0312-228 (SFD)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
51 }186 13 10131/2(
,.,Date ! , 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 ,p6nalty 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 STATE FUND Policy No. M3I131976(Cd,)
(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: ^ t - 1 Applicant =' t !1 ^f f
I rs
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.
Signature (Owner/Agent) t - `` Date
I I
BUILDING PERMIT PERMIT
0��,2-12kt
DATE VALUATION. LOT TRACT
I% )J- o__1) :,497.0 LOT 31269
JOB SITE I
ADDRESS 4-7-672 Ct1L1*' B..A.Y" L0T4
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LA.*..1FR0NT INVEMRS, WC.
14VO 111CWWAY i 21, .1 205
�18�+5 �t3,AR(��tai K �iO4
M1M ill Fri' 1 CFS. 92210
1yA M DESKa - CA 92211
(760)340-0850 CRL4 3024
USE OF PERMIT
SPI). 3,386•SQJ?T. L."VING (PLAN 2 MEDITERRA:t KAN) @ WT ik
PERMIT ra0&4 NOT INCLUDE ENTRY OAT&% }3 K WALL ,, POOL ,
SEP. DRIliIKWA'Y'ARP. PER.%11T & INSP. B'Y' PUBLIC WORKS RWD.
TRACT CONSTRUCTION 3,336,00 SF
Pd.3R.CiiifPATIC, 915.00 SF
QAJR.A4W1; kRPOR, T WS.04 8F
Erri'AIX0130 COST OF COMIS'19Ea;'(Jf"T': oN
2691,497--19)
Tyt•�+. ��1� e�i.�0lii�d�..�� .,.
CONSTRUCTION FEE 1014410.418-000 $1,024.,50
PLAN CHECK FE.E 101--000-439-318 $960:67
&AE;C1 A141C..A[, FEE 101 -0004 21.000 $111.30
'
9T,9CTRICAL FEE 101�I00-420-000 $2M.51
k'1,I)Mkfitll EEE 101.ON-419.000 51112150
STRONG MOTION ,/EES; - RESICe 1.01-000-24.1-000 $20.35
•
ORADINO FEE 1.01.000423-000 $15,00
DEVE1DPItR IMPIACT FE«, �a,4Q;.ott
A..Rf t}J PUBLIC PLACW -1$01E 270 -OW -445.000 $23.74
8UB-T0TA1. C.0N.'fT1t.'�,1'C'r10X d+,1n2 PLAN CWCK,
$4,862.4.7
LF33 PREAF.ATEII P1213
GECI 3 0 7003
CITY OF LA
FINANCE DEPT.
RECEIPT
DATE �,
BY
DATE FINALED
INSPE OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVA S
MECHANICAL APPROVALS
Set Backs
A Atli
Underground Ducts
Forms & Footings
Slab Grade
4 IV
11 Cy
Ducts JU
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 Wail Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS'- SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING
P O
j
Gas Test
Electric Final
Waste Lines
Water Piping
_
eater 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 J
Q p
Appliances
Final
COMMENTS: 'G
J '� ",
Final /77" t - a
Utility Notice(Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage.Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles-
eceptaclesG.F.I.
G.F.I.
Smoke Detectors
Temp. Use of Power
Final 1!
Utility Notice (Perm) _ _ y
JON TANDY
78-194 Elenbrook Ct.
Palm Desert, CA 92211
Office (760) 772-7192
�SPECIAL INSPECTIONFax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING
CERTIFICATION OF COMPLIANCE
1 HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIGfqATURE OF RE ISTERED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORKOTHERWISE I
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITHITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. 0A4 OF REPORT REGISTER NUMBER
X. Johnson & Nielsen Associates Svendlio-on
Nielsen
Per Consulting Structural Engineers wenY-on
Wen Y. Lin
Loruue P. Mount,
ty 647 North Main Street • Suite 4-B • Riverside • CA • 92501 • (909) 686-5122 • FAX (909) 686-6752 Steen T Thomsen
Los Angeles • R i v e r s i d e • Irvine Jackson K. Wu
JY
March 17, 2004
J & N Job No. 40-010
J.T. Hayhoe
17821 E. 17th St. Ste 240
Irvine, CA 92780
Attn: Scotty Perry
Re: Mountain View Estates
Lake La Quinta Lot 4 `
Dear Scotty,
This letter 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,QPGIUS10,
R
rq v
� N0.3&34 19t1
Lo nie P. Mount, S.E.cc
�xP33' zW4
* 4'qrATO
JOHNSON & NIELSEN ASSOCIATES F FaCA`�Fo`�
Consulting Structural Engineers
•
C:\WPDOCS\0-FORMS\inspectn.ltr\FRAM INSP 40.010.wpd
� Certificate ®f Occupancy
4 4 Qum&
,� 5w
G� OF iBuilding & 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: 47-672 CALEO BAY
Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-228
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
—ate By: TOM MORRISON
Date: NOVEMBER 12, 2004
Building Official
POST IN A CONSPICUOUS PLACE lu