0202-221 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury -that I am licensed under provisions of
cCnapter 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
.. 701039 B RX401 � 1/31/x3
Date ��'—T4, Signature of Contractors r—
:','ta OWNER
-BUILDER DECLARATION
ATIONreby affirm'under penalty of perjury that I am exempt from the Contractor's
License. Law for the. following reason:
( ) t,'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.
'U, I have and will maintain workers' compensation insurance, as required by
,,89,ction 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 {� } yy q/r FUNDPolicy No. tn} 1lA qq4 t
(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,
1 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 p ovisions.
Date: VZ,r� Applicant 41 s � 06
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
7.
application. �" 1
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 voidif �f
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 cancellatloh?,I
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'nsg ction purposes.
Signature (Owner/Agent) �� 1',a' Date
BUILDING. PERMIT PERMIT#
DATEVALUATION LOT(, TRACT
,591.9' �+�� 213£�.f
JOB SITE
ADDRESS
APN
19-'610 p o S ,.PASMAL
649-14a-01.15
OWNER
CONTRACTOR / DESIGNER / ENGINEER
k
Pali LA Qlaam,, UC
11R.+M wi�,.l r HOX3MTOr WC:
996€3111B)MT UMEET, ;XnIE 102
78-4-01 F.H101`iVi'AY 111
SM'DIE-00 CIA 92131
LA CIA 92253
(76 ,0),7 71.330 CBIA 4972
USE OF PERMIT
=GT L I?AMffy Dih1Mj,1A7:1•
3?0 - LOT42 i``i.AN iA. .PERMIT DOES ;NOT.I;l+if, LURE, BLOCK WALLS;
P001, SPA OR I: RIV'&'667.AV APPROA6; K 73% i`UNN C'H1kCK YU
REDUCTION FOR MULTIPLE 1.481JAIICE OF SAME PL '14 TTP&
TRACT CONSTWJCTION SW
P701ZCHIPATIO X16.00 SP
CkARAKRYCAi PORT 649.00 SY -
UF.AA.e"+u.NA J.MO C09f 011 CONISTRIMMM
AC.'�'. 191.. �e.TL�,20
FERMI FEE 9UMMARY
ti, QCKSTR6.i4.TIONFF-E, 101.000.418.000
PLAN Cf ECC Is',' 101-000-439-318
MI+,G13AA1C':f',L EE 101.000-521.000
VXCTIUCALIME t01-000-420-000 Q14%dS
3'I.IgYJt1+1�IC1 i'1's 101-000--419-000 81.91.25
,
S TA0N167 R OT1023 FEE 0 ft -WD 101-000-241-000 $19.19
'
C.I%l 31NO FEE 101 yet 00.423 -WO $20.00
D.W&J.DPE P, IMPACT MR
ff ar -pr i x. c� r iasc A�� ni
.Yee
•..�.lr
$31544.317.
yy yy�qP�C.ate �.pcR e�'
., ' F " ' d..�P.,,�T' .i'kl; .,i}. Fd'�/�•.CJ" °e6T
P :. " •$0,00
L6 27 2002
-RECEIPT - =-' `'-', :
'DATE- f ti
BY '
DAT FINALE%,
INSPEC ,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
-2 - Z
Return Air
Steel
Combustion Air
Roof Deck
�,,�1/ _
Exhaust Fans
O.K. to Wrap
p
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
'L
Drywall - Int. Lath
Final — 4 2-,
Final r- 7Z,
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 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
/ —
Pool Cover
Sewer Connection
/
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit _
Rough Wiring vV
vv
Low Voltage Wiring ZA
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power 10 5V
Final
Utility Notice (Perm) - �O
COMMENTS:
1 17DI1ala082 11:.13 8585763264 SWg1�ON ASSOCIATES s;PAGE ;B 0
- 7q-6, P ,
j" I 177 6 4Z
8014 My,Vkr/ CeW R!. q,,5 r 79-670
/ I
SUb M30
Son " V40, CA 88123 ' Dhono 1358) 57a M
Fix (898) 576.9¢84
WCornic Consolidated / Transwest Housing.
9968 Hibert Street Suite 102
San Diego, CA 92131
Attn: Herb
Subl.: 'Inspection
'•May 20, 2002
B.TRUC n AhUNQ INSPECTION SUMMA".
Tallante At La quiata
Inspection Date: May 16th 2002---- i
Model Number / type: Plan 1,2,3,416ta 42 ., u�45_\ .
Construction Phase: Phase 2
mazyofofFinjiin0s
The framing inspection consisted of a visual review of the structural Lateral System and
verification of shearwalls, hardware,and building anchorage. The as built product was. .
compared to the approved plans. The framed portions of the lateral system were found to be
in substantial compliance with tha approved.: plans, and the • previously discovered.
incomplete work was satisfactorily completed.
,The visual inspection is limited to the lateral bracing elements normally installed at
the framing stage, including drag straps, plywood bracing panels and holdown anchors. -
Since a portion of the project may rely 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 informational purposes only, It is
intended to confirm the framing subcimtractor's understanding of the atructura1 plans and
( installation of the framing elements shown on the approved d; -Wings. It does not provide
a guarantee or warrantee against dellciencles or performance of the building product or
pr(wide evidence of building agency approvals or special inspections.
' Respectfully submitted,
' Mar . Swanson, PE
r