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0002-132 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed 'Under provisions of Chapters (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 iiNiNi 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 propeily, AM eXCluslvely coruracdny Willi licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date I 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. al'M1LJ L!A'�� ?1`1flfalli ��.'. (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, an8 ag a that if I should become subject to the workers' compensation provisions of Section 3700 of the-L-abor all forthwi h comply with those provisions/ ^ 'r Code, �YDate: � � Applicant i 1� 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-mentioned property for/inspection purposes. Signature (Owner/Agent) Dat r6, �0 ' BUILDING PERMIT PERMIT# ` DATE VALUATION LOT + TRACT 3Lf�0,,4 ADDRESS 6+r9 -S36 is i' it ��n,.'si ei JOB SITE APN aa5_ OWNER CONTRACTOR/DESIGNER/ENGINEER cP A 1" %, r=r�nrc tear Ir yx'rrgar 3, � a,♦ !- Sw _. alff.•4 4 0. ea. #"! �-,l,,.f, lq'♦ •cis. LES l,i't1lWt'A 02253 1,A. Q1'INTA ("A. 921_~3 f7t4)J71-10.11 01111 i USE OF PERMIT �f.M:-l.v :i3 f'i.,r�fv 11Fc-.1�aauvili' i9�.;r..S tvui' titis�;.+;jiiis �i,u�•i+. �ti'A(,1,� uwt ikA)L. PSSo PLAN CHECK VtU, 10:iL)ilt"X' QN P'Qk 31s1Ctf;,t1114,L ISSUANf: i . ul- !; AN U - 'P L A N1 'II YP11'. :ii'T.R L-.TTIt1 2,6-15.0 r,• 2167.00 t�V* f AR,k ft: CA1(10QK- ` 6I4.W til a ,1rn�.i:inm con 1~.1.4•• i•a s, eiif��i�..'oN N11 0. y c�� Lx)NSIRL1(;'1 ION FEE 101-000-41tt4M �i1,4i f.1Nt fil AN rVI-1 'ic )'TV 1 Sl f _11)t1_430 -i T R 71 {T~!?it - wtr�v �'r 1^e�,• lYYLtt'k tlit A6 LtJl1,9.c '41;, 0 ,r1.'►fs 21 ISM 101-10= !' �'-'P�-F VilV a t / c fie, ,'d ql.,.! 1V t,3..fai: aJr�fe.'AL a� I t:. lfi 1.-v1�)-�1i,3-tlUv � te,� ui k'1.11N1E�ik�Yt� !,� E�� 1f1i,4tJtt•41.���ltl $1 i�J. �S ':`t`r3f�►tK Ael0i'tCjM'F;T-V _ Rr�911'1) 101 -11)(M-1411 -(M T1" I1 9 101 0001 000 i F V►L(,1 4`iil. tmfom!!a' 0A.;� ,yt1%.Irtl ARA' RN 1011,10JAt: PLAVEN = RE.S11 1 701 1.1 RECEIPT I DATE �\1S;1'R t 1t-T'10N ANT) VT .A N1r�1Crr"1- V(`i 1101"Al, sEM-'sFEES 1?411, NOVY DATE `..1,978.33 INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set BacksUnderground 1z Ducts z Forms & Footings Ducts Slab Grade jr —3—&-o 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 Final57— 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 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 Az Utility Notice (Gas) el 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) COMMENTS: �v ljlG/r�/�l�yno • +- �ia� �ir.s� r,� 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 ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ ❑ OTHER JOB LOCATION y d 0 �9P 330 - t 5 A Ci� i �D Imo.. C�.�� �Gt REPORT SEQUENCE NO. TYPE OF STRUCTURE SSD�NCCWA 1pho. PERMIT N0. DATE 5 is bo DAV OF WEEK MATERIAL DESCRIPTION inn S i.� �. ©x � x.945 ARCHITECT ,eY- fItf EK- UAt-)Djw INSPECTOR fk a MRS. CHARGED ENGINEER .- a ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR SUB ! CONTRACTOR 1 5 s a t�se�,v�edc,of q oa" 'i 6• A o 5 8 "-tktl f-kq o Q ("s C O 64E v AjC_G- u6/nt :Sim pga^-3 ox .7L,66. : 7 -LIS. - i + COPY SENT TO CLIENT ❑ 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. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE rnVFRNINr. RI III nINr, I AWc f S NATURE OF RE0STERE NSPECTOR 5 n F n[ ROpnR7 ocriercc .n u.oco 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 B 07/3 1 /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 01Nner of twproperty, am exclusively cunuautlny with IlDensed contractors to' construct the project (Sec. 7044,1 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 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 STATE FUND Policy No. 046-09MOIS (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 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 _ BUILDING PERMIT DATE 04ta0c VALUATION $220,M2.00 LOT JOB SITE ADDRESS 48-330 W,'.VJ d,I, CA`d.AC O OWNER PERMIT # 0002-1.32 3.3 CONTRACTOR/DESIGNER/ TRACT 29306 APN .a�^�,i}^t� TO I )IMM OTrVEW11 SPACE KS CO)MRUCMON NOBOXi 11.6 79.295 LAQU)NT1A. `:A 92253 LA.QTJDIT'A Cad (760)771-1941 CDI:ii96 USE OF PERMIT j 5FV-J,OT'35 PLAIN 91 R- PERMIT nOE.S NOT INCLUDE HLOCK 'WALLS OR 1''0067% PLAN CHECICFisPt�i�+:DU'CT1014 FOR t�fU(.T PLt WSl'I.ANCE, Ole SAME PI -AN T1CPM . ' CUSTOM CONSTRUCTION 2,635.00OF PORCHWA`PId " Z0.00 SP OAItAQFJC.AIa.PORT 614.00 SP SUB -TOTAL COMMMUC1110M .AND PLAN CIl.t?C1 $3,918.39 1,233 TIRE-PAWI'EM $0.00 T0rfAL I']n.�11MY TM ME.N0W 0,978.38 RECEIPT DATE BY DATE FINALED INSPECTOR ESTD 719D COST OF LONS'�liAiTf."rxTION 220,052.00 i'i0.Li14lI:T'.F:6'EX SUll AdARY CONSTRUCTION PEE 101-000.418.000 $1,063.00 PLAN CHECK FIX. 101:-000_439-3113 $217.90 M€'. 14,101ICAL FEE 101.000.421.000 $105.00 E12CTRICAL FEE 101-000-420-000 $162.01 P.11UMt5INGIMLE 101-000-419-000 %179.25 STRONG MOT102I FELE • RESID 101-000-24.1-000 $22.09 OR.A.i)INO Ii Els J,01-000-423.000 $20,00 DEVELOPER IMPAC!' FEE $1,A07.00 ART IN PUBLIC PLACE M - MIZE 701-000-255-000 $:302.13 SUB -TOTAL COMMMUC1110M .AND PLAN CIl.t?C1 $3,918.39 1,233 TIRE-PAWI'EM $0.00 T0rfAL I']n.�11MY TM ME.N0W 0,978.38 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set BacksUnderground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck, 114117 Exhaust Fans 0. K. to Wrap / F.A.U. Framing /"Z22 Compressor Insulation — Vents Fireplace P.L. _ Grills Fireplace T.O. Fans 8 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath ou Drywall - Int. Lath Final Final POOL , - . AS BLOCKWA A PROVALS 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 _pa 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: Final Utility Notice (Gas) ELECTRICAt 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) If