0301-062 (SFD)( LICENSED CONTRACTOR DECLARATION
I.;hereby affirm under penalty of perjury that I am licensed under provisions of
C)apter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals, Code, and my License is in full force and effect.
License # ,} yyLiY3y
c.. Cllyass Exp. Date y7
'674074
Date `� f > 'Signature of Contractor,f 1
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 370.0 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 i 3i'. IrC3i D Policy No. 040r 4003
(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,agreerthat,if I should become
subject to the workers' compensation provisions,of Section 3700 of the Labor
Code, I shall forrth\vith comply with hose provision's. . .
Date: d , Applicant-
Warning:.
pplicant Warning:. Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition toahe cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT -Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose, behalf this application -is made & each person at'
whose request and for whose benefit work is performed undertor pursuant. to
.any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
Work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
Y
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize+.representatives of this City to enter upon
the above-mentioned property for inspection purposes.
BUILDING PERMIT PERMIT#
l~®� t
DATE VALUATION LOT
TRACTJOB
SITE
ADDRESS �C 4 7 IA CO, QUSTM)O t
APN
1 ,
OWNER
CONTRACTOR / DESIGNER / EN INEER
T
9P X8 C099,r
PO ]DOX 1716
79.295 RA NCHO LA
1A Q1TJT@r"A. C& 92253
I.., Q-tTuN 5. CA 9225:
(760P17 -1 mi OBLO 2•996
USE OF PERMIT
M - LXYF 7 P:t„ A N VU. PXPMJT't0ES 140T WC1,tiP t HLOC.KWA,41A-5;
P004, SPA, Ci1:Z 33F#:!VMWAYAi'i'ROA{pH. 76% PWR CH M, ' FEE
RE,i.?f.IC` IO14 FOR M1J1, T1PJLB ISSt; A14CCZ OF SAW, , KAN TYPE
CUSTOM WNS:x R:It'WN 3AO 3t1 SSP
' Trtx7AWFED CO.T,Y. OP Ta�'d4 dd$EiKsS L ).
. ^V6G4 l7UfaSJ4J
CGNOTRUC11010N FEE 101-0017-416.000 SSIX.ji.0J!?.
P! m ClirC K My, 1Q3-f1�3(�►�9 31a /$2�d.2�
MECHAWI.CAL ra, 101 i,0001421 -000 $149.5
F.LWrMI.CAL nX 101.000-420-000 $213.04
1?��M.�k�i£1't�h� 1C31�Oi�C)-�l�n(Ti�i3 ��t►o.��
101-000-241-0000 21
10N'FZ9 IX,810 101- $�1 6.
pgqs�'3R���s^^'Ny{��G+��Mx��yy�g (`
DFIVIEOPZPtt IMPART Irr:P, 52,405.00.
.�"� t -"C"C� t� � CK i z ►7, ;t iC i' Vii} 1 PLAN CUE.0K
- Z'�?*�`A'I;I:aI+'JE�iat>
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S'i 'Y�C8Jd d i.+si�.l7-�.i.4 .6• A9i �Y 3J W� a1 .F.'1'Y.� YY
N,XA50
RECEIPT
DATE
BY
DATE FIN LED
INSP
INSPECTION RECORD
ti OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
2 —
Ducts
Slab Grade
Return Air
Steel
Z —-Ifs
Combustion Air
Roof Deck
�'
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
`�j
Condensate Lines
Party Wall Firewall
Exterior Lath
72
Drywall - Int. Lath
Final
Final=3
-�j'
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
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 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
Encapsulation
Gas Piping
Gas Test
—/ —
Appliances
/
Final
COMMENTS:
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)
COPY SENT TO CLIENT O
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.
CONTINUED ON NEXT PAGE 0P
zf
.a
, .. JON TANDY
`� 37630 Medjool Ave.
.
Palm Desert, CA 92211
ERED INSPECTOR
2:;07 -771--y-.
Office (760) 772-7192
F
INSPECTIONFax (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
[YSPPE OF .0
ECTION -
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY V �X�
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ OTHER
ORMED
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATI N v (oo -7 1 1 q m
V 1 ,
REPORT SEQUENCE NO.
TVP OFUCTURE��`1�\_V
PERMIT NO.
rhWA
DATE
DAY OF WEEK
MATERIAE tDEESSC
IPTTI�ION
,r\sqA
ARCHI ECT
INSP TO
NRS. CHARGED
1
W
(�q
ENGISE R
R S;
AS
HRS. CHARGED
INSPECTION GENERAL SUB ^�
-
DATECONTRACTOR
_ �CONTRACTOR.___
I
{
Q ,Q
-en
COPY SENT TO CLIENT O
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.
CONTINUED ON NEXT PAGE 0P
AGE OF
SI TURE OF REGI
3
ERED INSPECTOR
2:;07 -771--y-.
F' lJ
ATE OF REPORT
REGISTER NUMRFR
o Cerrirtc6te.of 0ccupancy
.. � - � � � _ - _ _ � •(. ; ` ,�.. • lip.
t
3 .s r - a � • M 'f' �, �� � ,
/�C�l �1
Safefy De
�. g partment .. �,.
,. w -: - S
Thls�Certificate is issued pursuant46 the, requirements of Section 109 of the California Building ,
Code;:_ certifyingahat, at 'the time of. issuance; _-this ystructure was in� compliance with the
provisions of the Building Code and the various 'ordinandes `of � s the City: regulating :`building
.~ coristriiction aril/or use. 4
' ,r, '�•:,`i - �' '^N- -� -- v r� �} - �'•[ �_� , f. lbw. . - r �-' .x� � �.{.
�- •..t"��,�_BUILDING ADDRESS: 49-607 VIA -CONQUISTADOR -�
-16
RyuF SINGLE FAMILYWELLINGUse classification: Building NPo.�O301-062 '
-Occupancy Group:AR-3 ," ` = Type'of Construction: VN `r f 3` 'r
t" - ; • •. r . Land; Use Zone: RL _
Owner'of Building: T.D. DESEkibEVELOPMENT v rZ , ' -Address: P.O: BOX 1716', '
'City QST ZiP:'LA QUINTA, CA 92253'
a° - .,
�/���
By: 'GARY SHOWALTER
z- Date:' March 3.2004 - -
x. Building, Official 1 - r
F POST IN A CONSPICUOUS PLACE •