarrodt: witietg or mtetal. F9w4ass will tmt aWW b moisture nor will R
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� otkei ms6la1on iiew-i els- - -
m This also comes than Cemkfeed fibex Glass 16sulatiol Las been professlooally metalled in this lmme
N _ to provide the foRowimgtLetmal,porforntaootr.:
cn Job Name: 32tindaiima 1i ract#28719 ]Plea S: ZA Phew: 3
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Lot No.: 7 .lob Address: 79-570 Daya Street — --
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CeWag Areae R-39 Blown Insulation Garage Ceiling: Non Recess:
� ... ........... .. :. ..... .. ..- .... ._ ...:_.. - ... _. - . . _ .... .. .... ... VWb I(.➢v1mg.Ahttve ..— .. � S�� des -
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Exterior Walter R-] 3 ikfaotad Bath i>�erthe�a• --------------Acrrsa.Arr�-
W With laving Above
e-
zInterior Walls: R l 2 Unfaced Baits � �° Floor:
f-
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Subc ontraemn. OJInsuleffen C®., Ina
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? 42Pio Nede, Temecubt, Ca 92590
Tours Berry, Gemral ager- Temecula BrenCL
R- neeuas resisoce wheat flow. `The higher the R- valae, the greater the insulating power.
Ask your builder for the fact sheet on R- vahtes. Keep this certificate with your other
vatued papers. Myou ever sell this home, this certificate should be passed on to the buyer.
05/24!01 THU 15:17 FAY 780 7727193 JON TANDY
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JON TANDY
3760 Medjcol Ave.
fse Desert, CA 92211
Of im (760) T72-7192
Fax (760) 772-7193
pwjer (760) 776.3338
TYPE OF 0 REINFORMO 00FIVIV i XSTRUCr, 06GL ASSEMOLY OH d
INSPECTION O POST TENSIONED CONCRETE O ASPHALT OTHER J `� �
PERFaRmFD Ia RLINFORCED MASONRY Cl FIRE PROOFING w (y
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CERTIFICATION OF COMPLIANCE
I HEREBY CEFMFY THAT I HAVE WSPECTWO TO THE 09V OF MY
XROWLEMALLOFTHSAOpV R PVRTEDWMRKL*LMOT C -WA SE
NOTED, I HAVE FOUND THISWOMII =IOU
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CONSTRUCTION AUTHORIZATION
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