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0002-137 (SFD)I R LICENSED CONTRACTOR DECLARATION - 77" I hereby affirm under penalty of perjury that I am -licensed under provisions of I." t Ch ,pter. 9 (commencing with Section 7000) of Division 3 of the Business and + N W '-Prof6ssionals•Code,1�and my License is in full force and effect. ' s'Licerise#,,! �y Lic. Class "y Exp.74 B, Date �y 07/1 W rw o Z Date 'f Signature of Contractor' O. .. t:. -.R✓ r J U OWNER -BUILDER DECLARATION . r HWID_ I hereby affirm under penalty of perjury that I am.exempt from the.Contractor's - Cny License Law for the following reason: Z - . ( ) 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). 1, as owner of the roe ` (') p pity, am -exclusively contracting with licensed contractors to construct the project (Sec. 7044, _ Business. & Professionals Code). ; ,� r cy)O I am exempt under Section B&P.C. for this reason N' Date - Signature of Owner O rn Q "� WORKER'S COMPENSATION DECLARATION C:) :2Z I hereby affirm under penalty of, perjury one of the following declarations: LO <, O () I, have and.will maintain.a certificate of consent to self insure for workers' X W LL compensation, as provided for by Section ,3700 of the Labor Code, for .the O J Q performance of the work'for which this permit is issued. ` m Q U ( ) 1 have and will • maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, fof the performance of the work for which this LO H permit is issued. My workers' compensation insurancecarrier•& policy no. are: ,It- ? Carrier ' S,1 Al 1.1UND a Policy No. ; �3<r•fJLi0 i31`; 00 J (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 mannerso as to become subject to the Workers' compensation laws of California, nd Q ee that if I shou d become 3 subject to the wo'rkers'•compensat9R pprovisions.of1Sectio.-3000 of he Labor Code, I.shall forthwith comply withithose provisions.. Date: �f �`� Applicant Warning: Failure to secure Workers' Compensation coverage is unla ,ful and 'shall subject an employer to criminal penalties and civil fines up to $100,04 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 t 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-ap plicaton'agrees to, & shall, indemnify & hold harmless the City of La Cluinta, 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 grope' for'specti .m=purposes. Signature (Owner/Agent).—,./ —Date �, J : BUILDING PERMIT PERMIf�3l�,, :. DATE VALUATION 520052.60 LOT 38 TRACT 2930 Y Al ,. JOB SITE 48-230 SISTA CAL1C0- APN W-RG2 019 ADDRESS OWNER:*�. CONTRACTOR / DESIGNER / ENGINEER SPARKS t r►3�,�,rP.t�;""tn:y 79-2.95 MiCHO LA QMNI iTr, illi.. LA C UINI lA 'CA A X212 5 LA QUINTA CA. 92253 _. ._. (76ii;+771-1941' - C;'R1i 2996 _ USE OF PERMIT - ; SF -Ii -LOT 38 PL -A v .V.1jz-.i1,E:f71 iT DOES NOT iNUDDE BLOCK Wii LLS UJR . ;. SSJAvE 0 �.. PdL.75J/03LA.N 4HS(,%, Fd1 JR!�' Ur,3 iN FV{L,U1.171E ISSUANCE ' MWERLAN CaOR<'�L�i'�AT'TC) Fu`�•th'i ;if.' CAI+.ACtPl� A€LC+O.i2'i' F.t!3.11t3 ST, 1tn.7•Am.ALVIT' ED. COST GX COd.y{S.A•11u1tJ`43101.'/ ,4'aWJylia�6r1/ty' PERMIT PEE o4Ui011VdA.Ih' r- 0NS'!`X1:.+C"t10N F-iT, 101-000-418-000 a't,t3f� .00 PL AN i-7-JFr_K FE ii�.°rij.Fllo Al, n i�.i,-�vi�-=u�.^i(r�i .�0 i }J.?�. Lt i°.d)rgicAf. FEE 1%i^ti>1U- i ►! (fi'il 31 2 +.l1. P�LUNIB1NO 1 TZ- ~' t01-000-419-'600 $,i79.`T a t�2pt�Nta�t 1411"1 t°t(;�4v f"tF : Ri:arn_ i{//���?.•tt�ttD ?:cli,-/t�)tj� R��,n!► ` • ta.�i,i Labs! %''i,°..\�; a'aJ�© r'� ,@9�V,tJ•7 I)WO.,C)P A,1,`ViPA. T I Ii:1b. Att.aT ltv t?1,I,L',L10'Pt,Ak; S - RIF,31C 701-OM255-000 S3 -►2.1J1 ' %Ji3-t( C,AL (_: ti" 1ti t ^1-;f1N AMC) `'1;np�t�a}C;'11{rpt{: �a..4 97{�}•j��s. .. 7._( ( - k ;' J L%4l d�l'Ll.i`7;!%'ll �i ik'F.� .4,11✓.uV T(YCALVERAUTFE A'S DUE I OW RECEIPT`' - DATE BY`A }�,/ DATE FI ALED s' INSPECTOR.,') (:1e ! 