0304-178 (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,SExp. Date
7LUt3�1.��• ja. @ � � t' � ��l�Q�
,_"Date(' ";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:
( ) 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
Sdction 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 STAT t:1`•UF, D Policy No. 46.03.3.;53
(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 she workers' compensationprrovision,s,of Section 3700 of the Labor
Code, I shall forthwith comply with those,provlslon's.
r � Daie: ,i� %c I/. ` fApplicant_ ` �
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-menntioned,,property for.inspection purposes. / a
Signature (Ow er/Agen ).�.�L- Date
�,..
BUILDING PERMIT PERMIT` €� - 'IS
DATE VALUATION a;Z% 'LOTTRACT
JOB :�2,68'II�.a�'+� (3]] dl MT
APN � r 4r•�'I � 'itFaS.
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
BIRDIE Y OW8 rt.'! ,1, UX!
t?.If�.aST I) A1;;z1�CA v.:. VE.Y.,cli-,w;isn.., co.R .
5 .L AEA CITRUS AMWE, g'1 -s 205
a L (sfi R'11'.s i A1iZ Mt. 20
Z�33Ll cS x'.11' 97-173
`lea •z 2x.AN� 2' l`.A 923"1
(909YifSi3-: )f3s CBL- 4911
t'
I I.SF nFypP�FRMIT _ .T+p��lF
Yr •��,eQ�n� t ��y
g.C172C1,•+u2. ~YSl.!l•2l2
'V;I•
Sr f1 t'—o tJ3 ;1', A..; l Adb/.'wY lV1 i°, 4VM �•J R. .b�-
WAL OL POOL, V ,A OP bR1V fi';hU,,N A)'.i''I• 66 .Cfl %J% M111":`iON 9.'t7 .PIL,'V?4
PEE DUl: ° O MULTIPLE 13S1JA)gCt?. OF SAME V1,AN TYPE
FjO&?ZTUPATIO 1,fk{4.0,1 SF
FISI -Am".Cf.3ST €3Z' �:�ltla�'tFFit:;��k{.t'i°�
341,351.20
��.:7:1."d�!I:Yi;C�i`Y':Yti efsia`VF_t:�o-.'it•
C00'i'RtJ•G'i ION FEE 1 01-000.41 -0010 fl.$t'•61MA
PTD AlVuCa3iECK F'!°,Sl(t�t7•':1fi�4ryO-41..9-p3�{1�9 $:iitUX4
.
SQ++CvTT��//;••.l: tppt i�l1♦♦d)1VJ��rr1ww'G4-Q1�G I I()
•Sif✓:.�.+O.fv�[1r.CSli' FE i OA �'^L/Llil`*•YG4%^-•VL!6a p,b�.." J'. y�v
?jJ11NI?.NO ITE 1 �t)G 1419-Otl€) $ r wi
STW.__r11f0 M n"924.PF.3�'-.1:N.C1"
MADING MeM,10'1- 1A � ^f9CC1' f,f!4.t:t1
t•e1rt�.Ed..+C�P�:1� ),fv5'��:.r C'� F'��. $:�,r14)�inint�
es:.RT 01 PUULTC:.r UX;RESIT 270.-W-445-000
M
Mrk?,� {°t it . C;U "� t'dI( °1 �1ATi b1�►f�
,! +X..�i7?�.�}�Crr'f:��c1A.
.. .. - J.d!.,eI+33A� ��1r�droA� �< '�d :`•
S'11+E��'•)
� y� i'30.�!lff FEES �tFUIE N )�aif
25 Mq'! (Ut.
�".13,9918+ _ t,^„x°•n•T A
RECEIPT DATE -Z;'-
BY
I D NINSPj@
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
-� ,r
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
POOLS - SPAS
BLOCKW
LL(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
Electric Final
Waste Lines
jJ
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:
%IST f� g -5-e 3 47' !Y)
Final rA
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
Temp. Use of Power
Final
Utility Notice (Perm)
I
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
78-194 Elenbrook Ct
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE UCT. STEEL ASSEMBLY O
❑ POST TENSIONED CONCRETE r13 ASPHALT THER
O REINFORCED_ MASONRY O FIRE PROOFING Co..- eAA
JOB LOCATION
.
bS 1
Q
REPORT SEQUENCE NO.
TYPA.OF UGTURE
i PERMIT NO:
TE
ki
DAY OF IEEI
MATERIAL DESCRIPTION
ARCHITECT
-3
IN R
HRS. CHARGED
1
ENGINEER'
ASSISTANTS
MRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CX)fTRACTOR �t�J� CONTRACTOR
o 110 X-31 Go
C,S
LtiQ� � N Cr
-QAC. ,,a O
L. A - G %LAJ L% c— CNIG&Z
COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 1 HAVE INSPECTED TO THE BEST OF Md
KNOWLEDGE ALL OF THE ABOVE aEPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WC1RK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
:AIGRE OF AEGIST IN PECTUR
O a 6ay-7-s