9708-066 (SFD)r
LICENSED CONTRACTOR DECLARATION
0 (D I hereby affirm under penalty of perjury that I am licensed under provisions of
�! I— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
M O License j � Lic. Class Exp. Date
fY , a !J�lZL�'! �
oZ r- Date "' Signature of O Contract0,2a
cD _
J U C) OWNER -BUILDER DECLARATION
Huj I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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
U')
N Date Signature of Owner
ON
rn
Q WORKER'S COMPENSATION DECLARATION
o Z I hereby affirm under penalty of perjury one of the following declarations:
0 () 1 have and will maintain a certificate of consent to self -insure for workers'
XW compensation, as provided for by Section 3700 of the Labor Code, for the
.0 J Q performance of the work for which this permit is issued.
C0 Q 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.
U Z permit is issued. My workers' compensation insurance carrier &policy no. are:
CarrierPolicy No.
o0 5 '�.�itt -711! 1: � . f"10. INC W,38.114'5105
t\ CY
J (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 whiJh 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' compensatio `provisions oftSection 3700 of the Labor
4ode'
I shall forthwith comply with t ose pr vis onate: f Applicant
�. '.
Warning: Failure to secure Workers' Compensation coverage is u lawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth ono his
application.
1. Each person upon whose behalf this application is made & each person at"f
whose request and for whose benefit work is performed under or pursuant to -
any permit issued as a result of this applicaton agrees to, & shall, indemnify`
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void,if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation. .
? I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prope for inspectieni—p- poses.
Signature (Owner/Agent �_.. Datq,46,$
r
BUILDING PERMIT PERM'Y,CONTROLN
DATE � /, 5/ VALUATION 5241.1819• 111 LOT S TRACT u5773,6
�
JOB SITE M�-.996MI_3iNI A GIR
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ili_ IJV .1;cd4l BLVD,
J>i 1.411 FGA alit. V L!
IA OWN11A CA. 92253
I-A.QMN''!'A CA, 9;T 3
(760)'171-3613 C31N 4676
USE OF PERMIT
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$7,.?4.47
CITY LA
3
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
4
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
IA4 A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap
7
F.A.U.
Framing
/ j i
Compressor
Insulation
—
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL P ROVALS
POOLS - SPAS
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
- S�
Encapsulation
Gas Piping
Gas Test
-Q
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL AP ROVALS
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
,. Utility Notice (Perm)
COMMENTS:
(SPECIAL INSPECTION SERVICE
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
13OTHERC
❑ REINFORCED MASONRY FIRE PROOFING
❑ b\ -)OC
!.
�`
JOB LOCATIO
P
REPORT SEQUENCE NO.
TAE ;'.'R TURE
PERMIT NO.
T�
Ct 01.3
DAY OF WEEK
MA RIICA'L DESCRIPTION
ARCHITECT
Mz
HRS. CHARGED
1
11 I
-1
ENGINEER
ASSISTANTS
HRS.CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
SUB
` _ CONTRACTOR
-E 1
t
f
Q
1 ®
1
t
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.
SIGNAf URE OF REGIST INSPECTOR
DATE OF REPORT REGISTER NUMBER
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: 80-396 HERMITAGE
Use Classification: SFD. Bldg. Permit No.: 9708-066
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: 6-8-98
POST IN A CONSPICUOUS PLACE