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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 effect.
License k Lic. Class Exp. Date
Date Af / Signature of Contractort 1. %�.%!�
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.
(�t}� 1 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.
4t71t€(1; tlIv, CoINC 431VV"I ),1.4
(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- ection 3700 of the Labor
Code, I shall fortwith comply with tbo`se p ovisions.
V6ate: #1 'Z Applicant. ,J
Warning: Failure to secure Workers' Compensation coverage sjunlawful 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.
BUILDING PERMIT
DATE It VALUATION S24111-&1
9
'20 LOT
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JOB SITE +:
ADDRESS Clitli=13Ziii?Rit4T7:
OWNER
5u -1-i) K.1A € L D.
LA Evil if MCA
USE OF PERMIT
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iir-RiIfAG,E Pi. AK 2B
4;A 9223 3
i U3TC_)&%I CONS. RLYC11'10N
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PERMIT # CONTROL #
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CONTRACTOR/DESIGNER/ENGINEER
,Su14t1 t�tjA BLVD
t.AQUIN['A CIA 92.253
Z87.1.60 137
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15 1'01(+-) f121 -00U
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L" X(_17 (ifC1XJ, irK1
101-000-420-0(h)
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101,000 -410 -OW
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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 r
whose request and for whose benefit work Is performed under or pursuant to
an permit issued as a result of this a licaton agrees to, & shall, indemnify 9 1111.` 1-YI-All. (3ONS-MuK`110N IS i+ O PIA r';K(l •
Y P PP 9 fY � r ' ,
& hold harmless the City of La Quinta,- its officers, agents and employees. � ` 1, ?;i:. €1111?-PAI€1 ITIS
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 NOV 12 1997
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. TY
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construction, and.hereby•authorize representatives of this City to enter upon... `
the above-mentioned property for inspection purposes
ur;4��te_//
ses
% h RECEIPT DATE
/Signature (Owner/Agent)�A�• ` _ , 71_%b
a C
,
f'4: TAL aYERN11T V IERS 01114: NOW
BY DATE FINALED
INSPECTOR
$9,225 73
1►1d.. 2:+.73
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings A
Ducts
Slab Grade 6 Ll
Return Air
Steel
Combustion Air
Roof Deck —
Exhaust Fans
O.K. to Wrap — q—
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
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
_
Waste Lines
Water Piping 4
Heater Final
Plumbing Final
Plumbing Top Out 14
Equipment Enclosure
Shower Pans
O.K: for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection —
Encapsulation
Gas Piping
Gas Test i
Appliances
Final
Final
UU14 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
r:
Final,':. a
Utility Notice (Perm)
COMMENTS:
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE X STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ IthI0AD
YOTHER w(1`n��
``GG t.
J& , AT'0�2 ^ Tl-
^C
1*
Y` 1L
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
a
PERMIT NO.
DA� ^�
y
DAY OF WEEK
MA ERIAL DESCRIPTION
ARCHITECT
%FECTOR
HRS. CHARGED
...r�
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
` o CONTRACTOR d
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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 A80VE 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.
�Ifi�ATURE �F REGISTE D INSPECTOR()
NSPE7) IFOCTOR.'
DA E OF REPORT REGISTER NUMBER 7J`
w
Certificate of Occupancy
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: 80-332 HERMITAGE
Use Classification: SFD Bldg. Permit No.: 9711-027
Occupancy Group: R'3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND II
Building Official
Address: 56-140 PGA BLVD.
City:. LA QUINTA, CA 92253
By: STEVE TRAXEL
Date: 6-23-98
POST IN A CONSPICUOUS PLACE