0106-404 (SATT)LICEKSED�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
P (Y C11
tho A
Date Signature rof:Contrdctor'
0 . WtiER-BUILDER DECLARATION
I hereby affirm under penalty of perjbry 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
,,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 f6r 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 i Code, for the performance of the work for which this
Permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
STATE FUND 10-3906-00
(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.S co,fi,on 37�he Labor
Code, I shall,forth ith comply with'those p an'g.
Date: J 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 Safetyo
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..) 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 inspegfiorrpurposes.
1-7
Signature (Owner/Agent) Date _;/1116,
r IV
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
JOB SITE APN
ADDRESS
7R-730 WA 91K CTMAD 0
OWNER
CONTRACTOR /DESIGNER EN INEER
Y10A, 810 14,26 X UNIV "M Y DRIVE
LA (ATMIA (A 9225! 100EVIK -AZ 85034 -
(002)IM-16,56 CBLH-. 4T,90
USE OF PERMIT
8L X'cc
37A, - WT 71Q 13LAN PIA PERP41' DOES 140T INCLUME,
WALUPOOL ORDRIV9WAY APPRQA(,*.H
TRACC-T (' *NX fRUCT10H 51284.00 SF.
MUG SF
569.0 W
EtUMM'D COST OFCOMYRIM-110N
1.99,11734W
('i0140RUM1014 FFA
)01-000-418-000
KIJIN rki PICK, FEE
MK(.*F"%N1i?A1L FEE
101.0 0- 471 -G(X)
101.000.4°1944,
-004)
$210,97
GRA). -ANO FFIR
101 -009 -423 -OW
SAW
DEVA1.10RU f1hplAACT PER
1-9(117100 AND PLMT CIRIC11t
a, FRI.MT P'ns IMENOW
-JUL 5 2001
EE
CITY Or LA 00,1TA.
.RECEIP'T
-4 BY I DATE FINALED IP
INSPECTIONRECORD
OPERATION
DATE INSPECTOR
OPERATION
DATE= INSPECTOR
BUILDING APPROVALS
MECHANICAL
APPRWMAI S
,Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O.K. to Wrap
Q _ _
Exhaust Fans
F.A.U.
`Q- - C/(GG
_
Framing
Compressor
Insulation
�a-/ ��—'
Vents
4z�
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
/017 % Q�
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 Lines
7--t Q?_
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
j Sewer Lateral
O /�/f
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
r
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
J
Sub Panels
_
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
- 0 6 diCr
Final
Utility Notice (Perm)
'r
0)
t _
�.' JON TANDY
37630 . Medjool Ave.
Palm Desert, CA ,92211 _
Office . (760)' 772-7192
SPEC IAL INSPECTI-ONFax',, (760)'772-7193 ,
' Pager (760) 776-3338
REGISTERED INSPECTOR'S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE -, ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSION EDCONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING -
^❑ k
O HER'
JOB 7 r
�',� (a Cr , . ` , •'
(� lJ �1 V W'l '
REPORT SEQUENCE NO.
TVP 0 5 U TUBEPERMIT
— O3
i.
N 0.
0 6 — �•
11-7 a
DAY OF WEEK
MATERIAL DESCRIPTION
-
ARCHITECT -
IN OR
HRS. CHARGED
ENGINER i
11R ,
ASSISTA TS
MRS. CHARGED
INSPECTION,
DATE
GENERAL �_ _ • , SUB._-^
CONTRACTOR CONTRACTOR , KQ'
COPY SENT TO•CLIENT D
CONTINUED ON NEXT PAGE O
PAGEi,r. <• OF
• CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY• r IGNATU OF REGISTE DNSPECTOR
,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. DTE OF RE ORT REGISTERNUM`BFRt