0301-058 (SFD)LICENSED CONTRACTOR DECLARATION
l,-0ereby affirm unclerrpenalty of perjury that I am licensed under provisions of
ChaOtelr'q (commencing with Section 7000) of Division 3 of the Business and
Professionals'Code,- and my License is in full force and effect.
j-icenge # ' I . . Lic. Class Exp. Date
674074 7 /13 1 iom
Datg;"- '7 Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of -perjury that I am exempt from the Contractor's;
License Law for the following reason:
( ) 1, 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
bo"'cle)..
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 f6r which this permit is issued.
Fhave and will maintain 'Workers' compensation insurarice,'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 18TAM' FUND Policy No. 046M 33-IOVJ
(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, andag , ree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, i shall fofihwith comply with those provisions.
Date: t 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 tothecost 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 tothe conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose requesf and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& 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.1 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 propertyif r inspection purposes.
BUILDING PERMIT PERMIT # 7
03-01 -058 too
DATE VALUATION LOT TRACT
2 8.14
JOB SITEAPN
ADDRESS 491L7Q31V7AC0N'QWST"0R 649-210-067
OWNER CONTRACTOR DESIGNER EN51NEER
T.D DEZETr DIMM)OPMENT COMITMIUM10.9
r. 0 �� ox 117,1 15 79-2,95. WWO-10 1A QU.NMA DR,
1_&QTJNTA. CA 922,53 LA QW&=. CA 91a2 a3
(16V)i71-10-41 CISU 2996
USE OF PERMIT
ODTG;f,.T-? RAM_J71rDWW.UT(3
SIS) , LOT 3 Pl,.AlN 141 PF_-RX1T W. -F.9 'NOT MMUD2 131ADICK WALU%
P004UPtt'ORD-P�IV,MVAVAPPR(-)AC'11,
POWKTZON FOR, MULTIPLE, ISSUAMM OF SAME PILAN TYM
ihIPT04M (11014STRUCOON .
%
POIRCHPATIO
00101D Sit,
6ARA?S_MtARP'()RT
8P
F-MMAIND COST OF CONMMMIGN
2821106.00
SOMN"y
4-
COM!TAUCT1014
/.1
S1;. EC P
'A' 01 .00"20-000
Ulm. taR
PLUMBINO 701
101-000-419i,000
$202,215
STR03NO MOT1030 MZ -.RES10
101 00
-000-2.41-01
$20,2
GRADWO FE9
W100
DFVZWPP-.-R IMPACT FUX
AM IN PUDLIC MAW M, 1111K 270 -000 -445 -GM
V.012-1
sm--rm-AL comrnvarxw Am) i)y_4),T cyrom TA,11,64_10
LEW Pitt &A111) Furia 50,00
7VT4L:VKRW.f M9,13 ObE NOW.
A
RECEIPT DATE BY DATE
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
u
Slab Grade
Return Air
Steel
>
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
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
/
Encapsulation
Gas Piping
Gas Test
y _
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring �z
Low Voftage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
tRility Notice (Perm) l7
_ �.
COMMENTS:
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
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY pCPCA
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LQkATION
4f3 L.�IN 42 1*c- Lc.- Q
EPOfT SEQUENCE NO.
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TV TRUCTUR�� t ,1 ®� ��q
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ERMIT N0.
DATE
2 3
X6.3
DAV OF WEEK
Q,, � -
M IAL DESCRIPTION
SQ
ARCHITECT
INSPECTOR'
HRS. CHARGED
TIC ®s
ENGINE R av V �
� S �
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL `� ^ SUB _
- DATE .. - 'CONTRACTOR "N Q�.Q�-,— ``=-"''..'--- =� -a-CONTRACTOR"
A S 1.0,/V, -' , -. pt 0, - k B -A
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(, COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
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CERTIFICATION OF COMPLIANCE
•I
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.
,f
.1
SI JATU OF RE STERED INSPECTOR //
jz-h 0.3 VIC96 `M-7?W
DATE F REPORT REGISTER NUMBER
ME
4 eI Q
Cerrivdat6 of OCCu • an,,
,- , _1,.--
=� Building -
'& Safet° 'De
f _ Y p artm.e-nf
- ,This ,,Certificate 'is issued -pursuant to. the `requireinerits,o f'Section 109 of the ,California 'Building
- Code,'' certifying; that, .jat'rthe :time Y of issuance; 'this- structure was � iri'rcornpliancer with" the �;
}
°�: provisi®ns'of.. ahe`'Buelding `Code Viand ,the •va'rious y®rdinances. ofthe. ,City regu/ating`�bu%ding,4
construction -and/or use:
'BIJILDING•ADDRES_S. 49=703 VIA CONISTADOR.
>.
__
'EJse classification• S.F.D. ' . - - Build g Permit No. `0301-058? '
Oc�upar'cy Group:'-R�3 f - Type of Construction N i0 Land Use Zone: R L
IS
Owiier,of Building:- TD'DESERT.DEVELOPMENT: - -�,-•',Address: 0.130k, 16 '
.City; ST; ZIP:, LA QUINTA CA 92253
By: G SHOWALTER
.•. _.-- ;; r , - Date: 03/24/0 = ..
' Building Offici
' ' •POST IN A CONSPICUOUS PLACE "-