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0304-043 (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 r 76rX1414 Dat_Pt/ - Signature of Contractor, . -r` E - 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. qp 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 1'' N'D Policy No. 16-03-93.1.3 (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' compe sation provisions of Section 3700 of the Labor Code, Lshall forthwith comj)ly Ith�,those provisions. ..Date: `f / i `V Applican: o A,�• Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and a$orney'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 au thorize',representatives of this City to enter upon the above-mentionedproperty for inspection purposes. Signature (Owner/Agent). I �r 9, wY�----+Date n PERMIT # BUILDING PERMIT DATE J VALUATION `a�rc LOT f TRACTJOB °j ADDRESS �4„A? `i iY .T111, 3t � �lXVT APN 1.5111=SM, )AX0 OWNER CONTRACTOR/DESIGNER/EN (NEER CORP. I r. (INT -17113:, NasTRI 205 a Y, C,,:d�"RAY2 f�,�,'? , fMi, V !� WY D8 CA, k)2313 PMAWOR CA 923 ill USE OF PERMIT Sea - ux. ,o, I -i" i., 6. � ET( .! f ULC W:• vT,,d .t c>h. 4A z i; :.4 "'k, i,ls J •, y P004ii',t�.O C:t3T'C?t�c C7)3��'Ii►!(TiL�;'� �„�2.Ot �' 04 001 SY /l:•AIAY:tdAZBU)4. OrJ'.:a OF l OTT-NUU+UNO,4't pylamr 1i P.T s umma�t'? C(,RQTRUJ ::TION FF:`F, 1 t�) t; i$aCI�JCY Fi41)�.2� %LA,_rt 0'11WX: f -VI. i 6i fiiQi? :�t�� l 9$Sf• t WiF,x.MANICALFfYs. 1 -001 x16.3.90 E ,K C11x1C:.A,L F CE 101-000-420-000 $492.1119 ).1L1JM,B "N43'RV?l, 1,111-000.419.0(.1) $ill ' ST A� t i�10 h-M)TION FE )'X211.) :l 0) -000.241.000 3+13.3? C1 rR 11LI NIO fRZ 101-000.423.100 S1.11-00 �tL�'�''l•:.LG�,�'It1D,`f:i,�,�"T't�i'fJf,4r�.U0 - AY,"IN PUBLIC Wt SIC 27C. -MV -4454' ?0 0:,1. '!�'E?? T.�1r!'CJS§T "tf!.) ^UOQ••4r�`:)••:19�5 ^�?5c.6A - 2a S' a-C.CrIo .. f+3.i7Fa;CAtfolnuf`x �t5,)06.01 IMS PTa,-PAID FEES, 471(1100 Clr° O- 0 FINANCr ^""'? s, lyd'. 'r�) . ;iA `� d �' :fir" D'C([:.t"io'Si% RECEIPT DATE E BY D FIN E INS OR 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 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 POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final 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 Final Utility Notice (Gas)f` ELECTRICAL APPROVALS,11w1 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) COMMENTS: - 3 14 %1 REGISTERED INSP R'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 Lp%: (� INSPECTION PERFORMED TO REINFORCED CONCRETE POST TENSIONED CONCRETE REINFORCED MASONRY O STRUCT. STEEL ASSEMBLY O ASPHALT ❑ FIRE PROOFING Y W ❑ CTHER JOB LOG-, / ..�� / T ,rte _ ; fry.,,, y 7�---_ � sem-+yip°' � ,� 0�✓ TYPE OF STRUCTUREO �N.�i�` '-t PERMIT-NO.'�----.fes '"'a+-��"''�.9.:: • \lam\ J4- t REPORT SEQUENCE NO. DATE DA��WEEK ERIAL DESCRIPTION icy S � iq CHM ITECT INS CT R NRS. CHARGED 2 EER ASS13TANTS HRS. CHARGED INSPECTION DATE - - GENERAL CONTRACTOR — -._ _� . ,. J _ _ SUB _ . -CONTRACTOR Co 2 loS� i - \\ � a : S CC�.cx c � ` t, l�SicL zoll aX COPY SENT TO CLIENT'0 CONTINUED ON NEXT PAGE 0 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. SIGNATURE OF REGI£TERED INSPECTOR DATE OF REPORT REGISTER NUMRFR 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 O POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING 0 0+� ER JOB LO�T/� + 11 `oa,Co u, REPORT SEQUENCE N0. TYPE RIJj�TURE a C. P1pkfts PERfM-•Jj�[J• Q� ^ O /� ��► DAV OF WEEK MATERIAL DESCRIPTION ARCHII`TTEE,C3`\7HRS. "CTO CHARGED ENGINEER ASSISTANTS MRS. CHARGED INSPECTION DATE _ - GENERAL SUB ". - ._;,_CONTRACTOR - _ Y -"' _ 60NTRACT6Fi. „� •� pre 1 " • COPY SENT TO CLIENT p CONTINUE N NEXT PAGE 0 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. 1 A RE OF REGISTERED ECTOR 0 O 1; DATE OF REPORT REGISTER NUMRFR A " • 1Y 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 YPE OF -!Y INSPECTION PERFORMED ❑ REINFORCED CONCRETE RUCT. STEEL AS ❑ ❑ POST TENSIONED CONCRETE ASPHALT jyTHER ❑ REINFORCED MASONRY ❑ FIRE PROOFING _ i `d JOB LOCAT10�;J _ T IIV� REPORT SEQUENCE NO. TYPE STRU15URE Ljo A ------ ---�_.,,,�- (`_-�-� PERMIT NO. , - -_- D DAY OF WEEK . MATERIAL DESCRIPTION A / ARCHITECT 1 HRS. CHARGED ENGINEER - ASSISTANTS MRS. CHARGED SUB DATE D TE CTION CONTRACTOFI ` CONTRACTOR S �l LJ AG -—-- -' As c�.c,ce � �r '� S meddle Tfl Wfoy-, COL .S� MLb h t4e.�p' ' ('ue-GSA COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT 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. kATU,O REGISTERED I PECT� 1 � V1 J TE,jbtOF REPORT REGISTER NUMRFR