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0308-257 (SFD)LICENSED CONTRACTOR DECLARATION 1'rwreby 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 7281:02 BID" �P3�910� n �141-11 Date ��`� Signature of Contractor � �if 4, Lz 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: Carver . oix, R.E}'1F:. uc mo Policy No. WWt'.110084,540 (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. tho'se/provisions. --Date: 12.1 Applicant—,, . /G�f 71 fi i 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 applicator 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 autliorize representatives of this City to enter upon the above-mentioned property,for inspection purposes. f Signature (Owner/Agent) // /1G ' t 1 ,/-"")f Date /d� �J BUILDING PERMIT PERMIT# 10 14", W"-2511 TRACT 30521- 2 t g DATE % VALUATION 7� qq qp yq,,er�r,, LOT y / JOB SITEA,�Pp APN AI ADDRESS 7 V P.SA`YdtON ,°v OWNER CONTRACTOR / DESIGNER / EN 1NEER / ]M?NNP, HOULES OF' C AL:fFOTt.ttlIA LIM AR HOW/9 OF CtlAt ll:O A ' 8y�-401 CIRICH�it�AY 111 7 8-4 01 C:1�,(�13'�AY I11. ' :I:.A.QY 0Nf'A CA r&2,53 1AQtM7'1:A CA 92253 - fti 60)777-0231 0�tdf :;434 USE 00 PERMIT a' SI C" o LOT 1-1, PLAIq ISR. Pi*RIAIT DOES 7.1a}T MC.'L.I.IDE, BLOCK 19AL-68, P004 SPA OR D.ftYi'EWAY k\'.PROAi:;K75 Ora IZEDUS`T10"I d To" PL AIA C1'?;k;Cl': 7?'Fi DUE TO MULTIPLE ISSCDt1;tiC'1° OF SAM PLA14 TYPZ b' 'I"I�,�X'T CONSTRUCTION P0&1:fi HIPAT110 498,00 SP j,. (JARAOI!1MUIPC)R 462,00 V Fi YJ `7C YR -R 6VM. KAARY CONST,RUCTION ION THEE 101-:000-418«000 $800,50 PLAN CHECK' WE 101.000-439-318 $1.65.42 MEcRAN ICAIi, M. 101-000-421-000 r7loo ELECTRICAL YME )DI -000-420-000 $126.22 P1,.C1M1i1NG FEE 101.000-419-000 $166.00 S9'RUNCf MOT1014 FEE - TLRSID 102 -00-0-243 -000 $14.51 GRADING M 101-00 0,423-000 65,0t/ 4).E'la'I?LC.'tPER. IMPACT MZ. s �J 4C1� OGt s' 11�- C3�'i>.C.O1+TLfiFcli"`T'.tC°l�T`1�i��:YyFCp1x.�1tl�vf���Y��T��r,�7�PA-9-4 s3,766.d13 r Nit - u5 '03i,. �' i;Nliif C3V° L(� RECEIPT ,.,.. DATE BY DAT INALE INSPE OR Ie•' lLYa zi .01 INSPECTION RECORD z OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms &Footings _ � � _ _ Underground Ducts 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 O T I POOLS - SPAS BLOCKWAI A ROVALS 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 AI Utility Notice (Perm) /i 03/17/04 17:03 CDFARIFACOSTAMESA 7607777011 NO.789 D03 ed LLporr-dFire A:aI Pr 0iec: r{utificatian or Iateint f,) Nlcve St ► oil fro -cu or witblu .unramiged Areas of Ori. ce)Riverside, aind Los Angeles (r+�ulaties `.Ft.IPP,<:utnp ante �767 vang CirylCo+lnR 1`1r�Y �rnt oLCA�m Rc�ucS� A _wt - F �c�res° 1�0 3ox 12 g� Gird. L oarC,A zi q2 Z3� 55 LzrFv;_dcnLcc��oa _-��a �QV� Oa--�- g.l~9 A. L DcsLiBaLimX„czat off: .. 'vee 1: ;�r,+,j•..:ICU' Qv-zzli-' Oi Sol) (c.e. K Ctl:;c l )• : �..�. _ ._ . urgcncrL.e�:tlforatamediacelnspeerioo£udRah. e: �C'fcic Oac I . Movcmnt o{ Soil is Pcmj lcC ' p el Si(c Lred \WLL!, SCifEr)(JI-P, 1'NSPECTION DATE h.*N'UYDI-tr.. t�tc'1 rsr��.�o of Tj7—,` Soi] i-����e�,cet is Se�ct<� PrcF�ibitcs fcr �c Fc't+u �'t .+: r, ct_:e _(S) �'�ci,�, ��� A�, . 1'CGicCI i.ea, ,r,•• Q til Z: �/ 4� 3 15 REGISTERED INSPECTOR'S WEEKLY REPORT JON T'ANDY 78-194 Elenb rook Ct. Palm Desert, CA 92211 Office (760) . 772-7192 Fax (760) 772-7193 Pager (760). 776-3338 TYPE OF,� INSPECTION PERFORMED O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLYF`� O POST TENSIONED CONCRETE O ASPHALT O OTHER ❑ REINFORCED MASONRY O FIRE PROOFING JOB LOCATION REPORT SEQUENCE NO. TYPE -OF STRUCTURE-E't r (�y�,�CS © Y•7 PERMo 0.z4 - DATE -S DAY �OFWEEK MAJJ IAL DESCRIPTION ARCHITECT INSPICTOR HRS. CHARGED ENGIIJEER S ASSISTANTS - HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR SUB CONTRACTOR- ONTRACTOR---% --7 fl .768 1 � � (:!r -,r -\Str uc'.\ 3 — SCA. rq\ COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF U CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY S G TURE OF REGIS RED INSPECTOR KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE !� NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED �v Z 1-1 - PLANS. SPECIFICATIONS.. AND APPLICABLE SECTIONS OF THE GOVERNING BUILDING LAWS. ATE OF REPORT _ REGISTER NUMBER