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0002-131 (SFD)LICENSED CONTRACTOR DECLARATION I herF,�y 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 vjoui i. is iiIr Gi DateSignature of Contractor6 �4'� 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 jiF606IRy, 9m eYCluslvely contracting wlth 'Ilueiisud 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: Carver Policy No. f0f>1Pr7 -$( AIGQ3,0 AlKi"30 (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,,an gee that if I should become subject to the workers' compensation,p ovisions of)Section 3700of-t a Labor Code, 11,sp, all,forthwith comply with those provisions. - Date: Applicant Warning: Failure to secure Workers' Compensation coverage i`s,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,auth-orize representativesof his City to enter upon the above-mentioned property for;,�Jlnspection purpose / �. Signature (Owner/Agent) Date- i(11 PERMIT # r�> BUILDING PERMIT 4910 -1JA DATE VALUATION4ia�4�^ i O.,) LOT ;1� TRACT �rD�tJh JOB SITE ADDRESS APN OWNER CONTRACTOR/DESIGNER/ENGINEER t I)jl1 .rITT R 11P.N1 ei SpAfffKs t,f)�fFM;TIx( ;'ff j"T PO BOX 1710 79-293 RANCHO LA QUW.c'1. IA f,AQLANTA. ('A 92 253 L;rlQt1INTA CA 922:x;3 USE OF PERMIT ii- u-1 OT 3« t%Lr�ly L ik- k'atAM,i! 1)UL.S ix i INCLiiiAt'' d�;LLlt;h WALLS i i2 I+U0L.`/5°'i,.PLANE 3ityt;A:1' : 13L'!)tl(,"1 kC3f� .K)R Ivli!!.TIPLh, KiSC.fA.tw',(.1-* O SANW 1,11.AN TYPE t:leiiil�s;}1:/('Afti91.)�'1° 6td,Ut1 SIS IAIIAT.F:ID �.00111"T 4111 �.�I.,a .l S.O �l.lJti _220,44Z."2.(YO �� ��(77.j ��((■■ ♦♦ y1"II yy� yy��kk�+♦1�j�j 1414", 4",)NSi'RiX*Tl()N14A 101 -M) -418-!}W S,1,(16t1W fitf AN h'► -F f t)t-t�lt)t)-•tx=a-(��/I R !?`B.�iR�iRt 14v i4.�B1L .�L 10.1 .01 M, iiLL5 ,;l teak AL K&E 20-000 $ it,4.U1 PZ.IIMfi7i f'f 1101-000-419-000 $ 79125 i).t VL.A,Ut',8H idbf4'ti(:"1'x'{!15 Si,907.(9) f R7V IN €'17tNAC VLAC'_S-RE'SlU 101-000-25540i V02-13 S1)Ei=TTYrAT,C0--OR"f`Rt�t"Ti0NA Nn PT. A_Nf'F`i4)•r1t 'p(+, �i13pTJ�i'1): TOTAL t>ERNITt° F EWS DUE NOW $3.97:8.33 RECEIPT DATE BY/ DAT ALED Wl A INSPECT ✓' ,p i. INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Grp Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap Framing F.A.U. Compressor ly 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 Pool Cover Encapsulation Gas Piping Gas Test Appliances Final COMMENTS: " ' �c s o•c/ �� ,. e..r, �,'�.luL o !C S—_2 r - ���� �Piv���o�/ ` Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles 7- G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) 9 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 1 8, q (� ; CIO /v- 1Cl,� • I-6Aj �O� REPORT SEQUENCE NO. TYPE OF STRyCTUBE S -fp Not cc � �Ca��D l�lasE PERMIT N0. DATE 5 l5 b0 DAV OF WEEK MATERIAL DESCRIPTION ARCHITECT �1' INSPECTOR HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR sue t CONTRACTOR -7 Q \ S 5 a hse�2,v-ed c - vv ofq E, ,-T "' A l i fkae�A d w �" F.w. oar � �• ,4. 5 8 , � . tl i-� 2 LZ ;div" JwA e �. o e i r C a CAS Z -p' V COPY SENT TO CLIENT O CONTINUED ON NEXT PAGE 0 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 r.nVFRNINf. RI III nINr, 1 AWG f 7� S NATURE OF REGISTERE NSPECTOR nAftr n;: RCDl1RT oCGiCT[o Kn 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 674014 B 07131/20 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 they 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 for4y 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 FUN'T) Policy No. 046-0007338 (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. f .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 PERMIT(#�(�,qq ,'•. yy yy iJL7LL•'i�d �•y,4 '• ' DATE VALUATION $220,052,00 LOT 32TRACT 2930JOB SITE ADDRESS 4S.&S 1 �.r;�P.9..i� C%�a CO - APN i^I�i•629 OWNER CONTRACTOR / DESIGNER / EN 6INEER 11%3 DMIS.1 M., DR:VKI Op v mlr SPAR°t3 C01\iWRUCx aka T°O-BOX 1716 7942 5 RANCHO LA QIW. f. DPL LA O1.T1V!`A CIA 92253 L.A f uinA CA 92253 (700) 771 � 1941 CBIAI 2996 USE OF PERMIT � 1..11FAi�1.,.Y SYWY5l 10 ; SFO-LDT 31PLAN EIR• PERMIT DOMS NOT INCLUDE' BWCK WALLS OR POQL75-A PLAN telae K FEE k. DUCTION FORMULTIPIX ISSUANCE OF SAME PLAN TYPE. t 3,63..3.00 CUSTOM CONSTRUI 11Ol7 SIS PORCH/PATIO 367.60 SF QARI GE1Ct.AftPQRT 614.00 OF F.. fMTED CO3'r 011 CONSMUCITON 2201&52.00 CONSTRUCTION PEE I01.0M 418.000 $1,063,00 PLAN CHECK FEE 101-000-439-319 $7117.90 MF:-HANICAL FEE 101.000421.000 $10540 MECtRIC.AL FFIE 101-000-420-000 PLUM -PING IEEE 101.000.419.000 $179.25 S'PWHO MMION FEE - R>~.9IL 101-000-241-000 $33.09 GRADING FER 101-000.423-000 °710.60 OEVEIDPER IMPACT PEE $1,907.00 ART IN PUBLIC PLACFS - TMT- 701.000-255.000 $302.13 S1Tt34(1'T'AL COl`1 IZUCI1ON AkTD PLAW CFWC`K $3,978.39 LESS PIRis 1'AID FEES 'Y(Y f, -L YMMIr T ES MY, Y, 2 Y O l :J r$0.00 t RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Forms & Footings /,� jam" !� �j Underground Ducts Ducts Slab Grade C_S Return Air Steel Combustion Air Roof Deck O.K to Wrap Framing �Q�_� _ _ �� 7 C—�! / �`� Exhaust Fans F.A.U. 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_Z/ Q� Final POOLS - S AS BLOCKWAI�L A PROVALS 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 _ ` Pool Cover Encapsulation Gas Piping Gas Test r% Appliances Final COMMENTS: Final Utility Notice (Gas) ELECTRIC PPROVALS 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 i Final G Utility Notice (Perm)