9809-237 (SFD)010
LICENSED CONTRA CTOR`DECLARATION
U). I hereby affirm under penalty of perjury that 1 am licensed under provisions.of
F- Chapter 9 (commencing with Section' 7000) of Division 3 of the Business and
�N W Professionals Code, and my License is in full force and effect.
C:) `_
License # Lic. Class Exp. Date
I O - bitI074 A .� Via 1/99
o Z r Of
VDate1�1fz .�� Signature of Contractor_---
O
U p OWNER -BUILDER DECLAR ON
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ t1 License Law for the following reason:
Z( ) 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).
C'`) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
EL Q WORKER'S COMPENSATION DECLARATION
o ZCc I hereby affirm under penalty of perjury one of the following declarations:
U') � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O -1 Q performance of the work for which this permit is issued.
fn Q U (X) I have and will maintain workers' compensation insurance, as required by
O UQ Seion 3700 of the Labor Code, for the performance of the work for which this
Il 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
V
J (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
3 supject to the workers' compensation provisions of Section 370(5of the Labor
Code, I shall forthwith comply with, those provisions.
r
ate: Irl Applicant
Warning: Failure to secure Workers'- Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
4 application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned properfy`for inspection purposes.
,/Signature (Owner/Age6t) --� �'"- '� Date �(r)/
BUILDING PERMIT PERMIT# CONTROL#
tiKl►g-i:37
DATE VALUATION S2,Z%8!I2.0f) LOT, 3i TRACT 2.8,3 A
JOB SITE
ADDRESS 7")S CALLE Z RISA
APN 649-210-003
OWNER
CONTRACTOR / DESIGNER / ENGINEER
n'rl TNrQ110r(iR�rV1/1Y184T kill'
1.L 1/,,. Y I.l,4+L .L/LI..FV L
VC) A-0 L,C nl1ArC-i :)i 1!'1 "(l fir
U1 !\lI{\w} 4VIV1.Yll\\J\,t L\JI•
P.O. k5tXX 1716
79-295 RANCHO F,,t QUIN`IA Oft.
LA. QUINTA CA. 92253
LA QURTVA C111. 9225.3
(760)771-1941 CIIL# 2996
USE OF PERMIT
51.1t1Oi.I': hA(tlli.l`l��Vh'l.,I,LI\lii
SM, PLANE!, QUOD:F.L) LOT 3?, PiA&11T.DOES ciOT INICLWE BLOC
WAI,I, OR POOL.
100, z V is.00 Sr
PORCiNVA'ITO 20.0 Sr
OAkAUILICAIiNOKIP 614AX)%wi
PAA h Y'r13 1..6J1'T G% ry L'1.I31'SPURJ101N,�
PERAM, FEE SUMMARY
1, 4ONSTRUC.°ftC.iNIP&; i01-0(IO-4I$-000 3I,0153.00
P11, AN rff "[c. wTt 101490Y•439-31 R $87161
XTECFift1;OMI .i11 -M 1101 -OW -421 -M 51050)
ELECTRICAL FTY. I()D-tiC }-+ 20 t�0c3 s:ac:.ut
PLUMBING FER I0I.-OW419-000 $1 19.14,
Kr ROX(l N4,01 -YIN FFV - RV81[l) $2209
ORADING 114" Otil-t>O0-X23 fltt0 $20.00
INFRASTRUCA URF, n, j,, 225-.00-44-1-342 $0 89.27
A10'.1 N PUBLIC PLACN3 - MStV 701 -000 -255 -NO $A02.0
FF 0M.)817 )SI! 101-fXX) 439-31 R
SI.B-1'C"irA,1. coN1 ,;MR,QC.910N ANT,') MAN CHECK
n7,61 A.36
"El PRE -PAID, )EES
4250.00
t'Q3'S'AL l'EItM T FEEN DUE' NOW
$7,364.36
I `
RECEIPT
DATE /\ `'-
BY �+ j (�/
D7E INA
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs -
Underground Ducts
Forms & Footings 1 41Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck Q - ;2-g—
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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:
— Mw En I 1 15
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 ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY 0. FIRE. PROOFING
JOB LOCATION _ Q
REPORT SEOUE14CE NO.
TYPEt F STRUCTURE o� ' -
PERMIT NO. -
--- --- - _
DE'
/(D�
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
I
JB g 4/T
INL/SP CTOR ,
HRS. CHARGED
ENGINEER
ASSISTANTV�SI I
MRS. CHARGED
INSPECTION GENERAL--I=-�� �
DATE CONTRACTOR V Lr1� � (�CQ-KJC.s1►
CONTRACTOR
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
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.
SL&NATLYRE OF EGISTERED QSPECTOR
01/619 IV a
DOE OF -PORT REGISTER NUMBER