0202-219 (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
10103 g 81G r 1✓ n,'3ijE9'�
Signature of Contractor
1
•fit l^y 1 L�tt
t,�s • t OWNER -BUILDER DECLARATION
I hereliy:afflrm under penalty of perjury that I am exempt from the Contractor's
LicenseLaw;for,the .following reason:
( ) I, as owner.o'ffthe property, or my employees with wages as their sole ;
compehsation;•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.
(J 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 Policy No.
VATS PM4D 010-AAR813-01
(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 thos ourisions.
1_11Date: - 7,P•e't7 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. 3-
1. Each person upon whose behalf this application is made & each person at F
whose request and for whose benefit work is performed under or pursu'antto
any permit issued as a result of this applicaton agrees to, & shall, indemnjfy
& hold harmless the City of La Quinta, its officers, agents and employees`:' i
2. Any permit issued as a result of this application becomes null and void •,ifs'
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 cancellatikon:'
Ga' ;
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 c�
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for ins efilon purposes.
Y�gnature (Owner/Agent) ° Date %'' �'' ®� j
BUILDING PERMIT PERMIT#
/
DATE VALUATION LOT (M 219 TRACT
J!'1 ' /:.• �- �"i :?,�►� .�k'k1� 44 29964
JOB SITE
APN
ADDRESS y RCUAL
i ��"'>� Rt�l�'.0 �l�,tlC :i'REt"C:�F�'t;�a
OWNER
CONTRACTOR/DESIGNER/EN (NEER
'PM L& QUWk TW
'i ILMS3 WEST I.TO S7 I NG DIC
SA141TEGO CA. 92131
Lk Q INTt, CA 9225
.
(75or'i'71-� 3363 CBLAq 4977,
USE OF PERMIT
'ULZFA_NM Y TY9EV 1Li90, -
S;PI) - :LOT 44 PU%N 2B, 1?I':RM 1? DOES NOT INCi> JDZ 8I..00h 'f1 AUA
1004 SPS. OR DIZ.i' E. WAY APPROACH
i
'Fi'Va T COTlN'1'kUCTEON 3gibm 8I+
PoRdrap.m.10 - 402.W SF
GA.FBMEJOARPOTr 07.00 11 i,V
EEs l MD COST OF {:O.t`a'SIMUL1 1.1109
1�Sxwam)
PX'wmtr btEE i'VMMA.Ry
CE 143 i'1tUCTION ME 10) -0()044 I S OL'10 $9041.50
PLAN CHECK F99 $798.71
MFICHWHICALYKIT, 109.000 -4,21 -WO $8$.00
L 101 -OW -420-000 $159.69
PLUM INO.' "p, 101-000.41.9.0.1-0 SITU$
STEt,ONQ 140TION FVE • RESID 101-00--241-P00 914.:36
OFt.tiMM ;199 101-WID-4t3_ 100 92411110
DZVZL0PMR..IMPACT 1E1:
SIJB-rorTAt; cmd13rkaucri-oi3 Am K" i..mx
A, 12€1.51
s
'FEB 2 7e,20 V` i
CY9°OFIS.AQVITA
!Cadep nne��;�.ra
RECEIPT ,
DATE-
DATE FINALEP
INSP C
/17 `
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
__ �j/L
Exhaust Fans
0. K. to WrapU.
Framing t
Compressor
Insulation
— G 2
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall -Int. Lath60
—/D- X72_
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
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
_ ,Q
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
70
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
Utility Notice (Perm)
d1.1L*
FROM PHONE NO. Apr. 11 2001 08:40AM P2
05lYdl2ya2 :3:'d3 6565763264 SWANSON ACSOCIATES PAGE' 01iei
S2)
414 Mupry carwos Pd.
S.0 A -I
;0urd an) Mao
Fa (948) b
May 20, 2002
MCComiC Consolidated / Tran6w'est Housing
9968 Hibert Street Suite 102
San Dicgo, CA 92181
Attn. Herb
Sub].: 1nzpecttoti
STRTi UMMARY
TjUzeto at La QuInta
Inspect:= Date:
Model Number / type: Plan 1,2,3,41x§742 firu 45'
Construction Phase, Phase 2
The framing inspection consisted of A visual review of the structural Lateral System and
verification( of sheartnaRs, hardware, and building anchorage. T'he.es built product was
compared to the appromd pians. The trained portions of the lateral syat= were found to be
In sabstanual conVIm oce with th.. approved plan, and the previously discovered
Incomplete work was satisfactorily completed.,
The visual inspection fs limited to the lateral bracing elements normally installed at
the &arising stage, Including drag straps, plywood bracing parcels and holdovm anchors.
Since a portion of the project may re -`-Y on stucco plaster and drywall bracing panels, no
opinion is expressed or implied about the compliance of the stucco/drywall nailing.
This letter is provided at your request and is for biformational purposes only. It ;lei
intended to confirm the fren ing subcontractor's understanding of the structural plans and .
in9tallation of the framing elements shown on the approved drawW' 9$. It does not provide
a guarantee or warrantee against deficicrcies-or performance of the building prvdiact or
provide evidence of building agency approvals or special inspections.
Respectfully submitted, _
Mar Swanson. PE