0202-220 (SFD)LICENSED CONTRACTOR DECLARATION BUILDING PERMIT
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 DATE VALUATION LOT
Professionals Code, and my License is in full force and effect. r
Lide'hse # Lic. Class Exp. Date ' Z % °' �' .3 A; t
JOB SITE
ADDRESS
701039 � �ThC I�1li}3
Date Z Signature of Contractor owNER .,
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 Sionature 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
Ssiction 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.
1TATE 1•"tbK) 000.1641)815..0.8
(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 provisi.- s of Section 3700 of the Labor
Code, 1 hall forthwith comply with tho4 �,ro I ions.
"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 builping
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insppcction purposes. - r
Signature (Owner/Agent) Date6 Z' Cl"'
j.r
I.M. L A C3L:+:WTA, :I:W
59681 DEBT ISMEXf, IMME 102
X311+.CTO . CA 92131
USE OF PERMIT
PERMIT #
TRACT
4';
APN
s
CONTRACTOR / DESIONER / EN61NEER
MkINITSrI x°HC3T SMS 14C r
lit -401 17HECrHWKY- I1 t
(760)771-3363 CWJi 4 1.2
.1
SFD - LOT 4:% PiJIN 51A. P.X10AIT DOES NOT INC',.1..UOP, BLOCK.
WALI.^o P00Iy SPA. OR DRIVE WAY.APPROA,CI.1.-1,5% PLAN C HU60K FZ
REDUCTION FOR, MULTIPLE ISSUANCE OF SAMIE TYPE
TRA,CT Cfa?1:1"i"RUCk'ION X535,00 IIF
rORMPATICi 676.00 SF
Ca » i1` �°fC 1� PtJI 662M V
.F S1 .WIND COOL f 01' V -005"I d UCTIOfd 21:3,672.2.)
COM'i':s UCT1L'91 FEE 101.-000-41.8.000 51,03 ,50
PLAN C.HFC-K PLE $21401
w7cwwICAL r,749 S92150
l:1.=WI'WC..AL FEE, i 1 f11 �i�t9-�taD-t)flt? $01117
PLUMBING rep, 4101,-000.419.000 MIX
0R4+,1 IWO FFX 101.000.4 3.000 $251,00
DEVELOM, IMPACT FLIZ $1,90.00
ART 114 PUBLIC PLACES - :RF'A1'1: 270-000-X145.000 $34.18
U.0—P, TOTJ�,CONSTRUMITIDX AR1311LAW ME C.X.
LESS PRR-:PA1D ITT. 0
FE27 2002 1W,#J1x)TAJ,,P1 rr F*NES, D 0 NOw
RECEIPT DATE BY DATE FINALD INSPEC
7'i 2 '�
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings11
U
Ducts
Slab Grade
O
Retum Air
Steel
Combustion Air
Roof Deck
_ L
Exhaust Fans
O.K to Wrap
,�
F.A.U.
Framing
_ _
;J�
Compressor
Insulation
_ _
,—�
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Q • Q- O
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 Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Water Piping
—7 C/, z
,roA
Heater Final
Plumbing Final
Plumbing Top Out
Shower Pans
Sewer Lateral
�����
Equipment Enclosure
O.K. for Finish Plaster
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
r
Appliances
Final
COMMENTS:
Final -
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 'vim
Low Voltage Wiring /
Fixtures
Retain Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final -
Utility Notice (Perm) Q • O
FROM PHONE NO. Apr. 11 2001 08:40AM P2
b51 Ydl'lyaY _ 3� 'd3 6585763264 SWANSOIJ ��ESOCIATES PAGE 01/ e1
414 M .Rd.
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eas
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MCComlc Consolidated / Transavest Housing May 20. 202
9968 Hebert Street Suite 102
San Diego, CA 92131
Atter Herb
Subl•.. inspection
STiiII atc it# a 9Wnta un4MAItY
srnto apt La festa
7a:!
Inspection bate: -
Model Number / type: Plan 1.2,3,4 lotk-42 thru 45,._,,T
Construction Phase, phase 2
&Ammary of Findinox:
The framing inspection consisted cf a visual review of the structural Lateral System and
verification of shearwalls, hardware. and building anchorage. The as built product was
comp8 red. to the apprormd plans. The framed portions of the lateral system were fow.d to be
In sabs=tlal cornpti2nce with th., approved plans, and the previously discot,ered
incomplete work was satisfactorily completed.
The visual inspection is :united m the lateral bracing elements normally installed at
the frard1mg stage. lncludirg drag strips, plywood bracing panels and holaown anchors.
Since a portion of The project may "e. -.y on stuccojplastmr and drywall bracing panels, no
opinion is expressed or implied about the compliance of rine stucco/drywall nailing.
This letter is provided at your request atid is for iitfortnational purposes only. It 19
intended to confirm the framing subeontractw's understanding of the stnictural plana and
in9taltation of the framing elements shown on the approved drawigs. It does not provide
a guarantee or warrantee against deficiencies or perforruanee of the b,wldirig product or
provide evidence of building agency approvals or special inspections,.
Respectfully submitted,
Mar . Swanson. PL