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0312-230 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of FF- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and cel W Professionals Code, and my License is in full force and effect. O =) M License # Lic. Class Exp. Date 519186 H 10131/2( Z r� Date.,.-/, 1 Signature of Contractors �O� J U 61 OWNER -BUILDER DECLARATION LU w r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a License Law for the following reason: Z ( ) 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). C`) () I am exempt under Section B&P.C. for this reason LO N Date Signature of Owner N r d Q WORKER'S COMPENSATION DECLARATION 0 Q Z I hereby affirm under, penalty of perjury one of the following declarations: r F- O () 1 have and will maintain a certificate of consent to self -insure for workers' X W u- compensation, as provided for by Section 3700 of the Labor Code, for the mJ Q performance of the work for which this permit is issued. Q U ( ) I have and will maintain workers' compensation insurance, as required by O U Q Section 3700 of the Labor Code, for the performance of the work for which this Il rn F- permit is issued. My workers' compensation insurance carrier & policy no. are: ? Z Carrier S'tARFI ND Policy No. W98113I99b(Cv}1} wZ) 0 J (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 3 subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. 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. z 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 - Dated BUILDING PERMIT PERMITq 03raG2-M DATE VALUATION3„190'73,160 LOT 6 TRACT 31289 /3)- ` -). .)­—<. JOB SITE �' ADDRESS 47-724 CAGEO BAY- La)1 6 APN 643-200-011 OWNER CONTRACTOR /DESIGNER / EN (NEER T,.E1K£ FRONT I1MM'P.S,1ldC . J.T. HAYHOR, ]f1+TC, 74770 1-11GHWAY 111, UU.CTI±: 205 411865BOXWWAIX 4204 JNIAIP I VOMLS CA 42:210 PALM J)MIRT C' 7A 92211 `760)340-08:10 CDUP 3024 - USE OF PERMIT 3W019 P.t1MMY 1DVT]?x3..WG S.M. 3,053 SF. WINO (PI:AN I MF:DITERR.�., =4) 0 LOT R4. PERMIT DOES NOT INCLUDE ENTRY C1ATES. BMC WALIA POOL . SBP DRIV1 WAY.&PP. PERma &_ rosp, BY P3.irk uc woms REF). TRACT CONSTRUCTION 4052100 911' r PORC1-I/PA'1'I0 706.00 SY 0ARAGElCARPORT `797,00 6F v EMN.PATIPM COST OF COWST 2UC:°.1?1[0N 1X1,731,601 FM.MIT I'ME SUM" MECHANICAL FEE 101-000-421-000 V I. L" ELF,,CTPJCAL FEE 101-000-4.20-003 $209.61 PLUMBING IEE 101.000-419.000 $192.50 STRON .MOTION FXF - Rix'S10 101-000-,7A1-300 $20.95 GR.ADINO FEL .101.000.42.3.000 $15.00 I'eEVE1,C)PER 1M.PACT FEE A405.00 ART M PUBLIC PLACES - RESIt 270-000.443-0019 $23.74 PLAN CHECK ME 101X000-439-318 $633311 CONSTRUCTION YZE 101.000-418.0170 •593:1.00 WE -TOTAL CONSTRT 07701 -TJ PLARCHECK,ssl.