9708-068 (SFD)• ' LICENSED CONTRACTOR DECLARATION
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
04 W Professionals Code, and my License is in full force and effect.
O =) M . r License # Lic. Class Exp. Date
r- 0 LO
r '� 1
oZ Date r Signature of Contractor
U C:) 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).
C'`) () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
C7
0 < WORKER'S COMPENSATION DECLARATION
�p fr I hereby affirm under penalty of perjury one of the following declarations:
Lo �' O () I have and will maintain a certificate of consent to self -insure for workers'
X w �: compensation, as provided for by Section 3700 of the Labor Code, for the
Om J Q performance of the work for which this permit is issued.
Q C) I have and will maintain workers' compensation insurance, as required by
O .q Q Secion 3700 of the Labor Code, for the performance of the work for which this
d 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
do 0CY
.s1..'d`+Q.'�;.{. ,IAV.... 4.,:✓. ` i., �tt�..+a3a !«. V
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' compen tas Ion provisions of -Section 3700 of the Labor
ode, I sh 11 fo hwith comply with those provisions.
J Date: o `i 7 Applicant / r t 1 (•=�s�r'`t�
/ !
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
111111 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 n
whose request and for whose benefit work is performed under or pursuanftot `
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 heretzY authorize representatives of this City to enter upon
the above-mentioned property for inspectiofi prJ poses.;"
Signature (Owner/Agent)' �! Date l�iJ
PERMIT # CONTROL #
BUILDING PERMIT 970144.4" 5
DATE 19 1 15
VALUATION Z� j� +y .90 LOT 10 TRACT t,I,ll .'t }ti
()/ J f
JOB SITE
ADDRESS l�[1i1:•-d4213RKRi*'H.JA(71N..
APN
7b i-;+cid-i►:E
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t ` p f1 Yt
is 1. i,dis idj F..9
li ?i. �,��:: �'�;i ')p
yti-'t<k"t irli. tea^Z u.
561401�GA 6' IL
LA t. UIXT-A CA 92253
LA QK,Jf g'rA CA. " 922 ?
(76' ),11771-302 (;13tt0 467(1
USE OF PERMIT
.SiID
't iOICU. 10. Li. A 97-146. Ti. .78X N
CU.3 Q1\1d C0 S7JRU : r1GN 2,65S,00 51°
t;rAkA0ti/ ;A;tPt3.€I;'t' 713.00 8
R,41Y."AINITED CMTOF CONS'! RIA -M, . '01N,
22,4.131051.014
Cf.X%W,`kU(11't'lt?NVfjt 10,4-(M-418. 000 xi,t)',r7.o)
hi,A W !';#±fwbt 171'1F {) i . {!fill-�l t 1 i, �#t7 •�
it:aRNd`Ci'. j1X 10 1:-E)i-421-OW V9,00
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-P111WA) N W1 1.01-000-419-0ft
.17�t`h11c.i�►f)'1'If3R1f Fl;_ifI tit1) `tf►f.(1ii;1711 (100
{�t li3t'Jt t L;"R 101-000.•!23-000 3w0.ki0
'tib-Cft?&_44J-342 �W,961.98
Ellx,`f' .ftp "k�t:�isf.tt-� Nt.AC Y`t 9'$f ti ll O1.000.11 -M -Wt)
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ya ,
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iffl "ITAI..�:ri�d t'32CSC°'{'1f)�3 AND (,: M1 C K
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AUG 15 1997. °904A,1., 1+1,r AII—C:FEMIS OtIle NOW
$7,705.73
CITYur LA QUINTA A�6
RECEIPT
DATE
By
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms & Footings
Slab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation.
i;4 Y
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wail Firewall
Exterior Lath
41
Drywall - Int. Lath
!!yC
Final
BLOCKWALL AP ROVALS
Set Backs
I Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Plumbing Top Out
Shower Pans
Final
Utility Notice (Gas)
ELECTRICAL A PROVALS
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
1,
"Final
Utility Notice (Perm) 17
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills .
Fans & Controls
Condensate Lines
Electric Bond
Main Drain
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final .
Equipment Enclosure
O.K for Finish Piaster
Pool Cover
COMMENTS:
f
JON TANDY
3580 Condalia Ave.
Yucca Valley, CA 92284
(760) 365-5045,
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE XSTRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
OTHER WONak*
��ii
JOB LOCATION1
`
H
`
`J`
REPORT SEQUENCE NO.
TVP OF STRUC
e
RE
PERMIT NO.
DATE
i
DAY OF WEEK
MA IAL DESCRIPTION
ARCHITECT
N PECTOR
HRS. CHARGED
j
1
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR 5
SUB
CONTRACTOR o
N
o.
1-3
w
o 1Q
COPY SENT TO CLIENT
CONTINUED ON NEXT PAGE O
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.
I ATURE OF REGISTERED INS
DATE OF REPOIRT 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: 80-428 HERMITAGE
Use Classification: SFD - Bldg. Permit No.: 9708-068
Occupancy Group: R 1 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: 5-7-98
POST IN A CONSPICUOUS PLACE