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9810-067 (SFD)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 bate ` 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. 70,44, 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) I have'arid 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 t� Policy No: y+R/.qry ti�'A ll. l �di C L4 VJ�b'a1• GL•3F� (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 provisions. Date: 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 Quints, 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 fo Inspe tion purposes. Signature (Owner/Agent) Date PERMIT # CONTROL # BUILDING PERMIT,a���� DATE VALUATIONLOT b^-�� �4C� �'> TRACT +► a �8-, 15 JOB SITE ADDRESS 7! =-235 TOROINJA APN 169-40410 s OWNER CONTRACTOR / DESIGNER / ENG{ IINEERR y7 7 yA ♦ 1 �+ RI 1 i"[�_1�1�u. S 1,��uE (� RI IN4i;,S �, Ei�:'l��J, l{`it e'ia iCiiticiii 1 2 _i C�'1vEV1 its 1)iuw CA 92253 PHOENIX AZ 85034 (602)7_57-1656 C13L# 4990. USE OF PERMIT f 1 Si'•T.i, ;La` T ## 8, f1 -J V14 V, #YkJW- T 1071.5 NOT .INCLUD13 Bi.uM'ifJALL OR Pool.. . 11FAt1b1T :FEE )L:I:CJtlLkiD Ify' 75°,+'e FOR MULTIPLE MUANCIE all, SAME PLAN rYPR, +;"i15",.'vU4L}NS"4RUV.1014 6.$177,00 3 K dfl. ap'A: CSG 201.00 Isr - f3iiFtAi'ihlC,t4[iI''(,�1't!' lIl�8.'#.YR,.�Y7 'l.ti.Y�:w1. tY$� '1..MJl'L�P 1�i .8iEJ �wYiOstiT.. �214j` -5140 ��yy. eep�'��y'y+g• (� x� •y�. ,�..RY 8�EC,61lR lt's�.E SM1�.+1.LVIl�RY Coidi'i'12UC3I.olsl IER, f.U1-Ut9U-�i1t�UUU �1,i}�42.(ni PLAN Q'If,"CK F'F 101 -OW -439-3 18 S214,47 f!4'kiM1\NICAL. F'ER 101-000--421-000- VII .50 ELEC-31100AL FEE 1UI-t100--i2413(i0 $159.34 PLUME: fNO FEF? 10.1-000-419-M $1t0. W STRONG MOTION T-Vd-RES.ID 101-OOD-24.1-000 $21.49 GRADING EFF, 101-S34t3-423-000 $20,00 1.H1?I`cA.S'i RV(_n`1BRU%. HL 225ACsG:443-342 &V773,50 ART IN PURLIC PLACES • .RL-Nl , 701-000-255-000 5287.14 * - I ..top �t 4 q(EP?iy�N7�yyJ?�h �+EES ,• LESS* 1.0 /�i?y OCT 4.1998 1 u eiT � LA RECEIPTDATE Z'• BY ' , DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs - _ Underground Ducts Forms & Footings Slab Grade _ Ducts Return Air Steel Combustion Air Roof Deck _ Exhaust Fans O.K to Wrap F.A.U. Framing a Compressor Insulation' — —- Vents Fireplace P.L. Grills. Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath G Drywall - Int. Lath Final Final � G' 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 I I Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines GL3(}- Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection 76& Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power t R Final Utility Notice (Perm)— �_ COMMENTS: kew1mEarth Systems Consultants 9-811 B Country Club Drive 7Bermuda Dunes, CA 92201 , Squthwest (760) 345-1588 • (800) 924-7015 DAILY REPORT OF INSRECTION OF CONCRETE SB/R.S CO. GOV. UBC TITLE 21/24 OTHER Building Permit No.: DSA Application No.: ------�___ Date of Inspection: ' � Project Name:' C— r q +tet S �t t(: i? 5-I r AC f / �I Job No.: s -T`1 Cn , /` I Project Address: L . i'7 d' Architect: A- !,� Structural Engineer: General Contractor: .� .�• Sub Contractor: /-r x'1 2 TYKE OF INSPECTION: Reinforcing placement ether E00 -/-9 �-&,F Description of Work Inspected: _ ` Pe? C— -f 0_e 5 ©� - S i 2C.h � 7' /?t � T /7< - 7`./74' uv P P 2 C_ o IL V V ` I (�' 1:- 75 nice.. 4 /Z ©0— , 2: S� 5 TOO V_ c, �► ' l� tl`j n Imo l L o rt -30 Unresolved Items: �. Descriptive Location of Samples: r Slump: Cone Temp: Time in Mixer: . Supplier: Admixture: Water Added: �� Air Temp: Specified Strength: Mix Design: Truck #: Air Content, %: �� Unit Wt.: Sample Time: # of Samples: - Field I.D. Marking: - I herebyzcertify that I have inspected all of the above reported work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved plans, specifications & applicable building laws. Final report issued t J project completion G(77 - te r �1 t C S _.....� Inspecto`r's Name/No. �� ,� A ALL � • �•-� � ��l `rte Inspector's Signature cr All'inspections based on a minimum of 4 hours; over 4 hours will be an 8 hour minimum. In addition, any inspection extending past 12 pm will be an 8 hour minimum. Contractor's Representative i .� BD -M-402 (10/98) Copy 1 ESC Lab Copy 2 Project Superintendent Copy 3 Governing Agency.