0301-073 (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
!rIlmiessionals Code, and rrf License is in full force and effect. a
License # Lic. Class Exp. Date �•
` 674974 BMCI
i
Date. _/ ' �%� Signature of. Contractor`''
OWNER -BUILDER DECLARATION r
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).
O I am exempt under. Section B&P.C. for this reason
Date . Signature of. Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm: under p`en'alty 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:.
Cartier STATE I'L1,Q D Policy No. '0440,M420103
420103
(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 thaLif I should become
subject to the workers'. compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. i
Date*, 4, - / -.• Applicant_1 1
Warning. Failure to secure Workers' Compensationcoverage is unlawful+and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for -a permit subject to the conditions and restrictions 'set forth on his
application. S y, - ' +
1'. Each person upon,whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold,harmless the City of La Quinta; its officers, agents and employees.
2. Any permit issued *as a result•:.of this application becomes'null and void if
work is not commenced within_ 180 days from date of issuance of sdch
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that l have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
` construction, and hereby authorize representatives of this City to enter;'upon
the above-mentioned property fo'inspect .puf rposes } r�
Signature (Owner/Agent) ) Date`- `` 4 �%
BUILDING PERMIT PERMITk
0301-073
DATE VALUATION ts�s�A 3,3sr � LOT TRACT a'i .14
JOBI;SITEADDRESS 49-3 ` 3 . CSG?�TG-yT�.ISEADu OR. ��
APN iA ,rD�,^�..10-I ty
OWNER
CONTRACTOR/DESIGNER/EN (NEER
F10 BOX, 1716
;i.,A: QU"FA CA 92253
LA qUKACAA CA 92251
USE OF PERMIT
MC:1OJ U isAMX Y'WjM„ . NG
.SVD . 1,01' �8 PI.AN'M3. PL�'Mf9' DOES NOT INCL1.1 0 BUICK. .
KAN CHECK FEE F.Jt1S TO MULZIPIZIJESUANIM OF SAME PLAN TYPE
UST 44 coNsTnuc flow Mo SY,
PORCHlfrATiC,i Ig n0 s?
s
AV
Z5 I M
CONSTRUCTION F;��,. r 101.4 -430•,000 U2.111V
�l,A%,aCIiWX ;1& 101_000-$Me19 �QeE1S,
FEE 101,100 0-4-21-000 S13100
PI,1J.MB)TNO FEE 101-QO" 19.000 005a
sn,Cm MOTION PES, - RE5113 101 -OM-241 -00 $35.14
i41-0.00,423.0.00 :11,1,&00
tr�hk7lsw�d'c�tN00 �.'t�snE,avtL
p,,
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0P v b4.0��?',R TriiY's`i.0 P :fwd''
AND KIM C701011-11: 011-11:
ss,2S2 05
JAN
. 2 a 20.03
CITY OF LA OtifN YA ;1 ✓
1 .
ATS =rq�( J
'BY: J D cINF
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
7_27 —
Ducts
Slab Grade
_ j
Return Air -
Steel
..� ., 3
Combustion Air
Roof Deck
Exhaust Fans
O.K: to Wrap
.Z 9
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 '-' ��
BLOCKWALL APPROVALS
Final — o
POOLS -SPAS
steel
Set Backs
Electric Bond
Footirgs
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 LinesHeater
f
Final
Water Piping
Plumbing Top Out
S
Plumbing Final
Equipment Enclosure
Shower Pans
O.K. 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 S — Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors i
Temp. Use of Power
Final L2-�
Utility Notice (Perm) —
•COM,ENTS:
f
'JON TANDYY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
SPECIAL • Fax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION'
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT: STEEL ASSEMBLY O
❑ POST TENSIONED CONCRETE ❑ ASPHALT O OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION
3 `3' A /+ opur "� LA
/`.YA vy /J�v,�
IvLJ
REPORT SEDUENCE NO.
TY ok±T 0j UREO
PERMIT NO.
D O�
DAY OF WEEK .,
MATERIAL DESCRIPTION
ow1
ARCHITECT _
INSPECTOR
HRS. CHARGED
Q
S V
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
-.-DATE-- -
NERAL
-r-CoRACTOR., -
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SUB 1 `_�: � /�• ^ _ _--
el 03
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' nCOPY SENT TO CLIENT O
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.
MRE OF REGISTERED IN CTOR n
JWATE OF REPORT FIEGISTER NUMRFR
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C-6 rtificate sof -0ccu - a n cy
OF9 Y ,-r, Build�ng�. & Safety Departmenttj.
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`r: This, Certificate is.issued pursuant -to the -,requirements -of Section 109 sof the California Building
- f�.Code,. Lcertifying that,~ at the 'time- .'of- `issuance,?; this structure' was . in "compliance ?with the
• ' ;- provisions of the . Building Code', 'the: various ordinance's' of the City. regulating building
e
construction and/or:use:
n
BUILDING�ADDRESS: 49-343. VIA CONQUISTADOR
Use classification:'-F.D. - �., Building Permit No. 0301=073
Occupancy Group: R-3 '� Type of Construction: 'N -V _ Land,'Use Zone: 'R -L
'
S. - _ ;
.Owner of Building:TD. DESERT DEVELOPMENT'' `� Address: PO BOX 1716'
`CA.
_City, ST,' ZIP: LA QUINTA 92253
,
By: G. SHOWALTER
Date: 04/05/04 ter`
Building Offici" - i, ,.. �_ ; '
r
POST IN A CONSPICUOUS PLACE
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