0002-920 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
t►i 7u i 07r3ii2Of
Date Signature of Contractor—
OWNER-BUILDER
ontractoOWNER-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 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:
Carrier 3iPi€"A1-Ui.73 Policy No. 046000?333
(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' compensation -provisions of Section 3700 of the Labor
Code, I shall.forthwith comply with those provisions.
Date: y ' Applicant,''
J
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.
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 enter upon
the above-mentioned property for inspections purposes.
Signature (Owren/Agent)' ` _ Da er
> �' ` PERMIT
BUILDING PERMIT
11P
DATE VALUATION ."(10.9 1.2(0 LOT 4`� TRACT ?O.A ki
JOB SITE ADDRESS °St3-V 7% 'Ro��ti Egt Qr l�E.9`!�1`�j APN t149-10-
OWNER CONTRACTOR / DESIGNER / ENGINEER
'1�13�TiSEi'�'t'':.`�:�'t' rrpil'f `;�"'.• r�>'lii�." � {`yC?�f;�1''�Z.I1�`.'T:'�..'I`t
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PO .BOX 1 1+0 79-295 RANCHO LA QUlid'j A ,GR, ,
LAQUIN; I i CA 92253 LA. Q1 INTA. CA 02253.
(760)771-1.941 car"",
USE OF PERMIT
8i'l461,F ]VAN11a' �� L71.L';ti:i,LlN(-i
S.FD4.01 44 PLAN Afi - iULU1i..ii0.B5!*)'A .lNLi,UO.cifm tr�K Wi% L OR
f?(:)C,)L. 750/b PLAN C'1- LC K ION FOR, A-VULTIPLE tSSl/ANCE, o
5ANG3. PLAN TYPL-'
ClUXI"ON1 3,v6.00 3F
C a�tii% *CikJt;rLi k'UkC'!' 693.00 SF
&STRAIATIED COS 1,01F CONSTRUCTION
16°R,kf!G`it F'EC SUlPAWAR
CON S'aRVC:710NFT11'
1101-000-41£3-000
S),203.0
Pf,AN+"i —,,(X VAR '
301-0t'10-414_319
V47.,07
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141_000-419-000
S183.00
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1011 1700-423-000
DEVEl,OPil.2.lfXlt�tlk;
AWI' 1:N PUBLIC ! LACT-;S - 0_-84; 701-000-255-000
5402,29
59.11 -TCYIA!E COINS'7TW110NANTl PIANtr�'11'P(y;7i�i'� ye ;�,;i47 �7
LESS /3�
'CJ'6AL PER"NUT F t!;1+'.S 1)3ii+< i si-.31.7.97
RECEIPT I DATE I BY - �! I DATE FINALED I INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS'
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
jfj at y
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
oe
Exterior Lath
, A
j
Drywall - Int. Lath
_
Final
Final
`7
POOLS SPAS
BLOCKWALL
PPROVALS
-
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 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
(0"
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
or
Temp. Use of Power
Final
Utility Notice (Perm)
,y�7
REGISTERED INSPECTOWS.WEEKLY REPORT
i
JON TANDY
37630 Medjool Ave.
Palm Desert, CA •. 92211-
Office (760)° 772 -71.92 -
Fax (760) 772-7193
Pager (760) 776-3338.
ASSEMBLY O •
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL AS
❑ POST TENSIONED CONCRETE O ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
O OTHER
JOB LOCAT n -
^/ '% ,�
/
REPORT SEQUENCE N0.
TVPEa6f•5T CT RE
J
PERMIT NO.
w
(jJl.
E
w
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPECTOR _ \
HRS. CHARGED
ENGINEER
ASSISTANTS
MRS. CHARGED
INSPECTION -
DATE
-GENERAL__ �� �C1/}^!/ ,e
CONTRACTOR V• ���
_� _
' CONTRACTOR`
�Ly
F
,
•
a
COPY SENT TO CLIENT O
CONTINU
N NEXT PAGE
PAGE
OF
CERTIFICATION OF COMPLIANCE .
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIG TURE OF REGISTER INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED�'� �S
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
'GOVERNING BUILDING LAWS. TE F REPORT' REGISTER NUMBER `