0308-069 (SFD)U)
F..
N LU
W
�aC)
W
OZ�
CDD � O
t0
J
W W
�a
U)
Z
M
Ln
N
ON
(.5 °)
�Q
Z
rQ0
0 J J
mQU
U
cl:��
`4- Z
obs
� d
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 Exp. Date
b .HM 9/30104
22'A -i13 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 OLD REPUBLIC TOO"() Policy No. Pt4WC10084MOa
(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, Ishall forthwith comply with thoseJprovislo S. /
Date:
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
the above-mentioned property for inspection purposes.
,.Signature (Owner/Agent) fr i'�'�� Date A'
_ t
- BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03W-069 TRACT
$107AGU.70 131 293.23
JOB SITE
APN
ADDRESS 433^++�i{19 qO a�FDEL OR-®
OWNER
CONTRACTOR / DESIGNER / ENGINEER
LIDNAR x40_1+05 OF CATIFORNI :
LENNAR H01iMS OF CAI :[.F"O1tWIA
78-461 C:1-i4Ciai' MAY 11!
7f$-401 C T 1.011W./ Y 171
L:
INSPECTION RECORD
OPERATION
DATE I
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVAF,S
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings _
Ducts
Slab Grade _ _ 6 _
Retum Air
Steel _ _ _
Combustion Air
Roof Deck —_ �' _
Exhaust Fans
O.K to Wrap —
F.A.U.
,
_ _ _ _ _
Framing
.Pompressor
/
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
Of It
POOLS -SPAS
BLOCKWALL A PROVALS
Steel
K,
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 Lines �_
Heater Final
_ _
Water Piping _
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL PPROVAL
Temp. Power Pole
Underground Conduit
�!
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels j
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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_E000
`
INSPECTION "� \
PERFORMED J
REINFORCED CONCRETE
O POST TENSIONED CONCRETE
❑ REINFORCED MASONRY
❑ STRUCT. STEEL ASSEMBLY
❑ ASPHALT
❑ FIRE PROOFING
'�%X
❑ OTHER
JOB LOCATION
L4 9 coo Q3
. ZANJ
REPORT SEQUENCE NO.
TYPE OF STRUCTUJR ,� T�P�1 ��G PERMIT N0. � � � � (o�
\�
DATE
DAY. OF WEEK �
MA ti1AL DESCRIPTION ARCHITECT?
�n
INSP TTOR
MRS. CHARGED
X ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE ._
GENERAL I SUB
CONTRACTOR f\QI- ` jfYVZ ®C CONTRACTOR
, C- ,
�� `C���►
-T W /Awlitsezk�1
1
o a
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑ 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.
SIGNAT E OF REGISTE INSPECTOR
3 m 'L .507'7 7/7-�
DATjf OF REPORT REGISTER NUMBER