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0301-085 (SFD)LICENSED CONTRACTOR DECLARATION I hereby. affirmljnder penalty of perjury that I amlicensed 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 # Lic. Class.. Ex . Date ,;,.Date_LZ'7=� Signature of Contractor }� w 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). ( )1, ;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 penalty of ,perjury one of the following declarations: O 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):'I have and will maintain workers' compensation insurance; as required by S ion 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 I5'i'ATE M. ') Policy No. 0'%fl?3Jo-70Q (This section need not be completed if the permit valuation is for $100.00 or less). O 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 Section .3700,of'the Labor/ 1 I _ Code, I shall forthwith comply with.those provisions. ' Applicant Warning: Failure to secure Workers' Compensation coverage.is"unlawful and - shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages -as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety }: for a .permit subject to the conditions and. restrictions set forth on his application. f w 1. Each person upon whose behalf this application -is made & each person at whose request and for whose benefit work is performed under or pursuant to. any.permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if., work is not commenced within 180 days from date of issuance of such` permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information Is correct. I agree to comply with all City, and State laws`relating to the building Construction, and hereby authorize representatives of this City to enterupQn' ,,t the above)mentioned property -for inspection pure ses 4 N /y Signature(Owner/Agent),���•r..Date s1 •� . , BUILDING PERMIT PERMIT# 'If�ii3.l,• SSS '�,' DATE VALUATION LOT" TRACT 61 fu 30 .29283 JOB SITE " • i ADDRESS 49.4'-72, VU C0FQ€T.!'XTADQR, APN i', 99 2,1Ct�W OWNER CONTRACTOR/DESIGNER/EN (NEER m bmw1 wa, LC?°.. ;.. r iii CoUs'i' tueMON PO BOX 3'l1 LA QUTw;A. CA 92253 L.A QUINTA , .CA M53 50)?. i 1,T 1941 C, KIN 29,96 USE OF PERMIT s WOUFAMY VW"°L 0 P1..kl i O'HROX ME VUX TO LqULTIKU 19SIT (13?, OF SAME PIAN TY.P,.;,. cflr£QM ComnRuc-T-1 14 V.%#r.'sF PO itt Ie't?A'l'l 496.�li3 SF • Vit.; D cosT or co,%'tsmucn w 295,409,99 . ,�•vL, 2+y; ty �yyg p,Yu,Yp �ys,cmA;# CONMIluellaN PEE 10.1 -0006418 -ow ' PLAN:CHINA K P199 ➢dil`:Gl•�,�#i�,?o.I.'i 1iJx �f��=,%LTi^�� �3a9,(ti) =TWrIA.L Ple ; x 01 0004204" nCTm.F3ma F0. WIN ORAk INQFU IQ14,019(sa423=0®t3 AkT IN PUBLIC PLACE$ • .stEf3ir.2'3'���d(3t3";44 j'�Ay{ J'.l�q,r�`��a�A;'�i'{,/Yfy • � M-Ta,:A �L CV.l�11d n�.4O. �3: 01.7 G14/.moi Kat t ni4n epi TY- M PAID FERS, $9100 -; TQT_ L;,T .:�n 1F.dA.Y'J,'.0 s 11'IY.Si.�'!41'P3 � 19'A�'6PC9�1569 II) F7 aiJ�iV2 9.2003 p,� .�4j, RECEIP QF L8( AAT- f � j BY.a{ +> DATE FINA ED INSPECT INSPECTION RECORD ~> 'OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel — 3. Combustion Air Roof Deck -,5-- Exhaust Fans O.K. to Wrap %��? 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 2 Final Z,3o BLOCKWALL AP 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 Lin - Heater Final Water Piping Plumbing Top Out / _ f00 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 - Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) d COMMENTS: 1 - `S• ' Wil. •SERVICE REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED 0 REINFORCED CONCRETE ❑ POST TENSIONED CONCRETE: ❑ REINFORCED MASONRY O STRUCT. STEEL ASSEMBLY O ASPHALT' O FIRE PROOFING ❑ /^ ❑ OTHER JOB LOCATIO i -70L CotA52 V -s r �v v` REPORT SEQUENCE N0. TYPE S U URE� a� �� PERMIT NO. 0at,03 DAY OF WEEK MATERIAL DESCRIPTION ARCHITECT 1 TOR HRS. CHARGED ENGINEER - - ASSISTANTS HRS. CHARGED INSPECTION .,,. DATE.....,,; �. .-s._.. GENERAL - �CONTFiACTOQr�.:..-CONTRACT.Oii__ SUB-- n © 'seeIan� o B .A tI-a S .... 0-S l% S I S 00 -,- OL k,� .. COPY SENT TO CLIENT ❑ "' CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I I HEREBY CERTIFY.THAT I HAVE INSPECTED TO THE BEST OF MY SIG ATU OF EGISTERE NSPECTOR KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE / NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED YQ Q O 6 PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF . THE • ` I GOVERNING BUILDING LAWS. DATt OF R PORT REGISTER NUMRFR t e � _-..,a',y��';,., � 3 ,. . � .. , .. ........_ J >` ,- ��,s,te.•.m�� - a� .. ':.+s yoq ;;i"- - --- - _ _ �IR��I ■ � + •�'�_d6I� 'Vin'{L �✓.G Certificate o f a n c Occu 0 -� ►.y � 'i i d r. w�. A 3 'd � G Building SafeD OF'T9::, ty,e &�artmerit p.M: ` This Ceissued: pursuant to the requirements of Section 109. of the ' California Building` r _ . r"Code,r certifying` that, a't' thetime,, of issuance, this-stru"cture` was in --compliance -,with': the rovisions_=of- the ;6uilding_�,Code andc the'--, the _Ci re ulatin 'ybuildin J .4 construction -and/or use • `fi "., .. ` 0 4 �:'h. - _ r .^}- ,ry . _ . F _ a _ •-y � : 1 - i �C. � J7 ' 4,. y _7-. BUILDING ADDRESS. �49-472VIA-CONQUISTADOR,.'_ t - 5k � 1 r ... � � f .• ,1 � + M. G A T 1 ;� 7 �n i t . � r � `� 1 � 4Y �� � - 6„ 4 L - . f �, ' _ Use classification.j.SINGLE FAMILY�DWELLING. . ' - - .r y % Building Permit No.: 0301-085. >'•.- �. �, �t �... ` = Occupancy Group :R-3 ,' Type of Col nstruction: =V N. Y ,;. , ��. ;. r� �•t` . i �, tl w a ^ ,��✓. L._ �} iy,/i; . J .}• • Owner= of Building TD DESERT DEVELOPMENT 'r Y Address:; P.O..BOX 1716' ,. -^ '. - [_' } _ ^-Y -y.! N ' J _ � ._. ,.• r '. .Y .7"- •:� ,y,. ,. - � � . . a `• �, t rr City; `ST;ZIP: LA,QUINTA. CA 92253- �� . SBy., GARY SHOWAL-TEW -a Date:- .12/02/03 5 'Building O.ffi:c, 1 r. ; ,yam _ a. «-,� .^l ..a . �; .. -��. , •µy YL .� 1 _ .. . U . _ , POST IN -A CONSPICUOUS PLACE