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LICENSED CONTRACTOR DECLARATION
I hereby'affirm under penalty of perjury that I am licensed under provisions of
ChaptP,r 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
723317 $ 05 ID 1/201
yDat' e !1_ Signature of Contractor r
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
I hereby affirm under ,penalty of perjury one of the following declarations:
() I have and mill 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:
Cartier Policy No. _
`�'XTS VUNJ) 1.423530"
(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
subjectIo the workers' compensation provisions of Section 3700 of the Labor
Coe I shall forthwith comply with those provisions.
Rate: l 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 pursuantp
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.
Signature (Owner/Agent)��+'�.•-t^:✓:*s�!r✓J,r'%..._.: Date
BUILDING PERMIT PERMIT
�'�
DATE 06/081 199 VALUATION S300.60 LOT 41.5 TRACT [.1N+70-1
JOB SITE
ADDRESS 78-465 COYOTE CANYON COURT
OWNER
CONTRACTOR/DESIGNER/ENGINEER
"r O & V A L IS11 JF IT
LUDIN TON LrINK f7.ENS:RAL
2660 NV 00[.XXEN
74-991 JON1 DRIV E 01 r
Wt 53W5
PAL4 DCSFKf CA 92260
C 1x)1568-6070 C BL# 2274
USE OF PERMIT
tvL[Sf `.�T�LA.N Ec�i.+
i Mi'd113.�\Ti �' t;C.►N ; <. tJC a Fv2`I "i RAdL0,2 E'ER, tvW 99-1-13
VAIXtk iC314 300,00 .LS
ESTat 'IVED COST OF CONST%WC710.N
30"Ato
PERMIT FEE SUMMARY
'3� iN Cala;3"1 t�14:'!'tC�Iv'ft2sLif Fs'i 101-000423-000
� "s `!�:dr C C)?��, ;t"3i�J'C71 iON t N1) l TAN` CfIFC.
PUT,-
JUN 0 81999 'I'VaAll
VKH.MM FC11KIN 061? NO
$200.00
;1i l ®'F LA 0111 NIT
RECEIPT
DATE
BY /
DATE FINALED
INSPECTOR
K-1
I 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
OX 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground P[bg. Test
Final I I
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
COMMENTS:
Final
Utility Notice (Gas)
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)
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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 ❑ C7 a P
❑POST TENSIONED CONCRETE ❑ ASPHALTpTHER J 7 ,/� 04
❑ REINFORCED MASONRY ❑ FIRE PROOFING Q' t(.�-�� of 04' -
JOB LOCATION /' 0 t ci4 LA Qvi
,/•��/
REPORT SEQUENCE N0.
TYPE F STR TORE
;� �',� . Lica-1 °T'O � �Q,�s .
PERMIT N0.
-
DATE
DAY OF WEEK
MATERIAL DESCRIPTION !-
ARCHITECT
CTOR
NRS. CHARGED
^-W t A^ �
]LINSPECTION
ENGINEER
ASSISTANTS
HRS. CHARGED
GENNE[RA`L/ SUB
DATE CONTRACTOR LV l �i9h L 11^I 1� CONTRACTORFb,J • L� •��Z t �g..
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CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
J
I NATURE OF REGISTE INSPECTO
I d 63 �C) (t�
DA OF REPORT REGISTER NUMBER
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