0402-016 (SFD)LICENSED CONTRACTOR DECLARATION
I ereby 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 y Exp Date
?S3SI?. B1 CIO fflro' ' ✓f 1/04
Date 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.
( ,) 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 Policy No.
EXEMPT
(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 �rshould become
subject to the workers' compensation provisions Section 3700 of the Labor
Code, I shall forthwith comply with those,provlsiodns. +/
Date: . E /> /a/r Applicant f- /Kr, b �
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 o.�this City to enter upon
the above-mentioned property for inspection purposes.
. Signature (Owner/Agent)- Date
1 .
BUILDING PERMIT PERMIT/i
DATE_ VALU ON'�`LOT Ot.-O�r•t TRACT
2 • 2914'-1
JOB SITE
APN
ADDRESS m -w0 sl ,mi.co,C.""EIZILrIS
761.4201-001
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
tiJFaxC:on- P.'onw s 1, T.,7..0
]CIU-110TI TIA C00191_Rucillox INC
81»07 0 e-EXIMMEM
78.070 CADIZ
LA QTJWrA CA 92253
IAQTJIREA CA 92233
(760)564-4832 CB1,0 3237
USE OF PERMIT
9WO E FAN91,S:'
VD - 1,0T 11P2AM 6: PIEAMITCX ES ?NOT .INCLU13F, 711.,00,x: MALLS,
P0*04 SP.A. L)F.3 DRIVEWAY APPROACH
CUSTOM CONSTRUCTION 3,516, 00 SF
PORCi PATIO 970.00 Sit.
(APLAGF;iMPORT 996.00 �) ?
3� 16-1MAdJ;.D, C0SA' (A W,7.Y.7rKRNAi..•Y.O
_Vi1,V17n40
CONS"TRUCTJON FES: 101-(K)0-418.000 51,3x.00
PLAN CHECK, I - Gr 101-0 00-439-318 v,113.411
MECHANICAL FZE '101.000.4,2.1-000 SI6150
ELFIC TRICAJ, FRE 101-00C-420-000 $210.3.4
P1,t1R41}INO FEY 101-000-419-000 S137.75
TRO7110 MOTION ftF,-13F.SIt3 '101 -000-'2.1-114)11 $30.60
0 MiD101EG 101.000.423-000 $15,00
TST,'Ir1A)PZR IMPACT FEE $2,405.00
PrW039 PLAN 101.000.441.345 $t00.A0
ART W KTIII..[C 'f LACI; - RESIF. 273-01310-1145.000
P;R;.1 ),q]'1' 101.000.439-'31'9 470,00
YV�r(a"MIRTIC-ITON AIMMAIJ o;:F :;
$3,855.62
O e� .` i21d^ 'Alii) li0' .�
-V50,00
FEB 10' 2004 `V r ti s 1,:P1:R='1 1 M.9 DVE':low
CITY OF LA QUINTA
FINANCE DEPT.
RECEIPT
DATE /
Illnr
BY
DAT FI ALE
INSPE
� , i �• r ✓��P
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
C
Underground Ducts
Forms & Footings
91_
Ducts
Slab Grade
_
_ /2--O
Return Air
Steel
Roof Deck
_
/�
Combustion Air
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
v
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
BLOCKWALL APPROVALS
Final
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 APPROVAL
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
ghower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
T
Encapsulation
Gas Piping
Gas Test
_
Appliances
Final
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)
COMMENTS:
vqe-
06/02/2004 03:54 FAX 001
R F STRUCTURAL CONSULTANTS, INC.
44-1 00 MONTEREY AVE. SUITE 201 -C. PALm DESERT, CA. 92260
F'Kl3P4E- t76G),- &aE-+Qlao . FAX (760) 836-01356
E-MAIL R.FRANdIF-(PVERIZC3N-NET
MAY 25, 2004
SOUTHERN HILLS DEVELOPMENT
8.1-070 CHANTICLEER DRIVE
LA'qUINTA, CA. 92253
Attn.: MR. JIM EVANDELL
Ke.:'TFfE-'S'CWMIT AT-PGAWEST, PLAN 6, LOT# I
81-010 SHYNECOCK HILLS
LA,Q'IJINTA, CA- 1 92253 53
FOLLOW-UP TO WALK THROUGH
JOB NO.: 4149
DEAR JIM
TFUS'LET TER- ADVISE S- THAT WE -HAVE OBSERVED T4ES-TiUCTURAL
REQUIREMENTS THAT ARE VISIBLE D-URING.-CO N-STItUCTLOIN AT THE TUAE. OF
OUR 'STITE-VISIT.-
WL-BL-L-*IE-VE--THAT--THE-:AS713UILT,.CONSTRUCUON"ATTFIE-TTrC� OF OUR VISIT IS
IN GENERAL CONFORMANcE'WI-a-I OUR STRUCTURAL PLANS AND RELEVANT
CORRESPONDENCE-ISSUEBY OUR OFFICE.
L
WE OBSERVED TEE BUILD ZING IN ITS FRAMED CONDITI.QN-P-RIOR TO
'NST-AL-L--AT'ON- - OF DltyWALL AND:MCCO. WE*OBSERVED THE VISUAL AND
ACCESSIBLE STRUCTURAL. REQUMEMEUT.& -(:EXC--LUSIoj,i&7AFTITEMS SUCH AS:
FOOTING'SIZE-A-ND RE04FORCIEMENT, TOP PLATE SPLICES, R SHEATHING,
AND ANY-STRAPS.-ABOVE-THE---ItpOF SHEATHING).
RESPECTFULLY SUBMITTED
a -d - 99130''SCH 09'L
P�p1STEgiep
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