�e LESS PRE -PAID P S $0,00 ! OTA-1..Pk1? rJr MS DUE:.RCiw Sox ,130 3 01003] ECEIPT QTJ; Q L DA ' k BY(-- / DATE F NALED INSP TOR 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 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 AYYROVA 1.01 Gas Test Electric Final Waste Lines Heater Final Water Piping f 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 1 ©S e Appliances Final Final /11.2 A0 Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground. Conduit Rough Wiring i Low Voltage Wiring 11 ooMir-- Fixtures Main Service) t Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final 177 T2779, Utility Notice (Perm) — COMMENTS: March 17, 2004 Johnson & Nielsen Associates SCarl B. vendHoluurni Nielsen Per T. Ron Consulting Structural Engineers Well Y•Ul Lomue P. Mount 647 North Main Street • Suite 4-B • Riverside • CA • 92501 • (909) 686-5122 • FAX (909) 686-6752 Stee„ T n,o,,sert L o s A n g e.1 e s • R i v e r s i d e • I r v i n e Jackson K. Wn J.T. Hayhoe 17821 E. 17" St. Ste 240 Irvine, CA 92780 Attn: Scotty Perry Re: Mountain View Estates Lake La Quinta Lot 6 Dear Scotty, J & N Job No. 40-010 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, L ie P. Mount, S.E. JOHNSON & NIELSEN ASSOCIATES Consulting Structural Engineers C:\WPDOCS\0-FORMS\inspectn.1tr\FRAM INSP 40.010.wpd P M0, S NO. 36M 1. EXP. "I -2W4 « r9 JQP \T �`41A U0 � SPECIAL INSPECTION SERVICE 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 of : L5"pJ wK�I ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER 1 ❑ REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATION REPORT SEQUENCE NO. TYP,F OF STRUCTURE PERMIT NO. - D E �S DA WE K MAT RIAL DESCRIPTION IA S Z ITS C! ARCHITECT INS CTOR HRS. CHARGED Zmt� ENGINEER C' t� ASSISTANTS HRS. CHARGED INSPECTION GENERAL SUB DATE "CONTRACTOR ��� �• CONTRACTOR ^- Z V7 Dl 2 3 `` _ M I I M " Z. W e alfa' rl • `� ,e�M � � � ' V�'�C3CXiV � S �� �a,,� � A S� w- - Nes 5 - S6 t -I - &jab K 2 --7 18 1 2 - a"® Nor S Q PsVo x or' Cir 1� oe ZI - 5 a S rel M e—c-. LAo- W �Tn.L% -z� — L.o"j -1`6I Ct Z_ /gt I S �Oc testier W �1 S t G� a,o feu, ,'\ f1.i,:_1FK 1 • ccs Co v•�n a. � S � . 6s '. • COPY SENT TO CLIENT' ❑ CONTINUED ON NEXT PAGE ❑ PAGE 0� CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MVKNOWLEDGE 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. 77 NAT RE OF RE ISTERED INSPECTOR D TE 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 ❑ POST TENSIONED CONCRETE ❑ REINFORCED MASONRY ❑ STRUCT. STEEL ASSEMBLY LS001Ckk ❑ ASPHALT ❑ OTHER ❑ FIRE PROOFING JOB LOCATION� `" 1j � j� ��� d ] Y l.Q jai REPORT SEOUENCE NO. TY OF STRUCTURE��� La Ve�� 0-� PERMIT NO. DAT l DAY OF WE K c� M RIAL DESCRIPTION ARCHITECT INS ECTO HRS. CHARGED ENGINEER �b tr) i N`I, n ASSISTANTS NRS. CHARGED INSPECTION DATE GENERAL -CONTRACTOR SUB CONTRACTOR Z 3 se"-PAor c Ito- �58 Lj zajsV x)e k r o o M t^• �! " ®{V44°!r'll[J R o 2-��8 3 ' �gy r �or� �s _ o0 2. _ �f Lz 65r _ a, !! ej f i-% W 8 N \\ h _ 14 1 w 14 v k ole; -• 0,^n 1 M "(- rer —[ �, ; ' A08 S'%HSL 00 -K 4r IV 11c,6sg M_ j r� M 7 Cabs f V73 -IP 4 rem w 4h I` .1 COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF Ma -k-, i -E o (e -S br-1 F,R.61 y "-%on CXQ.Qn CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF Mfr 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. ^� IG TURE OF REGI RED INSPECTOR (� J ZZ 1 DjTE_Of REPORT REGISTER NUMBER Certificate ®f Occupancy lfi4 4 4 g _um& Lvcosvo"TM G� OF }'mow 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: 47-724 CALEO BAY Use classification: SINGLE FAMILY DWELLING Building Permit No.: 0312-230 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