0306-167 (MISC)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.
Licenser# q 7 Lic. Class Exp. D{a+te
i
Datef 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 S'i ,,t' ,, � dL� Policy No. i69326-02
(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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his �^
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) % ' �� '�~ Date W - r -
BUILDING PERMIT PERMIT#
93iir7
DATE VALUATION LOT ' TRACT
• � ,r Ti,fii�l ..
JOB SITE Y APN
ADDRESS.
OWNER `• CONTRACTOR/DESIGNER/EN (NEER
5413
USE OF PERMIT
:NGS.At
;iU'F'PL MRINT.41.1t, O P14TCAUT # 9901,0310
atilLIl' tt+Ic7M
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PERMIT SV$N�.VAIAY
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D G,1 2
JUN 16 2003 '
CITY OF LA QUINTA
FINAPJGE DEPT. .
RECEIPT DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
d
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
S d
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
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 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
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: 6/116 3
MAK 30 2004 14.14 FR INNOVATIVE COMM
760 839 8246 TO 7714156 P-01
• .-ti to � � `� ,
CITY OF LA QUINTA
��BUILDING & SAFETY DEPARTMENT
ar ` 777.7012
` INSPECTION REQUEST LINE
777-7153
O,%kner Y
C�ntrdCtoK 'VAl ,
Peripit Nu1m1V
t�sr•
POST 07wq
I B ! NSP,lC0005 PLACE
_ SPEGrOR-MUST SIGN ALL -APPLICABLE SPACES
JQE ADDRESS'30-320 3NUSICOVE
S UPPLEM>E N TAL-TO PETtMIT 09901.133 TC
COMPLETE PARTIALLY BUILT MODEL
ABOON UTILITIES OR OCCUPY BUILDING
u�
I
JCM Inspections
39725 Garand Lane Suite F
Palm Desert, CA 92211
INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTIONS
REINFORCED CONCRETE INSPECTION REPORT Date:
Project Name: Project No:
The Masters @ PGA West 8117
Project Address: City:
Lots q 603-70 (, S La Quinta, CA
Title 24 AWS OUBC Other:
File # ❑ D 1.1
App# ❑ D 1.4
❑ Other
Client: Sub -Contractor:
Sladden Engineering Franco Concrete Const.
General Contractor: Architect: Structural Engineer:
Innovative Resort Comm. Colbourn, Currier, Noll Inc. Schmidt
Slump (inches): 4 Supplier: '�� w
Time Sampled: �,� 4 Mix Design: (. eC Cj 7 ��
Time in Mixer (min.): �' + Specified Strength (PSI): 30c -no
Water Added @ Jobsite (gals.): �^ Addmixture: ' .,_
Concrete Temperature (F): �� Truck #: / )r Ticket #: ` h
Ambient Air Temperature (F): j.-. Field ID Marking: `�=1-- �
Weather:
UnresolvidiNtems:
None
See Below
Location of Sample: L, � '�- (��; � � � n �„r. � _,� .�
No Samples Taken
Description of Work Inspected:
ip
C XC
.. _� N)LckLl SIR �% � n"1n .��n � �)•. I..,� �� R..1a '. �eC e-+� �ia rte. �. .�:,��r lr^ ��RC �iF "�i"��+.
., , < <, r r c.'. ,
I hereby certify that I have inspected all of the above 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 at project completion.
Inspector: Jack C. Millin ICBO Certifi, tion'No: 0842216-49
Co tractor's Representative:
Copy 1 JCM rftpe�ions , Copy 2 Project Superintendent �' _ Copy 3 Governing Agency Page —4 of