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0111-037 (SFD)LICENSED CONTRACTOR DECLARATION It,:�ereby 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 7 63 197 Date Signature of Contractor 4l. !.:> OWNER -BUILDER DECLARATION. I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: O 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 r;xclusively 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. (�,Jj 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 :F-EXI;l'H INIS, CO, Policy No. 2;042AX (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 a Labor Code, I shall forthwith comply with tho provisions. Date: r 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 a 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) -4,1864-4.. ,— Date PERMIT # BUILDING PERMIT L ; v! DATE- _ — VALUATION KZ� �0 LOT: TRACTJOB SITE ADDRESS ��-.i���i?,) rCs� APN °�',s.� OWNER CONTRACTOR / DESIGNER / EN (NEER f.30f ,a� rrrA 9a ? CIRV LA Q WCAO0 LP 2001 , •t fi61'XMf+CrTQY A:4A Z C k 92023 &RCO +DIDO CA. 92023 541: USE OF PERMIT / A Y MMIN(I V.. ES Nyenl TINIC r, . --y' �q'�fy'r4�t}�.i,�{�t5.&H .'e Y:� �o-°F.,}t�Y.gfe��i.1p7'7�V *Ty �,T.,riXY. p i + A1+SJa.b S"1.��n1U0 A �.�:i.okDRT V 3Stl A Z .APPR.Q4�..C'H 5% �I.�J'12:1 034,19CIr. F,I AS . ry'lw3cir-low Folt IVIU1,T)PLE", ISSUANCZ 0 SANS pl,hw TYPH C1181 -OM CONS.i'RIXTJON 2,983,0P SF' PO RCHIPATIO, 3.55,00 SF OJ.'4.PAWWWORT 674.x1. ff CONSTRUCTION FEE 101.OW418.000 %1,Ino PLAN CHF..CK F? 1 Q 1,-C2Ui1�13 3 i $ 39.OG 14 ECHAs41CAL+N'I��l 101-M-421 -000 L, f. tCTPJC:.Al , MIZ 101 -0004.W-0 $ S 77.96 P1,AlMB1110 FER 10). -000-419-000 $194,2$ STE`td:140 hfit7T)ON FEE li00D.101.0f)0-l., 1-.000 $25.05 C4k1R.WHO MY 1 01X000.423.000 VZVZL©P.KR IMPACT PER - �;ty28 f30 Ari W PLIRLIC-' PW;El - RUM 270.000.445-000 7. F . 1!- W , � d%1'C'°1."1�om `*41'jla .���` t "1:1 `i x'°.,1.6. N0 1 1.,, S3, �� 69,46 .�� FRE-�aAr ► 0 $0.00 CITYOFLA®UIF, RECEIPT .. DATE 1,/— f .,.J { r BY - :fir ! DATE INAL 6 INSP TPR 0 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings _vy� v �� Q_ 6 f2 Ducts Slab Grade 11, �� Return Air Steel_ Roof Deck O.K. to Wrap _ a �� ; l(�G�pQ,�O� Combustion Air Exhaust Fans F.A.U. Framing '3LOr ! II�4fj� Compressor Insulation f,�$/p� �4Gldpd�l� Vents Fireplace P.L. Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lathe 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 �li��/ Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection .�2D Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: Final ��_ &A/o/ 6,�/ Utility Notice (Gas) t, ELECTRICAL APPROVALS 9•�T�! /2�l�1 . 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) 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 / , I PERFORMED 5(o'O` T 3 O REINFORCED CONCRETE UCT. STEEL ASSEMBLY O S� O POST TENSIONED CONCRETE ASPHALTTHER O REINFO'R'C^E-D� MASONRY O FIRE PROOFINNG11 JOB Lg �W��� - 0���;��:V`: l f7•' Tr T CTURE T PER&W IM NWTERIAL DESCRIPTION ARCNITECT —3 REPORT SEDl1Et10E NO. Y Of WEEK HAS. CHARGED ^ R y ENGI O �V1SO V A�'�"" NRS CHARGED AL SLIB DA(lrt[WN CONTRACTOR S� CONTSMCTOR QTE ISEut1Q.t� tTr1 1&IG-S •rl v Z6 s t�►3a�.� �>a C.otr���as 'Ott C41D w o� t_- - C- - COPv SENT TO CLIENT 0' CONTINUED ON NEXT PAGE O PAGE _ ' :O� CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV SIG RE OF ;;EGISTERED PECT0L jr KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE T•t,. n NOTED I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED / 6 CLrtifi. cate of. Oc cupanCY. 41 Cit ofLaQ Uinta Builditiandty,D6partment��MOFg.- . Safe This Certificate issued pursuant to the requirements of Section 109 of,the Uniform Building Code, . certifying that, at the time of issuance, this.structure was in compliance with the various ordinances of the City regulating building construction or use. Forithe followin`g:' BUILDING ADDRESS: 56-043.WINGED FOOT Use Classification: SINGLE-FAMILY DWELLINGBldg. Permit No.: % 0111-037 f *. Occupancy Group: ` -,R-3, Type of Construction_: VN Land Use Zone: RL t Owner of -'Building: CRV LA QUINTA 70 LP . Address: 200 E. WASHINGTON AVE.' _ City: ; ESCONDIDO, CA 92025 By: DANIEL P: CRAWFORD'JR.- .Date: -5/28/03.,. Building Official c , ` POST IN A CONSPICUOUS PLACE