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9903-088 (BLDG)
LICENSED CONTRACTOR DECLARATION ,hereby affirm under penalty of perjury that I am licensed under provisions of •• �/: Y P tY P 1 rY F C6apter•9 (commencing with Section 7000) of Division 3 of the Business and X4 W Professionals Code, and my License is in full force and effect. O =)m License # Lic. Class Exp. Date r Lo I W 700'799 B .� '6Z 1—O e Signature of Contractor CD o. "�- V J U 0 ' OWNER -BUILDER DECLARATION W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ a License Law for the following reason: Z_ (•) 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 N Date' Signature of Owner O• rn d< WORKER'S COMPENSATION DECLARATION U') :Q,.�. I hereby affirm under penalty of perjury one of the following declarations: O O 1 have and will maintain a certificate of consent to self -insure for workers' X W LL compensation, as provided' for by Section 3700 of the Labor Code, for the �..�; Q performance of the work for which this permit is issued. 1 have and will maintain workers' compensation insurance, as required by QSection 3700 of the Labor Code, for the performance of the work for which this F- permit is issued. My workers' compensation insurance carrier & policy no. are-, Z Carrier Policy No. STAIE FUND =0 Q (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 provision Date: -1/1-11-711' Applicant ,rte . __ SIO - /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 b 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. A., 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 theabove-mentionedproperty for inspection/purposes. Signature (Owner/Agent) -A— ,� _� Date BUILDING PERMIT PERMI"03-088 DATE VALUATION $,'N(M ((() LOT TRACT 11- iT9 JIOB SITE 49LOSS C'ALLC P-LORU APN - ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER TNC, D.L. r'KI3ls": AN1, ;1-:C. i3 -5N) M,H8SANDR.© DR. #200 72-880 FRED WARING• DRIVE C-13 PALfvfDES,Xr CA 92260 l'.A.LM.1 MKT CA 92260 (760)773-9024 M .# 5390 USE OF PERMIT ai.- MAI., RALDING W3Ivv't)OW 17 S`I'ALLA i Rt3i, AND STRUCTURAL TURA,L AL -101,A'! IGNS V.AL13ATlON 5,003,00 LS �ST1►�i�fL'TED C , "d OF c:'ONSTYfZff3CHON 5,000.00 PERNIff FEE SUMMARY i'LAN CHECK REV, 101-000-4'39-318 $46.80 re lit f((S1i��1 t'C; .! Y" N >+M 10! -00 )-41 8-01KI $ 2. (it) MS�✓NO- 1tOTION 117-3- RIN11D 101.000-24.1-000 $50 ,:Ji3T[.Y±'ALCOMP.tRUCftONPLAN CHECK $119.30 LESS PRE -PAID FOES x;0.00 $119.30 �n c� R�EC/�'I T DATE BY /{� 0 DATE FINALED INSPECTOR Y � —A\ INSPECTION RECORD OPERATION DATE. INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs 09 Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing -C ompressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath .Z l Final Final o 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 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 - Utility Notice (Perm) r 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 V TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB LOC n - P=� I ,p f / �' REPORT SEQUENCE NO. TYPE,.OFSI,R,UC1TURE----PERIv1N0. _ De 1 �. DAY OF WEEK MA•T4JER"IC+A.,L-DJiES1CRIPTION - ARCHIT CTI�yAUCTOR J (7\11c MRS. CHARGED ENGINES I v4 5 ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL •" SUB CONTRACTOR Ce,%VjAt CONTRACTOR 3t-� �� SIA c,.%`� 3 T�3ft. All77 lt) I COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS 'OF .THE GOVERNING BUILDING LAWS. 4t SIG IATUR OF REGISTE�E ' iNSPECTO II� -1 l 71 f (- DATE -10F DATE10F REPORT REGISTER NUMBER 1