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0002-135 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of r Chapter 9 (or mmencing with Section 7000) of Division 3 of the Business and Professioralkode, and my License is in full force and effect. Li6ense # Lic. Class Exp., Date ii7�ifi7 ! 3 �. �i31�2i91 Date`— Signature of Contractor OWNER -BUILDER DECLARATION V .. 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). ( ) 1, as owner of the property, am UdIUSIVOly COMtracting wlth Iluerlsed 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 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 Policy No. ,S) 1r AEF M1''T1I .Jf,�ia:, 1. ��a3.ta 8I'It "f':�i3Y,',)e• (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)hat if I should become subject to the workers' compensationprovisions of Section 3700 of tth. abor Code, I shall forthwith comply with.those provisions. Date: C,// %Fria Applicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $1'00,000, 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-allCity,City, and State laws relating to the building construction, and hereby.-authorize�representatives of this City to enter upon the above-mentioned/ property for ii etion i rposes. Signature (Owner/Agent)- ---- D/ted .f- ' BUILDING PERMIT PERMIT# DATE VALUATION LOT TRACT lt)°3 ),6 JOB ADDRESS 44-270 VK A CALICO APN 649-00-019 OWNER CONTRACTOR/DESIGNER/ENGINEER 'IX) /1lTC!1QTYi T1r•R1t ,._+ 6, 1%, 4 iDAT) 'Q 01N*%i�,r*1 3a f V )tiFi ��a....�sr N -A 14,40a. rev .s3r.�a. F0 WX 1716 7!4_2293 R U,10401.A QUIN`1A DR_ LA QUI NIA CA. 92253 Lt1, t?tA14' A CA 92253 (7F,Ci>771-1941 M41:3 2046 USE OF PERMIT :i1tVt l.€: t At1 ILN 1)WELLti�r i iii-D-LOT:U; Ki�iA Eir(-:P0ANi1:i .IJ000, NUf !N-,:.�C, JDL.I3:s'..i2l^I i,12 0C)OL. /Sao PLAID f:}ilsC& 2rhb Aki-UUC l'ION 1%O !tl-ltlf:l'.[3aii..ls iSSUANC .0 OF AME PLAN °l'YP , i u.11T0,lll ONSTit.11C 1014 :,oj.' lw,, st ;1R11i71�i\tlf,1 :xJ:.tiU SP, E+At{A>`7?%�'.Jiit.l✓tlt{`I' 614,00 ti}'' £�f.�'pft�Ri ♦"!' '3f� O'�l1Zi'M' �1" ((+V l� Y psr�'.'q'4!Y'17 .e;�.v Q YL tr 4.9 sr.Al biiJJ..t d Y' '�. l s l.i �{!4. A .iV.t• .G � s s' µ'► 3.41 10L LrtY' 3°L.�ili L°rt i� -rt+'!� �iQi�►i.�A1c!' CONS110!/ 11(*)N FEE 1.01-tM-4111-000 �1.t�t,of.t► + riff -t -K Fs�Or'F t f-�(1gfllf/l�-1tt i�-N1tfR1 �i 17 90 T?QTS gr+Nf 7) /(1i i�.\irl,31AMI AL F'`li �t 1 00 1000 UA .&,; iA.R Fu, 1,144 f of 060-4i4_t'60 $ wz.L1 t PLUIVIb1NiO Ff*: 10t_0004t9_000 0 $179.25 �:1►2O1afYT 1�AC/9'S(li\f 3t� i.'+!;97i f f11 {)flf) �dl-fif!(1 "t 114 7tZ,�,C)tN� c ; `1°f: ! 0� Qf}t} •=123. AJ1) gHt►,tr« t 1,Vlsi,Us•fWt 1iLWAG °1. r111 s1,YfJ'f'vo kH`rt; 701-f)C1t)-155-00U 3Uh, i3 StIR-'r(TrA1_, 1,,-rFoNANI) PIT. AN( -HC -K vi,trx"4g TOTAI, PERMIT YCKS DUE NOW $3.978.39 11 1 RECEIPT DATE 7f4/I BY /�� —Y DAT FI ALE y INSPECT �! INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade —aa Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to WrapF.A.U. Framing IL 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 z 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 Voltage Wiring Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final 0(1 Utility Notice (Perm) LIV :1 COMMENTS: 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 ❑ STRUICT. STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB LOCATION �r ^ o p _ (i CIO G /`�/.r�`•Il REPORT SEQUENCE N0. TYPE OF STRkATURE Sfp MPT scat' 6 Nose PERMIT NO. - DATE 5 DAY OF WEEK MATERIAL DESCRIPTION L045 ARCHITECT j/ /p /� p &Y-�E"r l,.t t') INSPECTOR R NRS. CHARGED ENGINEER ASSISTANTS HRS.CHARGED INSPECTION DATE GENERAL CONTRACTOR SUB CONTRACTOR 71 %we- t 5 r s a bse�2,v�e�DLCLC--p-V*&t,1-�of E-, , '' I� t t �4-1►�.