5 �z r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings — 2-t Ducts Slab Gradet2_Cp 0-C) Return Air Steel Combustion Air Roof Deck O. K. to Wrap Exhaust Fans 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 Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voftage Wiring Fixtures j Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power -Final Utility Notice (Perm) COMMENTS: 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 674.074 A 07/31/2( 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 coristruct the project (Sec. 7044, Business & Professionals Code). t () 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 thOLabor 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 .STATE: FUND ' Policy No. 046.0007333 (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`. Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictio6sset. forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date PERMIT PERMIT# C :BUILDING ON2431 DATE04yt &� VALUATION p,�20.2•� LOT 3� TRACT. �v� �B JOB SITE ADDRESS 48-230 W71A CA11<C;C3 APN 49_10"V OWNER CONTRACTOR / DESIGNER / ENGINEER PO BOX 1716 79.7.95 iZANC HO J,A QUllUADR. LA QUMCIA, CA 92253 LA QUI°1 A CA 922533 x'760;1771-1941 CBLA 2996 USE OF PERMIT , OlNfiLE 1"AWL Y UlR ELL1tl G SPD -LOT ?3 PLAN 'F.1R, PFJ?MtT POES NOT INCLUDE BLOCK WALLS OR POOLI%5%PLPAN CHECK FFF.!`EDyJCTION FOR MULTIPLE ISSUANC'-F? OF SAME PLAN TYPZ. CUSTOM CGT STAUCT)ON x,633,09 SF POR.LHIPAVO 757.00 V 0ARAWC,ARPORT 614:00 :1F 'FSTa"M COST OF C®1srRyXI1ON 21"4852,0} Yy6WF'KJ/K (Ag4M$R$ CONSTRUCTION FEE 101-000.418-000 $1,963.00 PLAN CHECK: FEE 301.1000•-44,:39.318 $217.90 MECHANICAL I&E 101.000-421-000 $105.00 ELECTRICAL FEE 101-000-420-000 $162.01 PL,UMBINO FEE 101*000.419000 $IW.25 STRO140 MOTION FEE - RESiD ) 01-000-241 -000 $23.09 GRADING FEE 101.000.423-000. $20.06 L3WMOPZR IMPACT lata $1,907.00 ART 114 PUBLIC PLACES - RUSIE 701.000.255.000 $302,13 8116 4(W AL CONI t Xi'C'17011 AND PL' ,AN CHWK IMS PR&PAID "3.3 X00 'I'0TAL 1FXRl1 rX ":XN I)' '1E IYCaW 7; r RECEIPT DATE BY DATE FINALED INSPECTOR OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs ,O _ _ �2 3 G Underground Ducts Forms & Footings CJ Ducts Slab Grade 2 Return Air Steel Combustion Air Roof Deck�py Exhaust Fans O.K,to Wrap Ji 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 Finale OS POOSPAS BLOCKWA UPPROVALS 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 — / — �D Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ _ Pool Cover Sewer Connection CJ 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 Temp. Use of Power Final Utility Notice (Perm) JON TANDY 37630 Mledjool Ave. Palm Desert, CA 92211 •�, Office (760) 772-7192 ® ' fax (760) 772-7193 Pager (760) 776-3338 REGISTERED INSPECTOR'S WEEKLY REPORT TYPE OF INSPECTION PERFORMED ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY O POST TENSIONED CONCRETE O ASPHALT ❑ REINFORCED MASONRY O FIRE PROOFING ❑: ❑+ OTHER JOB LOCATION • 23� ; o� �0 1\X\. Aj � � REPORT SEOUENCE NO. TYPE OF STRy�TL—U11RE SSD YA2i� (Ga�VtD 1��1asE PERMIT NO. DAITE 5 d DAY OF WEEK MATERIAL DESCRIPTION tiM S N o k B� K�'i� ARCHITECT e1� P -E��' (`_,Mt3 INSPECTOR It , 'D, HRS. CHARGED ENGINEER R Zy. ASSISTANTS HRS. CHARGED INSPECTION DATE , GENERAL _...•.,I _ _CONTRACTOR.. i SUB T CONTRACTOR _ 1 1 plisloc o bsgcv-ed D cLc_,ev,. Of qE, X, `' A [ l + +tiE;141-ci at.-b'ie• A, 5 g L tl 6 e a ex Is C#/064E4-e— u 6 .a +ti o x COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE 'HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY 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 r.nVFRNINf. RI III nmr.. I AWC S NATURE OF REG,'STERE NSPECTOR c, ndTF nr PCPnQT PCG1CTCP.1su.oco