9708-064 (SFD)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 !#3 1253 Lic. Class Exp. Dale
Date J1-1f� Signature of Contracto
Jxj�er
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.
(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
s9bject to the workers' compensation` provisions of Section 370,0 of the Labor
Goode, I , hall fo hwith comply with those provisions.
'Date: Applicant f
Warning: Failure to secure Workers' Compensation coverage S lawful 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 personjat°;
whose request and for whose benefit work is performed under or pursuari't 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
a 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
korrect. 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 prop�errty for inspection-p.urposes.
/Signature (Owner/Agent, Dater R
BUILDING PERMIT PERMIT,/03-41164 CONTRO#
DATE VALUATION S �#' ''?� LOT #� TRACT i.iS • L#734
JOB SITE 60-,164 1l0.,)Kii'i 3 `ika.i!.
APN �fti- /�Q1•#►Ca�
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K84,1,ANt)
1.A.QUINrA CA 9:253
LA QUiNTA CA M_53
f' 601771 -?f+4:2 C €j1A -1676
USE OF PERMIT
t:1i:0.11t'AQ814,AN 2A
07,0 SF
Y113,01AIATED CONTOF CONSTRUCTION
24 1,439, Z9,
P 030 NTA.j FX' SO NIYH.AV
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altX111ANtQVI FEE
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PILL 111HtNciF"'i:t?
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e.
P Au-TMAf L'rON.A.W.)1,.S, 1.0) ('f ff?CX
$9,125.71
t
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0.()o,
5 1997
T4]F#'M. 3)91&: IVr•3W
1TV NTA
RECEIPT
DATE
BY/
DATE FINALED
INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING AP OVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap y
F.A.U.
Framing ,3Af7
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ,
DrMall - Int. Lath
Final
Final o I
BLOCKWALL A49OVALS
POOLS - SPAS
SteeG>
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
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
p Utility Notice (Perm)
COMMENTS:
UNFM �wm�l
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
OTHER
, _ `n
Ujo'\d\ !�2j
JSLQLATION
-
REPORT SEGUENCE NO.
TYPE OFURUCTURE
` y},
1l— FF
PERMIT NO.
TE
DAY OF WEEK
M ERL DESCRIPTION
ARCHITECT
PECTOR
HRS. CHARGED
—9 1IT
—t
ENGINEER
AS^SI�\STANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
CONTRACTOR
o
e
1IL-
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
'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.
SIGj TUBE REGISTERED �CTOR,
DATE OF REPORT REGISTER NUM1/BEE_R
Certificate of Occupancy
City of La Quinta
Building' and Safety Department
This Certificate issued pursuant to the requirements of Section ) 09 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: 80-364 HERMITAGE
Use Classification: SFD Bldg. Permit No.: 9708-064
Occupancy Group: R 3 Type of Construction: VN Land Use Zone: RL
Owner of Building: KSL LAND II Address: 56-140 PGA BLVD.
City: LA QUINTA, CA 92253
Building Official
By: STEVE TRAXEL
Date: 7-10-98
POST IN A CONSPICUOUS PLACE