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9809-218 (SFD)rn f— _N U) W O =) M CY u7 W o Z �0 JV� WW ►- a U) Z CV ON U_ a' I Z r 0 0 JJ m<U O � 0) 1�t Z_ co :) �o Q J 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 /Ekp. Date ate �' /r �' Signature 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 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�p r Policy No. S A'X 1'P. f1;XV 1371095 (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, II soh, !I forthwith comply with those provisions. VDate: /11/ " ' ��� 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 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 th above-mentioned property for inspection purposes. jf ,rf ' Signature (Owner/Agent) BUILDING PERMIT PERMI,9809-219 CONTR/O�L# A DATE VALUATION LOT `3 TRACT �e C V VVV ADDRESS 79-125�.1�LLE 13HIS.N JOB SITE APN 649-210.03 OWNER CONTRACTOR / DESIGNER / ENGINEER •t�.�a.:��s1�r: i� �ar�f�=,r.r���:��:R� r �;r��;>�s cs�r���r:�Jc: nc)�: P.O. Tlu;X 1716 7P -29i RANCHO LA Q1JtN17k DR. LA QilliV'M CA 93253 LA OTJWrA CA 02253 f7E�01771-iqt() (:F3111f 2946 USE OF PERMIT S[Iti4 LR, hA ffL1' D WELLINCI SUD. PLAN M3, LOT B, -PERMIT t DOES NOT INCLUDE BLOCK WJ .1, OR P01 A..1-ILAN CHL?t:K F.HE iZFi)t CY0 79-'9 FOR MUI:fI 'LE ISSUANC L O CUSTONI Cv` NS7RtiMON 4,243.00 SF PORCHI A110 $2100 S11 QAII.€ k1PY :ARP0 1' 710.049 51: :PE'RNO i' FEE .'UM1YiARY CONS RUC,°'1IONFrIE 1.01 -ON -419.000 s3. 21.si PLA'K 04ECK M� 101 -000-433-319 V1 01,73 NXCH&NICALFEE 101-000421-000 SIM. -NO E3 EX'IMCA.L i17. t01-000-420-000 5216.71 PLUMBINQ I -FE 101 -WO -4.19-000 5205.01) S'rfi.OINO WYrTQN MT. - REM) 101 -OM -241-0M 535.1.4 GRADWO F.UE 401-000-423-000 520.00 1M,'PJQk' ,RUCTU,RliITEC 225;000.43-342 S6,0)0.00 AKT CIV P1J.6LIC PLAC F3 - RIESiC 701-000 ;255-000 $62$.47 S1_.�}1-71f AL COl`)S"E' UC"'"f ION AND PLAN C,;l f[:CK �V, t 02 05 LESS PrIE-.P.MD cEES $rl,00 'fOTA1, PERMIT TEES .Oilft+;`l NOW �y,ttlx,US ,REQEIPT-' V , DATE �„ f ��,. BYE'"- W D € FI J,Fp INSPECTOR ..-.^'. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade _ (lG Return Air Steel Combustion Air Roof Deck L - Exhaust Fans O.K. to Wrap G F.A.U. Framing _ _ `�.f Compressor Insulation 22- (,GC 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 2 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 Sewer Connection Pool Cover Encapsulation Gas Piping Gas Test- _ e Appliances Final Final / Utility Notice (Gas) Gam` 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 c Final Q.�i, iltil'rty Notice (Perm) CL COMMENTS: • 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 PERFORMEDO ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY O POST TENSIONED CONCRETE O ASPHALT REINFORCED MASONRY ❑ FIRE PROOFING ❑ O OTHER JOB L* '701 r, G A 1 I e , p /�` 5 ,/- (I r / A . Qu`vN7r � r 1 (� REPORT SEQUENCE NO. TVP OF_IBULTURE LOT �\�!` PERMIT NO. DAT "' DAY OF WEEK MATERIALCRIPTION S -3 G �-S3 ARCHITECT I � R NRS. CHARGED -: ENGINEER ASSISTANTS HRS. CHARGED SUB INSPECTION GENECONTRACTOR f;, DATE eA eK e.C-T CONTRACTOR p q ©-- 649c je (tq Tt, Co N Nt�T 00 OXTP TC -7- p �S. COPY SENT TO CLIENT CONTINUED ON NEXT PAGE O 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. SIGATTURE OF REGISTERED PECTOR V _ 9rct 2 -Z7C-60 DATE OF REPORT REGISTER NUMBER