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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
Date - Signature of Contractor
✓I s -
`t
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 EXEMP 7 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, provisions.
Date: f ` ' f" ' Applicant—c-11
er } • p r
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'. r
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 pursuarit 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 voidif
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.
Signature (Owner/Agent t,- --rIv�f Date ��" •l. "'r
BUILDING -PERMIT PERMIT#
DATE i( f� VALUATION,`} 133"oLOT' �r �y TRACT 2914
JOB SITE `"� ►" :
ADDRESS
APN
OWNER
CONTRACTOR /DESIGNER / EN INFER
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10-070 CADIZ
J_& Quraqu' CIA 92153
LAi�,vwp, CA 92213
<140)564,4332 COV3237
USE OF PERMIT
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PERMIT DOES P00 3 ,11PA 01Z t3RI?fENViV
JA.I) Rd;JAC;H..
,' � t +� r: 1� i• ,ti
CUSTOM (.11 IMglP.i3CTRII)* 4,641.00 SP
PORCHiPAT.0 310.00 8?
4ARAMM"' 6YOQRT 91,70.0 Sri
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ART It? VUBLIC I'I,..N.C!, f3 •'•.Af:°il'>" � 7Ci^�Jfit1-X43-Uf1Ct $rti�.�S
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RECEIPT
DATE j° .r
BYit��'A^
D E FAt7
INSP
r� %
IL
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
j>
Return Air
Steel
Combustion Air
Roof Deck
.-d
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 Wail 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
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
.
Final 41 '44 F.C97
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:
RAYMOND FRANGIE STRUCTURAL CONSULTAIVt!i--iNC.
-------------------------------------------------
44-100 MONTEREY AVE. SUITE 201-C, PALM DESERT, CA. 92260
PHONE (760) 836-1000 FAX (760) 836-0856
E-MAIL R.FRANGIE@VERIZON.NET
SEPTEMBER 9, 2003
WEISQOPF PARTNERS
81070 CHANTICLEAR
LA QUINTA, CA. 92253
Re.: THE SUNMT, LOT # 53, PLAN `B"
57-785 BLACK DIAMOND
LA QUINTA, CA.
FOLLOW-UP TO WALK THROUGH
JOB NO.: 4034
DEAR Mr. EVANDELL
THIS LETTER ADVISES THAT WE HAVE OBSERVED THE STRUCTURAL
REQUIREMENTS THAT ARE VISIBLE DURING CONSTRUCTION AT THE TIME OF
OUR SITE VISIT.
WE BELIEVE THAT THE AS -BUILT CONSTRUCTION AT THE TIME OF OUR VISIT IS
IN GENERAL CONFORMANCE WITH OUR STRUCTURAL PLANS AND RELEVANT
CORRESPONDENCE ISSUED BY OUR OFFICE.
WE OBSERVED THE BUILDING IN ITS FRAMED CONDITION PRIOR TO
INSTALLATION OF DRYWALL AND STUCCO. WE OBSERVED THE VISUAL AND
ACCESSIBLE STRUCTURAL REQUIREMENTS. ( EXCLUSIONS ARE ITEMS SUCH AS:
FOOTING SIZE AND REINFORCEMENT, TOP PLATE SPLICES, ROOF SHEATHING,
AND ANY STRAPS ABOVE THE ROOF SHEATHING).
NICHOLAS ASOU-FADE
N0.50588
gENEwAt DATE ..
SOF C;
NICHOLAS ABOU FADEL