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0210-006 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of 1Chapter 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. ClassExR. Date ,Date/n "'/' 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. 'V) 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 STATE FUND Policy No. 046.000g7 3 (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'iftl should become subject to the workers' compensation,pr6&ons of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. ✓" ��� Date: ' "' " ' Applicant 1- 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. t r: ,,,Signature (Owner/Agent) ( t Date BUILDING PERMIT PERMIT# DATE VALUATION p 1I LOT TRACT . ry , r JOB SITE a ADDRESS •-956 RANCHO Aria LTA INTA DMVEI APN OWNER CONTRACTOR/DESIGNER/ENGINEER 130 BOX 1716 9.295 RMCk E0 LA. qCTINT DR, 1-4, gU%i,7v- CA 92253 L,A QIWAII,. Com. 922S3 (760>771-1941 lj.� 2996 t F PERMIT USE OR Vp E.,G` tVOLY .. M `f W SF?) ^ P..+C}`.►' s INCANT01 PE..RMIT DOUS NOT 114(1,Lt.DI f4:f,.C+C K WALL 3, P004 SRA OR, DRIVEWAY APPROACH, 13% MCN C:B°li1vr:,"Li, Fri R. . FLEDUC ZION FOR @JI>;.T1..'fiLPIX ISSUANCE OF SAME PL.F.1:4 TYPE OU.TINI ;tbI CONSTRUCTION 2,924.00,01? PORCH/PATIO 233J.16 so GAMMICMPORT 470.00 81' ESM", C.O.Ff OF CONSINUMION" 1:7110 240417110 MMMUCTION FEZ 101 ^W-418-000 %1,mm PLa3NC"NECKY+I:rF 101-000-439-319 013.17A R�i1t�C1i.�?aI�',c�td I 101 ^I9LSE��°21 ^OOG �l�La,4� ELr 'Ti .WCAL FEE ti 01-000-420-000 $160.24 FLU 1"#f131.N0 "IF, MSM 5'1'lk'.t'7NQ MOTIGN FREE Rl?SID 101 X000-241 -000 $2A.W (311ADD40 Myr 1.01.OW-423.000 0EVL1L4DPXR 111+IPAC:'f FFMI ART lel PUBLIC Pi. ACM • WIL 210.000445.000 �f rgft,�9 - SUB -'fit TAII. C.ONSp.CRid"LMON AND PLAIT CHWK $4,385.03 111SN .1? R UItP"D'r.Mkl Is $0,00 D MA -1:a MLa`11`M-1- 'FnMV`' 1) VEE NOW OCT 3 u 1001 CITY OF LA QUINTA RECEIPT 1? " 61 . �v irk t py i j +le P� DATE ALE `� INSPECTOR .' INSPECTION RECORD 3 OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings / -,9 Ducts ffc- Slab Grade Return Air Steel p Combustion Air Roof Deck .- — Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation - 1 - 3 Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall _ Exterior Lath - — Drywall - Int. Lath Final - 5 Final `' BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines _ _ �� �— J� _ Heater Final Water Piping Plumbing Top Out ��� Plumbing Final Equipment Enclosure Shower Pans / O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection — — Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) b �/ ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures _ Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final - Utility Notice (Perm) COMMENTS: REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ POST TENSIONED CONCRETE ❑ REINFORCED MASONRY O STRUCT. STEEL ASSEMBLY1Z— . ❑ ASPHALT ❑ FIRE PROOFING ��((�� ❑ OTHeR�X� JOB LOCA ON ` ` ` ` � � REPORT SEQUENCE NO. TYPE OF STRUCTURE - Lo 'z (� # c' ©,,,�� PERMIT N0. DATE 3 3 DAY OF WEEK MATERIAL DESCRIPTION roc\ AHITECT ?e C-4 e �f.- S ECTO HRS. CHARGED sloq1 ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR CYC ', SUB CONTRACTOR tl O N� `CGS• Q. C ti IJ W 1 _ M �$ Y<Xl � �. b�12 COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY 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. NATURE OF REr TERED INSPECTOR \ 3 IC26 SCh Z -1^1 Q DATE F REPORT REGISTER NUMBER REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. 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 ❑ POST TENSIONED CONCRETE ❑ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ��O �( OTHER JOB LOCATION Q A ` l � LN aQN\--, REPORT SEOUENCE NO. TYPE OF STRUCTURE�qpPERMIT \ NO. DAT o DAY OF WEEK M ERIAL DESCRIPTION t 111 ARCHITECT - INSPECTORI INSPECTOR MRS. CHARGED (� ��W..//, v tl ENGINEER vS-dVV! ASSISTANTS MRS. CHARGED INSPECTION DATE - -- GENERAL CONTRACTOR.- S y SUB ^,. �-CONTZ;TOR 1 30 L, L• ` ;c t� w 6r COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY 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. SIGNATURE OF REGISTERED INSPECTOR DATE OF REPORT REGISTER NUMBER