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0312-227 (SFD)U) H N U) W O :3 M d o Z OO I.- c J D W U) Z C0 LO N ON U °) CL Z T Cr Q O 0 J J mQU �Z co n t-- C) a 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 Exp. Date 5193186 R `�0/31/2C Date t f ? 0-7 Signature of Contractor _am t'� - w 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 STATR FUND Policy No. -wool, 1:3Im(m) (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. iiA f Date: t 1 I f a•( 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 any permit issued as a result of this applicaton agrees to, & shall, indemni D & hold harmless the City of La Quinta, its officers, agents and employee 2. Any permit issued as a result of this application becomes null and void work is not commenced within 180 days from date of issuance of su permit, or cessation of work for 180 days will subject permit to cancellatio . I certify that I have read this application and state that the above information s correct. I agree to comply with all City, and State laws relating to the _buildi construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection, purposes. t Signature (OwnerlAgent) i. `�� . + Date BUILDING PERMIT PERMIT# C.��12-�217 DATE VALUATIONLOT TRACT A9l, f9LOT 31289 JOB SITE ADDRESS l 47- 1EO BAY -° LAX -r.) APN ' 643-200-009 OWNER CONTRACTOR / DESIGNER / ENGINEER LA"K, FRONT INW.W. RS, INC, J.T. HAi'HOF, AIC:. '74�'7y`•��4�� GHWA.Y' 111 � 8. UT1a. 203 ' 6 AUr. #204 4�y1g8r�,3��3O WMA2 CA ty� { t � �7'? A i (7601)340109,50 0811. 307.4 USE OF PERMIT ((�pp �� 6�TH� �A re1t`{S.Td:.L? Ljf'�k1JLI lL• 1 WF1i. N`C4 SIM.,%051 SQ.FT. LIVINO(PIAN I T'JSCArC}. LOT $3. MR.11R'IT DOES NOT INCLUDE II'TRY C1A'TES, BLOCK WALLS, POOL, SEPAPLOLTE DRIVZW.AY APP,.•PERNIIT &ANSP..8Y PU13.11C WORKS RRga TRACT CONSTII,'UCTIoN 31051.00 Sl;' PORG HAIATIO 915.00 SF G RA.WCAP.PORT 775.00 SF 1dNSA7i.NSR►'1 . COST OF C,C3RMITC-7rION P1't,I?M,rr ITEWKKA Y laitW,HANACALFEEE 101.000-421*000 +1111.511 ' 91SXTRICALP731,r 101-000.420-000 $wgm.. PLUMBING FEZ 101.000-419.000 $191$0 , STRONG NOTION FEF • RMIDD. 101-0004AI -000 $20.95 i1.RAIDINO FEE 101.000x423 -0W. $1100 DEVZOLOPER IMPACT FEE $7,405.00 ART IN PUBLIC PLACES - RUN 270-000.445.000 $23,14 ' PLAN CHECK ISE 10l-0000 439-•l,3$ $624.93 CONSTIRUCTI0N.F&E 101.000.416.000 g96t,fib KM-. �+� C;ON'IMSC."i`D•0 *1D P1J%11T CHECK :$4,56338 LEE IFF, 3 $0.00 JAN 16 2004 CITY OF LA QUINTA FINANCE DEPT. , RECEIPT DATE BY DATE FINALED INSPECTOR M INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVA S MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings 47 fl4 Ducts Slab Grade LReturn Air Steel Combustion Air Roof Deck IV Exhaust Fans O.K. to Wrap F.A.U. Framing . Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 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 APP OV SGas Test Electric Final Waste Lines _ Water Piping Heater 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 ll oS o Appliances Final .Final 11Z /,2 ,j 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 / /Z/ E d Utility Notice (Perm) COMMENTS:Q - 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 ❑ REINFORCED CONCRETE ❑ STRUCT, STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATION REPORT SEQUENCE NO, TYPE OF STRUCTURE 1 `g� LV PERMIT NO. 1�l 2-Z21 DAT DAY OF WE K MAT RIAI DESCRIPTION � L ARCHITECT INS ECTOR HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE CONTRACTOR o' CCJr's CONTRACTOR Z 3 - `r •_` ct �\ r��S i 'rte n e >li'Ir, �• r - PAD - ' Grrxar rncjuS%A-q- 6 i S n k - h^ e,. -p l� ILI O V - pfi u t,J C°or n4 (- - t -A - - P 2- nrWsA or � PtNA!N rS. (.°arch - PC' or - ra vrM MOW perr-nnt EkLao. (Ac,<' (b2 c- ,3)10 16b oP ro K Ga - w1 �" M C 'aS it 'l AjL:J4e w,n 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 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. !MATURE OF RE TIERED INSPECTOR 1\166If-6 Ll" ultt 6AJE OF REPORT REGISTER NUMBER 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 ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING os/— ❑ OTHER JOB LOCATIONr �_ i �� C_JL c `-` J i� REPORT SEQUENCE N0. TY OF STRUCTURE �C� �t . I� -ARCHITECT ERMI O. ^�� DATE JWJjS`.CCHARGEO DAY OF WEE M RIAL DESCRIPTION INSSPE TOR HR17 SUN, >c t6 2 ENGINEERJ :yC-4tN-\%vN se ASSISTANTS NRS. CHARGED :INSPECLION DATE.CONTRACTOR GENERAL SUB �� , CONTRACTOR_ tt (aJ s -rot COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV 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. SIGN URE OF REGIf8ERED INSPECTOR 72 l 7;1 ANTE OF REPORT REGISTER NUMBER Johnson & Nielsen Associates SvendHoluuon Nielsen Per T. Ron Consulting Structural Engineers wen Y.Ut Loluue P. Mount 647 North Main Street • Suite 4-B • Riverside • CA • 92501 • (909) 686-5122 • FAX (909) 686-6752 Steen T Thomsen Los Angeles • Riverside • Irvine 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'3 Dear Scotty, J & N Job No. 40-010 This Itter is to serve 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, QPppESS!, yQ�o Z 3 31-2031-20 nie P. Mount, S.E. Nq. EXP. 04 v JOHNSON & NIELSEN ASSOCIATES s9T�9�OZ�QOQ�•� Consulting Structural Engineers FOF C:\WPDOCS\0-FORMS\inspectn.ltr\FRAM INSP 40.010.wpd a�^�,cAff 1 -. Certiricate ®f Occupancyo 6 -^ == LvroRrowhnIM 1 F Budding & 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. F BUILDING ADDRESS: 47-646 CALEO BAY Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-227 Occupancy Group: R3 Type of Construction: V -N. Land Use Zone: RM Owner of Building: LAKE FRONT INVESTORS Address: 74770 HWY 111, STE. 205 City, ST, ZIP: INDIAN WELLS, CA 92210 By: TOM MORRISON Date: NOVEMBER 12, 2004 Building Official POST IN A CONSPICUOUS PLACE `