��d f^ oar 4 6,A, 51&" tl tA, & ��' .w� ►� e a e s u6inrlil•� . I COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE O PAGE OF CERTIFICATION OF COMPLIANCE �. I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE NOTED. 1 HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE f.nvFRNINf. RI III nINr. 1 AWG 1 S NATURE OF REGISTERE NSPECTOR A F nr RCPFIRT RG!_ICTCD ..11\.-0 _LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter '(commencing with Section 7000) of Division 3 of the Business and Peofessionals Code,'and my License is in full force and effect. License # F9rt �yLic. Class Exp. Date/� j p 674( 74 B - 07131/.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 construct the project (Sec. 7044, Business & Professionals Code). () I am exempt under Section B&P.C. for this reason Date Sianature of Owner WORKER'S COMPENSATION DECLARATION I. hereby affirmyunder 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 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 .ST,ATF FUND Policy No. 046-OM32 (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 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 l 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 BUILDING PERMIT PERMIT Ji }F Otft3Z-136 DATE ,VAL'UA IV$220,M100LOT ,36 TRACT VISTA S X 8-271? C,'�5IX,() JOB SITE ADDRESS APN -649-100-019 OWNER CONTRACTOR/ DESIGNER/ EN (NEER TD i3'.�57��C`�° T3k Vl-'WIWENT SWIARKS COWITIRUC 11014 PO BOX 1716 7911.29:4 RANCHO LdA. QUINTA D3,t LA QU1NT'A CA 92253 LA QUINTA CA 922$3 (160)771.1941 C'B10 2996 USE OF PERMIT E1 Cff-F I?JWLY'' DW -W-40 SFTJ4.t?T36 PLAN .EI R- P18.,1'.M1'1' .I'.)OES NOT 1NCLUDP, ,LOC K W.11.1,L5 OR POOL75"A PLAN CHECK PEP, REDUCTION FOR MUl'IPLis: ISSUANCE OF SAME PL0,11 TYPE , CUSTOM CONSTRUCTIbN 2,635.00 OF PORCH(PA A f0. 267.00 SFS `3ARAGEICA9PORT 6114.40 8F COOT (YF CO1`I5'1T��3CrION 220,;02.01 y�g '��q�rp� v� 9 yg,g y�,���NS'IX12A.'iXD Y�k,C�-l7' r FEW S��1V.619'iARY CONN TRUC.'T'ION FEE 301-000-418-000 $1,063.00 ' FLAN CHECK FEE 101000-439-318 $217.90 MECH.ANICALTEE 1.01.000.421 k000 $105,011 _ E1..W, TRICAL FELE 101--000-420-000 $162.01 PLUM WHO FEE 101-000-419.000 $17912$ STRON0 MOTION FEE • RFMI''D 101-000.241-000 $22.09 GRADINO FSE 101-000-413-000 $20,06 DEVELDPL"R.IMPACT Fi"E �3;9Y? tIQ ART IN PUBLIC PLACES - 11 701 X000-255.000 $'302.13 SIOR-TOTAL C ONTITi tt, CT`IOR AN!D PLAN CF . ' 3,97E.3� LESS PRE -PAM MS $0.00 ' I OTA -16 PM'tt'1 IPEEb 2223X; .nOW RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs, /� Underground Ducts Forms & Footings l3` Z��dZ� � Ducts Slab Grade Return Air Steel Combustion Air Roof Deck _ �j, Exhaust Fans _ O.K to Wrap //_ p�/ 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 "' _ _ 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 Electric Final Waste Lines =��_� �� Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral _ _ Sewer Connection �j Pool Cover Encapsulation Gas Piping — — - Gas Test Appliances Final COMMENTS: Final Utility Notice (Gas) v, 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)