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LICENSED CONTRACTOR DECLARATION
(.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 a ecteO
License # Lic. Class Exp. Date
58 6 C5a
Date Signature of Contractor
OWNER -BUILDER DECLAI 1ATION
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 STATA FUND- Policy No. 1344032-02
(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 mannw. 0 s to become subject to the
workers' compensation laws of Calif I and agree that if I should become
subject to P.e workers' comPee sa'ion provisions of Section 3700 of the Labor
Code, I shall fo hwith comply with those provisions.
Date r9 ) Applicant �A V l
V
Warning: Failure to secure Workers' Cimpensatlon 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
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.
BUILDING PERMIT PERMIT#
DATE VALUAYiOW" LOT 103A.2^17,-5 TRACT
102
JOB SITE APN
ADDRESS 79„05.0 CALL * PARBA -
OWNER CONTRACTOR / DESIGNER / EN (NEER
7 9-05 0 CA�Ull BUM. A 53'00 AVi',J.>]!t?A R.42vMZ
&QU(NTA CA 92253 T.AQU'ou. CA 9M3
(760)5V,-3fs55 031A 2893
USE OF PERMIT
-POOL. AaMAD.P SPA
POOLARA, 13EQ (Q:N31.X71.55.1995) AL•AR,MVia.AR.RJFKRS SHAJ L 6F l;l
INCIAIDED
POOL ANDIO R, 011A
I7!gG00, 00 I a`3
ESI!4'dA17D Coal, OA?' CONRUTIC;ITON
I'f�" GlIisCK TTF )01-000-439-338 $I I%Dti
CONS'1`MIC;T10W FEE 101-000-1418-1300 4190.00
MECHANICAL W, -• POOL 101-000.421.000 $24,00
ELECTRICAL FEE — POOL 101-000.420-000
i'x dDMBING .F.EE -- POOL 101-OOO-419.000 V2 71 0
I certify that I have read this application and state that the above information is, L
correct. I agree to comply with all City, and State laws relating to the building
construction, and .hereby autho,�representatives of this City to enter upon
the above-mentioned prope for inspection purposes.
�J �, RECEIPT
Signature (Owner/Agent) Date `� • i ')
271C100100
r�
DEC 3 0 1003 7 ► MfUWrx FEMS DT SOW ,
CITY OF LA o1j,Aj .
DATE BY. ATE FINALED INSPECTOR
s'
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. 1
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
Steel
POOLS - SPAS
-p —
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover"O
- D A
Equipment Location
Underground Electric
— V
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
Sho•,ver Pans
O.K for Finish Plaster
Setiaer 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:
JON TANDY
N T37630 Medjool Ave.
12 Prn Palm Desert. CA 92211
REGISTERED INSPECTOR'S WEEKLY REPORT
Office
F;jFax
Pager
(760) 772-7192
(760) 772-7193
(760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
X 1E.Pox
CI OTHER []
JOB LOCATION.^
�'^
`7 V C A 1 `j 1 l J`5
-
Q lA l w1 J
REPORT SEQUENCE NO.
TYPE OF STRUCTURE - - -
Sr6 Q moo:, i\Npt
-
PERMIT NO.. - -
-
DATE
i 1-3100
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR
NRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
Owl 11,II, CONTRACTOR AV)e-k k
3 coo
Obse-f ec1 ens
oll
fit. Iwk b .P cp #Ae
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF 1
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.
SIGNATURE OF REG ISTERE INSPECTOR
00 zC-80 111%3Z/o-`l9
DAYE OF REPORT REGISTER NUMBER