0106-407 (SATT)�
-,LICENSED,CONTRACTORi DECLARATION
-6f J nd6r provisions of
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
~'
oote _6=Z�r_ Signature of
� OVVNER'BU|LoERDEoLARATION
| hereby affirm under penalty of perjury that | am exempt from the Contractor's.
License Law for the following reason:
( ) |, ouowner mthe rty, or my employees with wages ootheir sole
oumponetion, will do the wmrk, and the structure is not imenuouv, offered /o,
sale (Sec. 70** Business & Professidnals Code).
( ) |, as owner o/ m;'prop6rty. am exc|uo|ve|''nontnuoUng with licensed °
contractors to onmm,�
uthe project (Sec. 7044. Business &ProfessionalsCodo). -
() |mnexempt under Section, o&PC.for this reason
�________
Date Signature. of Owner.
'
WORKER'S COMPENSATION DECLARATION
I hereby affirm under. p6nalty"of declarations:
compensation, as proVid64 for by Section 3700 of the Labor Code, for the
performance of the work for which this permit is iss6ed.
���"�'--_- -ill' maintain-_ Workers'_compensation insurance,' - as -`_i�ed_ by`
. 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 Policy No. .
2VrAT9MYND
(This section need not becompleted if the permit valuation isfor $1on.00nrleoN.
. .( ). ioertify that inthe performance ufthe work for which this permit iuissued,
I axan not employ any person in any manner ooanto become subject tothe
vyo,kvm'.'cumpenaaUon laws ofCalifornia, and agree that if | should become
subject vothe workers' compensation provisions of, SectionX GOr of the Labor
Code, I shalVorthVith comply with those provi§
, Applicant—
Warning: Failure tosecure Workers' Compensation coverage is un|avmv| 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 inSmmun'oroe
oxthe Labor Coue.jntanootand attorney's fees.
,
IMPORTANT Application iohereby made mthe Director mBuilding and
for a permit subject to the conditions and restrictions set forth on his,,, -.--
application.
1. Each person upon whose behalf this application each person at
wxupo request and for whose benefit work is ponnnnou under o,pursuant m
ohypermit issued aooresult ufthis appnuamnagrees to, &shall, indemnify
8 hold xann|oo» the City of La Quimo. its o0ioem, agents and omp|ny000. .
o. Any permit issued aaa result ofthis application becomes null and void if
nm,x is not. commenced within 180 days from date of issuance of such
pa,mit, o,cessation. of*o�xfor 18Odays will subject permit mcancellation.
|certKy that have read this application and state that -the above information is
correct. | agree tocomply with all City, and State laws relating tothe building
oonmnuonon, and hereby authorize mpmeontaUvou of this City to enter upon
the aUovo'memiunoU property for inspection
` '
Signature �wn r/Agem Dam _
PE.RMIT'
/-BUILDING
DATE VALUATION LOT 01061140? TAACT
JOB SITE
APN
OWNER
NTRACTOR DESIGNER ENGINEER
92253
AZ 85034
4.990
USE. OF PERMIT
TRACT CUMTRUCTION V91.00 3F
0ARAGHKIAXPORT OF
C-OKSITRUCTKYK ME 10) -000-41 V-!0001 $047.50
PLAN 1
TOTAL CHE CK
L 3101111 PRE -PAW WIT092
S0100
4i F-
U)TAL FERMU FM DAV, NOW
U JUL 2001:
RECEIPT 1:
5bTAtTrEffT BY
DATE FINALED
INSPECTOVcz
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
I BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel_
Combustion Air
Roof Deck
�/ —C!
_
Exhaust Fans -_
O.K. to Wrap �yi �/ (
Framing _�(
.�
�`iG
F.A.U.
Compressor
Insulation
Q U�
��
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
01,�
Drywall - Int. Lath
Final
Final
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
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines7
_
�� - �%�
Electric Final
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
i
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
6
Utility Notice (Perm)
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(u
P.O.. Box 1504
•/y�� 78-.495 CALLE TAMPICO(760) 777-7000
Sliming nghterTfkipEver LA QUINTA, CALIFORNIA 92253
FAX (760) 777-7101
April 11, 2002
RIVERSIDE COUNTY ASSESSOR.
Attn:_ Mapping Department
P.O. Box 12004
Riverside, CA 92502-2204
Dear Mr. Hargis:
Please be advised of a correction to a street name -for the following structures.
The structures formerly addressed as 79 7 79-730, 79-750, 79-770 and 79-835
Via Sin Cuidad, the construction for which building permits #0106-407; 0106-404,
0106-402, 0106-398 and 0109-019 were issued, will now have a street name of
VIA SIN CUIDADQ.
Please note this change and contact me directly at (760) 777-7019 if I may be of further
assistance.
Thank you.
Sincerely,
Diane Aaker .
Building & Safety Department
SPECIAL INSPECTION 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
O REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑POST TENSIONED CONCRETE O ASPHALT
O REINFORCED MASONRY O FIRE PROOFING
❑ Y
THER 4P-4(
JOB L I — �0 V
A U
REPORT SEQUENCE NO.
TYPE OF STRUU�CTURE
SF
O r
PERMIT NOD.
1
E 3f ot
DAY OF WEEK
EI
MATERIAL DESCRIPTION
ARCHITECT /�. -
1
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL
CONTRACTOR
—SUB
CONTRACTOR,
Twe
uSc r
S -'M o
n�
COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
�j
9J
G AT RE OF REGISTERED I SPECTO
0 �t
ATE OF TEPORT REGISTER NUMBER ��