0105-187 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalt;Rof perjury that I am licensed under provisions of
Chapter 9 (commencing with -Section 7000) of Division 3 of the Business and
Professionals Code,'knd my License is in full force and effect.
License # Lic. Class Exp. Date
3;a7tft C53'>I 1 -1 -Tc
DateSignature 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. ., .l
(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 pro isions of Secti n 3700 of the Labor
Code, I shall forthwith comply with those s&on ,
Date: d" ,,�I 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 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'cf 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
4, the above-mentioned property i s' ectti�,onn , rposes.
Signature (Owner/Agent)�f- Date
4" !�
_..!-.__. --- -
BUILDING PERMIT PERMIT#,
DATE VALUATION LOT 01024 87 TRACT r J
$91S .00
JOB SITE
APN
ADDRESSL9 q 53 i y f y "E 810=1
OWNER
CONTRACTOR / DESIGNER / EN &NEER
MR, alavitT00.
'WESTEMN 1>001,10
79-15 3 . IZA4 IFAV01.410, 30=4
4337$ T"0121024 W
T A (,,)MTA OA 02253
INDIO OA 9.22A2
(76(1)347-5959 CBIA 1151
USE OF PERMIT
P001, AXD1'i0,R :SPA
iP00I. "SPAIWATM W A1`UIMS,.sAYA,t21t W3.4+.3f�.i1 P,3 5HAL L HF, tN PI ACK
AT KUP—PLAOTM' ItI3M-710N, .POOL iQU1PMFXT ENCLO31T1M NOT
YNCL aDED.
POOL ANIVOR SPA 4 ,,MOD U
H1s'.CMA330 COST OF (:0ASIMU Ofl1i'
1172.f N C.URCK FEE 101.000.4"39«31.8 VA8130
(:OWa'iRUC110N FEW 101 -000 -418 -WO
MECHANICALEE .t.?tPOh(t9F 101V-WO-41•2/R�-1/100
IfLIFI ;7' tICIAL, PRE ... Pool, 101.000.1620-()QQ
flal.ilil B341O'Pi�F ,.. Pool, •� �aK q> 3d?,Ct1
MAY 1 7 2001
CITY OF LA QUINTA
FINANCE DEPT
"LM P 1pFm M.73M
$0.00
TMAL MOW 1W.S DDE XOW
RECEIPTDATE
m I..,1..
Y
vJ-`
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
SYsal
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
steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Je S
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
Gas Piping
Encapsulation
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:
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,SPECIAL INSPECTION SERVICE-�
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 ❑ OTHER
REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION'-- 1 '^�^�-'-�-+--
•� 9 �- I S j X50 M4L!a A�
REPORT SEQUENCE N0.
TYPE OF STRUCTURE- _ •- _ -
5FD Nc�� ..�� a 71 ^Q-VLw
PERMIT NO.
DAT
.DAY OF WEEK
MATERIAL DESCRIPTION -
ARCHITECT ff
it 145-Soc.I>,
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS.'CHARGED
INSPECTION GENERAL�j pp SUB
DATE CONTRACTOR * S �O FSE{ s C.ONTRACTOR.. o .A- ✓ . '
q 6�
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COPY SENT TO CLIENT ❑
CONTINUED ON NE%T PAGE ❑
PAGE d, OF
CERTIFICATION OF COMPLIANCE ;
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY } SIGNATURE 0F.REGISTERED ECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE,
« NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED C.B 32� Ax
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS -OF THE
GOVERNING BUILDING LAWS. DATE OF REPORT REGISTER NUMBER
. r -
SPECIAL INSPECTION SFR
REGISTERED INSPECTOR'S WEEKLY REPORT
JON.TANDY -
37630 Medjool -Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7..193
Pager (760), 776-3338
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE D ASPHALT ❑ OTHER `
/ff.REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION„
---f �� -'L51 fv w� . 'Fazio �� LA a A:10
k -REPORT
SEQUENCE NO.
-ik ,
TYPE OF STRUCTURE '--'' -' - - --
`S 1PIb .i) a t.•.ttC.c.T (Les ® -q-
PERMIT NO:_ -- --- -_.��
d oa b -- l ZZ
-�;
DATE
I f c'o -
DAY OF WEEK.
MATERIAL DESCRIPTION
ARCHITECT
o As S O L
INSPECTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE - ' CONTRACTOR 5 o e.
SUB
-- CONTRACTOR
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' 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., I .
SIGNATURE OF REGIST ED INSPECTOR
DAIE OF 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
O POST TENSIONED CONCRETE
PoOREINFORCED MASONRY
O STRUCT. STEEL ASSEMBLY
O ASPHALT
❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION-
- /7, /rl
-2
_
/V . 6,14-r/ 14
REPORT SEOUENCE NO.
TYP OF STRUCT E
3a
PERMIT NO. - ------
DA
o0
DAY OF WEEK
MATERIAL DESCRIPTION
ARCH
ECT
19
I PEC
HRS. CHARGED
ENGIN E
a kd
ASSISTANTS
HRS. CHARGED
INSPECTION - GENERAL-_
DATE CONTRACTOR —
SUB
CONTRACTOR
LIP
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/2 u
vsk
G -
COPY SENT TO CLIENT O
CON NUED ON NEXT AGE 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.
4
SIGNAT RE F REGISTERED INSPECTOR
7 Od 6-0-57 .4 ),q --F�
DATE 0 RE ORT REGISTER NUMBER
7,.
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
,SPECIAL' • Fax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
O POST TENSIONED CONCRETE O ASPHALT
REINFORCED MASONRY ❑ FIRE PROOFING
❑
O OTHER
JOB LOCATION -71— 5/ / -0� FA?-je (�
REPORT SEQUENCE N0.
TYPE OF STRUCTURE - -
S -D EN+ u c ci ® i ko Chu
PERMIT NO. - - - -- - - -
00 Die - /Z Z
1INSPECTOFf1HRS.CHARGED
DAT
2!eoo
DAY OF WEEK
MATERIAL DESCRIPTION
$ X 6' �c l
ARCHIT CT
6C OA A5S'0 L
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ENGINEER,(, j L
Ho -x (s sA G'i •
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL
DATE CONTRACTOR S
SUB
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COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE
' i 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.
lflJ CC4-16MRCI�
SIGNATURE OF REGISTERED IN CTOR
TCDD Iri1.3ih�'�
DAT OF REPORT REGISTER NUMBER