0211-105 (BLCK)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
7 7 23007 C29
Date7Signature of Contractor—
OWNER-BUILDER
ontrasor 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 STATE, PUNS: Policy No. 046-10&3-02
(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,those^p�royisions.__11�..- ;_
Date:. +TG -+'J; Applicant ;i y ..� -K
Warning: Failure to secure Workers' Compensation overage 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 pursuantto
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 buildinIt g
construction, and hereby authorize representatives of this City to enter upon'
the above-mentioned property, for inspection purposes. E'
Signature (Owner/Agent) % �"'�Date>s" .%'� P��°%
BUILDING PERMIT PERMIT#
021.1-1
DATE 3 VALUATION LOT TRACT
_
• r
JOB SITE `
APN
ADDRESS T 1-5m AMI -NDA F=WWWO
OWNER .
CONTRACTOR / DESIGNER / EN (NEER
SIEVE E DAViS
BOG Akf I. FLSOU`RY
7?-5V)AV'MMAF17_F;__D0
P101 BOX 2:395
L�1 �i;i i_TA �'�. x+ 25
"MCC. VAUL�1� �;%i 142286
(767)365-4213 (Mldf 6200
USE OF PERMIT
GENW IMr WILDING
0017 IT 63WC K.. rs'd'A 1., PER R:DO W'1~31SP.0 MPXID APPROVED PL1 t"S
6 J-7.117AII 490,00 LV
P��yy:7��I
�"a1`�r{'.+�(a�(s,:�Y'��h3��V�:P�'.�#RY ry1 F1p�/� �p y=� 181,75
} v+y(
S"LMN \n%`�ECK sY'1 9 � V d ^V1/V����7 hr � A Q 181, Tia
c"OlanzycTION PEr. ! 11,8 100 $135.63
cilu
C -OF QUIti'f
HANCE LEPT. A
,411..- k )TL CONI£ ":'x UC"1701q,ANT) Isla• CTIECK
LEX3 PRE- PAID FM
V100
TOTAL 1:1 -MMI YEEN DUE 14ON-V
$212-75
RECEIPTDATE
�)
BY JJ
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
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
Drywall - Int. Lath
Final
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
Heater Final
Water Piping
Plumbing Final
P14nbing Top Out
Equipment Enclosure
Stlower Pans
O.K. for Finish Plaster
S wer Lateral
Pool Cover
S ver Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Trrnp. Power Pole
Underground Conduit
Rough Wiring
Lcw Voftage 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
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY O
❑ POST TENSIONED CONCRETE O ASPHALT ❑ OTHER
VREINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION -77-
^O A 11C , `' Dw h f-M�� I A /� /�
'�) K N ry 1!/'�
REPORT SEQUENCE NO.
TYPE OF ST CT E
G� '�E l+( A� (. AVi E 3
PERMIT NO.
D (t - -(o5
DATE
1
DAY OF WEEK
MATERIAL DESCRIPTION
lima - eft y qY66 b x Xl
ARCHITECT
INSPECTOR
I 'P . 'D•
NRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB
DATE CONTRACTOR CONTRACTOR AT Aff 0 ASOt
P05 -r ?, mf4 \[ Z S
OkL ST Q -r 5t" U" tfied &ac's
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7 LAT at d L L. p NA VCr�
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-A -" lrAt kkbo4k V
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4 mw n/ e c e 15 �` u INTI) ALICAJAICNI
OF eMu e'ed- 'VEbR Nn 'W
TRO -P (,17 F)D (-t 1 QA/ T( ib -7ZP 110,1676VOL
.COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE CI
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF M1
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 REGISTERIQ INSPECTOR
! 2 23- C2 /111.3?6- y
DATE OF REPORT REGISTER NUMBER
,it
5-6-2004
P.O. Box 1504
78-495 CALLE TAMPICO (7 60) 777-7000
LA QUINTA; CALIFORNIA 92253 FAX (760) 777-7101
STEVE DAVIS
77-500 AVENIDA FERNANDO
La Quinta, CA., 92253
RE: BLOCK WALL PERMIT 0211-105
Dear STEVE DAVIS
The purpose of this letter is to inform you that your BLOCK WALL PERMIT 0211-105, for
the project at 77-500 AVENIDA FERNANDO, has expired. In accordance with 2001 CBC
section 106.4.4, no further work may be performed until a new permit has been issued.
Please contact RICHARD KIRKLAND, Building Inspector, at (760) 760-777-7016 to obtain
any information you need regarding a new permit and/or any required inspections. Should you
choose not to complete the project, we would then have to pursue any or all of the following
actions:
1) Abatement of the project through the City Attorney's Office -and Code Compliance Division.
2) Notice of non -conforming structure placed upon property profile.
Please contact us at your earliest convenience prior to 10 working days to resolve this, issue, and
for any questions you may have.
Sincerely
RICHARD KIRKLAND
SENIOR Building Inspector
cc: file
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