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0401-387 (MISC)LICENSED CONTRACTOR DECLARATION ;.h,qreby 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 779165 A:8 �;ftr� ,Date � C �'O� 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). ( ) 1, 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 Se,�ction 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 3�'ATT, FUND . Policy No. ybf3��6i•nSfJ3 �> 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 r workers' compensation laws of California, and -agree that if I should become subject to the workers' compensationfproyisionsiof Section 3700 of the Labor Code I shall forthwith comply Iw th those prouisiphs, /Date: j t t 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 t`o'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 R& 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 f�,or•iins{pection purposes. ,.Signature (Owner/Agent) <.-f �1n�s 4- Date -it` BUILDING PERMIT PERMIT# 01100 � 01387 DATE VALUATION S71W LOT TRACT -~ JOB SITE ADDRESS %'-031 WinG2b ArOOT ^ APN OWNER CONTRACTOR / DESIGNER / EN (NEER TMY & RRONO MARK 'CANYON WRI01TOOLS .56-031 WWC103 Fool., 2295 X TAMAXNb- •CRD 7 A Q1JMgTA CA X2253 Pf',L:.iM 3PRT1gTJ CA 922621 (760>778.2,700 011114 2951 USE OF PERMIT COUP,i'Y,APD f IREPI.A.CZ PER.FtiP^f'.i VEL)) 3T1ZUCT C.'rLX.S"/P1.AN3- 2001 VALUATION "P,DOarU0I8, EMMA,TED COST OF CONS'INUCr'k"lt3N 7��sOtB.flO PEk3MT TJrR'Zt 9€1F�V ARA PLAN CHECK YKE 101.000-439-318 053. 0 CONSTRUCTION NEE 101-+000.418-000 PUJIi-HDrim G ple.E 101.000-419-000 0:3,00 MAR 12 2004 CITY OF LA QUINTA FINANCE DEPT. 31M_T0i4. && CtaN:S"IRU itis: T MD PLAN Mime, . pi ty6.Ss1 LESS FIKE-PAM F Ma Moo Ta7..43, MWAYi':6+OX' i W -E NOW RECEIPT DATE BY /♦ , JJI LE IN/S/�Pj�C}9R i 01 INSPECTION RECORD r OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel 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 POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric _ Final / Underground Plbg. Test 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: JlrM Inspections "EON mm 39725 Garand Lane Suite F 11:1 Palm Desert, CA 92211 INSPECTIONS Phone: 760-345-5554 - Fax: 760-772-3895 INSPECTION ,s STRUCTURIAL MASONRY INSPECTION REPORT Date: 3-30,fey/ Project Name: \ r' �{ �} (� '' Project No: t e> G \' t. �1ni'1 kk C—V Oe— �' R" 2 \1 Q.0— `- �1 it � 1A O --1,30 Project //Address- 11 jam' U CR b��3� W�i1 a iri A, Title 24 AWS UBC Other: File# ❑D1.1 App# ❑ D 1.4 ❑ Other Client: Sub -Contractor: General Contractor: Architect: Structural Engineer: Slump (inches): C(, ; Supplier: S Time Sampled: a:(�C�. >, I Mix Design: Time in Mixer (min.): 1 Specified Strength (PSI):, Water Added @ Jobsite (gals.):, - .;?n Addmixture: Qc,� Cy Concrete Temperature (F): % Truck #: Ticket #: ' { { �� Oq O Ambient Air Temperature (F): 9 N Field ID Marking: -::A,\— Weather: Unresolved. ems: © None ❑ See Below .ter' / Q ( • r L Location of Sample: ❑ No Samples Taken Description of Work Inspected: ' ^ c, 0 %. 1 , 11tP n`,(nrc't/ (J\EtCC i i( )(1('rM1 ` IC(31tI £":. ' to 12X ti I1�' r q A\.`'\'S<t 17tk a jk. \,n Y1C a A\ r1 e'A CC'\ 1 1rC_rn�i 47c Av -A'�s nn oa-- 1, Ll S t7l�� o :. 1--) •>� 1:k . �`CGrsrl I� _'TC a\ �,�C;7 oc—` Q\A tZc 'r':�� .� M1^rgcAte{ 1,C% 'CAL f.+. dU�Yrc,:_-. �,.[r�. e�r�. .,�1 C*"'+a'- nk s 7£fs"m- Gi1e�.� E`= ��t� ��.� � e! �1.�•'� .L ��n,l� t; � !�. r'f.le� A�£<' �?11�. 1•� �t•i� EJ- Cn"'i r'7:�a.�1.�•"Lc.,�' �* \Q, Q_i` (� f '1 + Q1.1" C" r elrflu 101%c',T - iAa�_. Cr r"--1 '- "IIS '?r 4� r ,^ C ld c kV n I,% '1 .r �Ai��e✓1 C 4I r' � �1 t� �� "/i, ..'TVA\ a �f ..i �L £ W/ 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 Inspecto : Jack C. Millin LCBO Certification No: 0842216-82 Contractor's epresentative: Copy IJ ections Copy 2 Project Superintendent d Copy 3 Governing Agency Page of i