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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,'land my License is in full force and effect.
License # Lic. Class Exp. Date
519186 10131/'2(
Date i /' `* Signature of Contractor 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:
Cartier W?.&TF, P{) -NT) Policy No. W981131976(CA)
(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: s Applicant �,'' + %x t?►
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
the above-mentioned property for inspection purposes.
! _ t
Signature (Owner/Agent) � -44 4 ' Date
BUILDIN_G_..PERMIT PERMIT#
DATE_ iVALUATION LOT Jl'� TRACT
JOB SITE APN
ADDRESS 417- C ..11L r0 J9AY L(Yr 1
OWNER CONTRACTOR / DESIGNER / ENGINEER
ld�XF. IMOAT rnrsr ISMRS, DTC.., J.T. HAYYT0 ,, DIC'.
147701UGETWAY 111., SU -117-7 205 41865BOARDWALK *204
I%TF.JW3 :,TILS 'CA 97,210 PALMT31:SRPJ�. ,:;:.CA 12211-
(760)340-0850 PLO 3024
USE OF PERMIT
S:i1 OLE P'AIv3I1-Y
S.M. 3,5186 SQATT, WINO (PIAN 2 TUSCAN) @ LOT01, PllAJAIT
1098 NOT INCLUDE E14TRY MATE, O.LOCX WAirL�1 POOL. SEPARA,79
DP1°V'1V:ariFAY APP. PERMIT di:.'INSP. BY PUBLIC 14C7IdKS IB;s".C, O,
TRACT CONSTRUCTION 39386109 OF
PO C:HPPATIO 313.40 Sir
UARAOMARPOW 355.00 Sy
lb -M. 'A'1:'EM COST OF CON4`MUC:,''�701V
u
2.i1P.497.30
I''m22Ji ,r m4 911'I<haV%�.'� Y
WE DEPOSIT 101-000.439.318
-$750.00
CONSTRUCTION FEE 101.000-418-000
$1,024.10
PLAN C:HF,,0r. FEE 101-000-439-318
5850,67 ,
MECIi,RNICALIrtE 101-000-121-000
$111.50
EiI,EC TRICAL:."M 101;000.420.000
W&61
PLIJMBITJ0FISE 101-000-4•I9-000
$192.50 '
1"ROH0 MOTION IT9 • RF.3110 101-000.2?1.000
820.96
GRAD1140 ME: 101.000-423.000
$15.00 '
DF,VP,V,,JP011 IMPACT PKK,
1;.4405,00
ART IN PU'SIAC PLAC:K,4 • RLSIL 270-001-445-000
$23.74
SUB -TOTAL C09&1.i UC' 1014 AND FLAX
CHFZGI�:
$4,862.47
IEBS .T�' ,�I?A .D RMS
-$750,(}0
'APLr WTT rMN D1JF .N0W
54,1.fl2. Y
3o 1003
aryi�i; ..
( RECEIPT DATE'; BYr � / , JDATEFINALEDD� /O „ INSPEC'.� `j'/
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 z
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP OVALS
Gas Test
Electric Final
Waste LinesHeater
Water Piping
Final
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 o 3 Id,41
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 l 03 0
Utility Notice (Perm)
COMMENTS:
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772 -7193 -
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE
❑ POST TENSIONED CONCRETE
O REINFORCED MASONRY
O STRUCT. STEEL ASSEMBLY ;4 j5p- 6 X�
O ASPHALT ❑ OTHER
O FIRE PROOFING
JOB LOCATIO
_ / C,(
C.(l
G
REPORT SEQUENCE NO.
TYPE OF STRUCTURE�.L>\� q
PERMIT NO.
GATE
DAY OF WEE
'
MA IAL DESCRIPTION
t 6
22
ARCHITECT
INSP ICTOR
HRS. CHARGED
za
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2
ENGINEER
a1So i S
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR N
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS, AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
NATURE OF R GISTERED INSPECTOR
1 e1bJGZJ , 5127 l�
ATE OF REPORT REGISTER NUMBER
: Carl . Jolmson
:X -
::,"Johnson Nielsen Associates SvendBH.
Nieis en
Per T. Ron
Consulting
StructuralEngineers w. Y. Lin
Lonnie P. Mount
647 North Main Street • Suite 4-B • Riverside • CA a 92501,6 (909) 686-5122 FAX (909) 686-6752 Steen T Thornsen
.X.
L o s A n g e I e s • R i v e r s i d e r v i n e Jackson K. Wu
March 17; 2004
J.T. Hayhoe
17821 E. 17th
St. Ste 240
Irvine, CA 92780
Attn: Scotty Perry
Re: Mountain View Estates
Lake La Quinta Lot I
Dear Scotty,
J & N Job No. 40-010
This letter is to sere as written confirmation of the complete framing inspection I made at the
above address on March 17, 2004. Based on this visitation, it is my opinion, that the
complete framing is in compliance to plans and specs.
If you have any questions, please feel free to call.
Sincerely, cP
P
N'0-
3834
L *e P. Mount, S.E. F -XP 3-31
2004
JOHNSON & NIELSEN ASSOCIATES
Consulting Structural Engineers
C:\WPDOCS\O-FORMS\inspectn.Itr\FRAM INSP 40.010.wpd
r Certificate of Occupancy0
I^coevouity
SOF T Building & Safety Department
This Certificate is issued pursuant to the requirements of Section 109 of the California Building
Code, certifying that, at the time of issuance, this structure was in compliance with the
provisions of the Building Code and the various ordinances of the City regulating building
construction and/or use.
BUILDING ADDRESS: 47-594 CALEO BAY '
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0306-110
Occupancy Group: R3 Type of Construction: VN Land Use Zone: RM
Owner of Building: LAKE FRONT INVESTORS, INC, Address: 74770 HIGHWAY 111
City, ST, ZIP.- INDIAN WELLS, CA 92210
By: TOM MORRISON
Date: NOVEMBER 3, 2004
Building Official
POST IN A CONSPICUOUS PLACE