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0309-065 (AR)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Wb Professionals Code, and my License is in full force and effect. :3 m License # Lic. Class Exp. Date P -;.v LO 11;'0 ].1 H1.CJ3112E r r- _ •^ ----^� I Z r� Date �Slgnature of Contractor �. �O� T J U � OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ CAI License Law for the following reason: Z_ ( ) 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). C'') () I am exempt under Section , B&P.C. for this reason LO N Date Signature of Owner ON rn d Q WORKER'S COMPENSATION DECLARATION p Cc I hereby affirm under penalty of perjury one of the following declarations: LO O ( ) I have and will maintain a certificate of consent to self -insure for workers' X U �= compensation, as provided for by Section 3700 of. the Labor Code, for the O � Q performance of the work for which this permit is issued. M Q I have and will maintain workers' compensation insurance, as required by D U Q Section 3700 of the Labor Code, for the performance of the work for which this LO F— permit is issued. My workers' compensation insurance carrier & policy no. are: Z Carrier STATE PU.ND Policy No. 1154142-01 ob 5 r\ C) J (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 Sectiog 3700 of the Labor Code,, I shall forthwith cortipl'.with thos4rovisioos. fDate: /—Z0` Dry' Applic'ant_` • Warning: Failure to secure Workers' Compensations c verag unlawful and shall subject an employer to criminal penalties and"clvll fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. ' 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. —Jit s'rf'/!3 r/ C Signature (Owner/Agent) , _ Date f, � BUILDING PERMIT PERMIT k DATE VALUATION 5831043190 LOT 2 TRACTJOB SITE ADDRESS i9-+$�'�SD'iTOM .lr`.AVO _r A V:O ;�I01i`S Nt APN OWNER " CONTRACTOR/DESIGNER/ENGINEER TERRY JOIRM 1,A QLrMTA CA 92253 USE OF PERMIT A ZE:"i3DE EARL Alr►DT',Gl' N 13Aix' ADDITION (3061 3,F), 2001 CBC CUSTO.?d CaNOTRUC1ION C3. R AOWCA, ,PPt7RT °I.R.. NOTE W NSMI UC."TION 14.894 LL'1JNON Pi.P.C14 S'i:K C-1 TIAIL?uL 3JEM.RT CA 92260 (/60)341-7942 C',LLO 2518 A 1,061,00 an.nct �r{ IFF 1: w'rS'i"ii"TED COST O CONSr"1RUCMO'1.V 8301390 CONSTRUCTION lei R 101-000-438-000 $507,50 PLAN C;NECK F1,;E 101.000- 639-318 $445,34 MECHANICAL FEE 101.000-421-000 W.50 XLPX,'TR1CA1,F'EE 103-000-420-000 $73. 3 9 PLUMBING FES 101-600.419.00€ $49.30 N'ri?.ONO MOTION IM -1, u R N S13D 101-000-241-000 S3.30 RECEIPT KIB-TOTAT, CC?1LTS:'R1:FCT 011 AND P:1.,1AN (14MCK LESS PRE -PPM M.13 L[TAJ, F -n n- YlIKEISDUE NOW JAN 14 1004 OF LA iFljVA�,iO5 (INSPECTOR `w�1:182.C15 �t4,6t� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings Underground Ducts Ducts Slab Grade AReturn ?8 Air Steel Combustion Air Roof Deck Z 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 POOLS - SPAS BLOCKWALL APPROVALS 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 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) r,... , iPr'� r�7r—FI!w"�'h•� ?"-��` - ,... ..ae.-.y,�r; ; :*,,. p. ..,,,�^•.: e.:. .... �.-n9r,•-•�'-�"r+'R7 .. INSPECTION LOG GARY HARTMAN ¢bsyf,,p' 'y<.::r:........ _.. ,a , �_..._... ,,.i'-.0.,.yi'.�^�`' "r. ''�i31.. stir.:xyz»• . _.�,>;:;;.,�,s.:d,•�;>.�„ Pill—, `c L .7 a L.t i;oa4 �Z- ct LA �i t Ste` I - /k, G L 33 �' c yt� ise cam' ~ �` i .r's-• �:"'� ate:. StoneCceek�: c t `�.t �� �✓•-3 c� 2 5-z z? - A.�3 L 9 i Zia 5'2-,� z 44.6�� f L It-/ 3 IA 3 -FUS-...,, S ✓c'cC✓ til �( C,�Q c 7'.,--� �� ..�-t {241S ff 112-1-1 �✓ (� 1Lj L( L 3,�e Y A 2 i? �.2i W rellc r�,<* I . {, r - - N ry 1! y w fT�, q,.� ✓J%' �j��+},e}{� ... .. x . �;: ✓i<.KSv' 7J�.'r-�.��.J.�+fa•A� +x�x4• G3J' K>r.. +.;i.=?'2l i+; �L t'*. g! �� a�µQy�V�f�,7�Qy }{.�fj ti-4�. •L>I�AFy:].AwJ=3hr�. -IV , ccit 1�.^:.. tlw.l4 p�<Nr."°.1,,,.it.:a'��2:.••'3:f.'::�}s-[+ti ~Y , i }. 711&�- .s ` C-� l i=tom✓ �,% 7—U 'i Date: / • /- � S �. RFr:IsTFRFD INSPECTOR'S WEEKLY REPORT JON TANDY 78-194 Elenbrook Ct. 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 O POST TENSIONED CONCRETE O ASPHALT -THER O REINFORCED MASONRY ❑ FIRE PROOFING JOB LOCATION /E / ^ 6A2113 U -A tAv . [-Io�L.L k* REPORT SEQUENCE NO. TVPE�MURE PERMIT© O -- , E o- DAV OF WEEK MATERIAL DESCRIPTION ARCHITECT v INTO r HRS. CHARGED o ENGINEa-- IRB {'TA c ASSISTANTS MRS. CHARGED INSPECTION DATE - GENERAL --CONTRACTOR - - - - - - SUB - • • - CONTRACTOR Lo 74. j jJ'� UlS �'v lam' l tL C) .S McA-,A- i COPY SENT TO CLIENT O CON ED 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. W r` SIG ATUROF R GISTE O INSPEC'OR ���� aIJI D DATE OF REPORT REGISTER NUMBER