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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 effec
License # Lic. Class itrp. Date
7i31t3S� E3
it
Date /�7 ZZ Signature of Contract
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 Policy No.
T'.i�C�1T�1C: �.ACYi1.>S? 1�f'�: 4SDd1Id'r;73
(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 manne}} so as become su lec o the
workers' compensation laws of California, �,lagr e that if I s ul ecome
subject to the workers' compensation p . rsIons f Sectio 37 0 the Labor
Code, I s all rthwith comply with tho e,p�ovi 'ons.,,.�''� `
Cote:Go Applicant yy�� '''�
War ing: Failure to secure orkers"Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to'$100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at ,
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the abbe information is
correct. I agree to comply with all J�Ity,✓and tate laws efing to the building
construction, and hereby authori 2 prg2ntatives this City to enter upon
the above-mentioned property •� _Sp , ion p�Irp • e
f O� f01;Y
Signature (Owner/Agent) "`91 Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT OZy�gTRACT
JOB SITE i
APN
ADDRESS
_qp _2�_�'tt y {„ q V, wyyyVF
OWNER - j
CONTRACTOR / DESIGNER / ENGINEER
MV11, TILL
MRR OY CAUFOM,A RX
16940 r', Q'_qXt",/ffl',A,V,h:, aTR 200
23 C`<OhPf3RNO,fgA.,�iOrM 245
IRVINE CA 92606
A7aVORMB.',I ACE.1 CA 92660
(943)' 13-4975 CBLW 63 64
t
USE OF PERMIT
1s'll+1i 1L1-1 � FIA ML•ly` :i7' YY -r1.1.<113 G
M, LOT 2r} PLAN 9.A.R. fPMM1TOOZ3 NOT rNCLUM, 8L=K
WA•.LO,1'1S01. SRA. 09, t7111't�'�7r'AY r. PPROAd-+; H, 7511A PE" C"I~iEt:.K FEE
CUSTOM CONO'i'kiUCT30N IU11$.00 81<
PORCIVRATIO 912160 SIR,
ti.Af2Y.5A 1.0.YVC4PJ1OR U0.00 K7'
PRIM"1" ii`ER SUMMARY
001493RUCTION RES A01.000.418000 S1,1421 Gp
3PLAN C.NWK PEE 101--000-449-318 $788.0
MECHANICAL FEE 101.000-421-000 $12koo
XLECTRiCAL- YFM 101-OW-42MOID $203.06
PLtQMB1,190 PEE 101.000-419.000 $199.75
STM41 0 Mal fCEN FEE - PJ-PSID 101.000 -241 -OM3 $32.47
rMADI NO F199,101.000.4231.000 $:dUN
,
DLf;F?_'J C)PF,R?MJ11 s.Ir,T VEJ!, $11,907,00
i
d=id PRH-PhM T+.f,..T:o3
V%1 00
SEP 112001 ' O'Co ,fY.�.''' ref DI'A NOW
$4,51340
.
CITY OF LA QUINTA
FINANCE DEPT. "
ABY••
RECEIPT
DATE
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs_
Forms & Footings
����J 61 _ _
Underground Ducts
Ducts
Slab Grade
Q 9 _i5� _
Return Air
Steel
Combustion Air
Roof Deck
�� _ N
Exhaust Fans
0. K. to Wrap
6�
�`�7-61-
F.A.U.
Framing
�_�
/ /
Compressor
Insulation
IY4-1�(
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
_
3�2J1o?i 1�lu.Ca
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
y_ _
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gj
Pool over
Encapsulation
Gas Piping
Gas Test
�7A7:6
Appliances
Final
COMMENTS:
Final'V
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)
TANDY`S INSPECTION SERVICES, INC.
PO BOX 13766- PALM DESERT, CA 92255-3766
OFFICE / FAX- 951.769.9717
PAGER 760.776.3339
DAILY I WEEKLY SPECIAL INSPECTION RrEPORT/-'- r`�
TYPE OF INSPECTION PERFORMED
PERMIT NUMBER
TYPE OF STRUCTURE
DATE
s _ s _o 6
PROJECT ADDRE S
FI-150GolF v�Ew
A Qui-VrA- ,
PROJECT NAME (INCLUDE: COUNTRY CLUB. BUSINESS PARK. CORPORATE CENTER OWNER ECT.) �(
ANA6D1r104Pe-:
MRf-W43 AUW Srn,(r/-�
ARCHITECT
Koker-A, Arfr frog/
ENGINEER
_.-
GENERAL CONTRACTOR ✓
X08 �OH/RILDS GaNS�u�T'�onl
SUB CONTRACTOR
..,----
DESCRIPTION OF WORK INSPECTED
N
6&'e—avea /N5TALL QF E oX //vr0 C44,Ve a -G
A16- , E X 1.5 t'IAAS >'o 'A/ E aJ gS o o l,J ;
5 771_ 4
0 h/EC. T FAST" AIC�it.G .4 /G
'a6 w e -L-1 v a 0 ce/Z d +,V..D aA/
E 9-c-/ LCL [ c -o as#co W -70'-0e_,VL11M MIN e4y8Co*eA#
i"
WELDING INFORMATION
WELDERS NAME CERTIFYING AGENCY NAME AND NUMBER PROCESS AND ELECTRODE
s'-
SAMPLE INFORMATION
TIME
SUPPLIER
TICKETNUMBER
MIXNUMBER
AIRTEMP
SAMPLE"
TEMP
SLUMP
WATER
ADDED
TIME IN
eMIXER
SET # 1
LOCATION TAKEN:
SET #2
LOCATION TAKEN:
I HEREBY CERTIFY THAT 1 HAVE INSPECTED ALL OF THE ABOVE REPORTED WORK, UNLESS
OTHERWISE NOTED, AND TO THE BEST OF MY ABILITY I HAVE FOUND THIS WORK TO COMPLY WITH
E A PSPECIFICA� PUCABLE BUILDING LAWS.
SPFC RS SIGNATURE
INSPECTORS CERTIFICATION AGENCY AND NUMBER
.f
J,
Certificate of0ccupancy
City of La Quinta
Building and Safety Department
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. For the following:
BUILDING ADDRESS: 81-250 GOLF VIEW DRIVE
Use Classification: SINGLE FAMILY DWELLING
Occupancy Group:. R-3 Type of Construction
Owner of Building: SRHI-, LLC
Building Official
Bldg. Permit No.: 0109-056
VN Land Use Zone: RL
Address: 16940 VON KARMAN AVE STE 200
City: IRVINE, CA., 92606
By: BILL GORDON
Date: 3/21/02
POST IN A CONSPICUOUS PLACE