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0002-129 (SFD)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Char 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 40 14 Date `J Signature of Contractors 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). ( ) 1, as owner of the property, am exclusively 66VACiing with licetlsed 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. `4aits&..K ;tNL f'•164 0;.11; (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-1 should become subject toe workers' compensation vls ,prolons of Seciion 3700 of the Labor Code, I shall forthwith comply with thostprovisiohs. Date: , � '� � Applicant— Warning: pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,00,0, 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 application 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 spectlon purpos . �,.. / L Signature (Owner/Ageht)" "— (Date "1 '? -66 BUILDING PERMIT PERMIT# r DATE VALUATIONLOT A) TRACTJOB SITE ADDRESS 43-394)V TSTA d.�faJACO APN OWNER CONTRACTOR/DESIGNER/ENGINEER SPA.RKI'sC'ONSTIRT11.ii;'+1 79-293 i2.akiv(;HO LA. QWiTrA bit. !.A QC,llNTA CA 92293 LA f, VINI'A CA. 42251 (76M171-119,411 0'33X. 7946 USE OF PERMIT �i� r�=i.0 � :iu NirATd ;itt- A'LitlYii T' i�u:5 :N[ii f' ,1cvCi.tii��:tli.�t�ri. 1Vr1.t.1.S ral: 1't�'lalf `!54•0.!'%,Ad�P t',ii K"st, I•h� S.F_t3ldC:"1'1t )fV FOR MU3.°i'I.t'L!,' 1.SS1 f.ANCL cep; SAME sy)...AN' YPE k71U AkjM (.Il)N.S97RA1.01171(yN 2.05.00 Sl' 11L)1tt ,.VVtkS1L) .67.11{) .114` t3rt.t2rl(.i0CA.!<k'0KT 614A) iY x!`; 11NO IT 8 D Mgt Of, Citi STI UCTION 220, S.tI '1a 1'3l;ithiff i"E"C' SiUAVViira kY i )Nf,TRtf(" f 10N YEts 101 0 O,418 -00i W.AN('TWf-V I37F o() ME' 10.1.000 42,1.-000 01111 W.,E "YlttOflimsFJiti 101 -00U -42(.0X) $16401 I Lt �Il�ttlt tc ?as.F: 101-U(iu-4114.0 0 $179.': ,1i .^+'1'fx(lt O)V,0TI.(7N1+1')%_10140041-t:W C1R, )AING axil 10I-000A23"co© 1°4b,1yU rai�v�i.�F�:t�Ez.:ii�a�a ,�1;t: �i.94)i.t�t► Aid'1' [r1.I Ufii;lti" !+ -AC1 S - I 5t1' /Oi-thit)-295-{Sii i S W2_1 1:3 Si Ito. -i tTVA If i''O KM T 111I)P7 AN F) PI , AN. C°7-1T'vw . 18 r :'tyh 1)Y1 it A tP ?C. 17 t• 4�t„Rf�.. At1 !9 RECEIPT DATE BY DA FINALEDINSPE INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade /p —per Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K to Wrap F.A.U. Framing Compressor Vents Insulation 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: 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 17. Utility Notice (Perm) 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 O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY O POST TENSIONED CONCRETE O ASPHALT ^ O REINFORCED MASONRY 0 FIRE PROOFING O ❑ OTHER JOB LOCATION LAI-310V,:S�A /V' . p AI; CIO � "� /`xl• �` �Ck REPORT SEOUENCE N0. TYPE OF STRUCTURE i S1fD VFAU 11 E"Co►rV�tD 1Nwie PERMIT NO. 1 INSPECTOR DATE 5 DAY OF WEEK MATERIAL DESCRIPTION onn S N rt. f9 �t ScSt7-i�3�IS ARCHITECT .e1� P -E��' °� E -R I 'D, HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL CONTRACTOR SUB t CONTRACTOR T A%wo— ` Y of E, �� �' I� t-�►�>C d 61A0 ( ti{µ/ 6 Q 103 (S C G L'46 � a oVt_� ri6iN Ox L�Q. 7'-/ COPY SENT TO CLIENT ❑ CONTINUED ON NEXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT, I HAVE INSPECTED TO THE BEST OF MY NOWLEDGE 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.OVFRNINr. RI III nINr, I AWG .5-/SYGNATURE OF REGISTERE NSPECTOR /;571 D--© 4MC4649 f // 132 - 415 n F nr RrPnRT DCrICTCD knu.. 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 674074 07/31 /2C 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 6YCIUSIVGly CUrltractlny Wllli Ilcerlsed contractors to construct the project (Sec. 7044, Business & Professionals Code). O 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 S TAT& FUND Policy No. 046-00073:13 (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. '72. 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 Ii DATE 04 ` /2(X VALUATION $2205200 LOT 3� TRACT 2 A. JOB SITE ADDRESS 4&: VLVrA. CALICO .W - APN 645-.1110-0. 9 OWNER CONTRACTOR / DESIGNER / EN (NEER ;C a D,I;+S. i`b.+:LQPM;'XT FWARr,9 O'C?A1'�':T"CUL=14 13qq��ry1T��Cyp�1716, 't�79_� -29y 110 LA Q�CI��i TA.DR. yyPO 1q� yryq L.k Q W.iiV r A. - CA 922 3 y5'[�F.fm�3A LA. Q eA CA 9221 (760>771-11941 'But, USE OF PERMIT SING EYA M1,T DW&.1.M11 t SFD.I-t)T 30 PLAN E1 R• PERMIT DOES NOT I'N6,,UDB SLOCK WALLS OR P001.75Vo PLAN CHWX FEE REDUCTtOA FOR MULTIPIZ (01JAIXE OF CUSTOM CONSTRUCTION 2,635.00 SP PORCHIPATIO 167.06 SF KIARAMC.QARPORT 614.00 SF ES 'M COf? ®3, CO RiitK""1 ON 22OA52.00 FER-M T' V1s:Ja MMWZY CONS'PRUCTIOAI FERE 102.000-438-000 $1`063.00 PLAN CiiWX FE9 101-000-439-31.8 $117..90 MECHANICAL. FU 101-�OW.-421.000 5105,(10 ELF,C TRICAL = 101-000-420-000 $162.01 PGL MB.1110 F 1.01.000-419.000 $170.25 3TRONO MOTION RESID 101-060-241-000 $22.09 GRADING FEE 101r000-423-000 Sd(.0 DZV1':I P8_R IMPACT FEE: ART IN PUBLIC PLACES • I09M 701-000-35:5,000 $302.13 =8 -TOTAL CO13SI RUMMY AND PLAN Cr,#',WK $3,978.38 LUM PRE -PAID 14M Saw 3.'a x mmS,r i x s i Now $3.97€1.'.% / RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs � 7 Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck , �a _���-tom Exhaust Fans O.K to Wrap � _ � Framing _� F.A.U. Compressor Insulation ��� Vents Fireplace P.L. Grills Fireplace T.O. Fans 6 Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath l Drywall - Int. Lath Final ' Final I_A POOLS - S BLOCKWALL AP' ROVALS 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 Sewer Connection �( Pool Cover _ Encapsulation Gas Piping Gas Test _ Appliances Final COMMENTS: 2 3 Final Utility Notice (Gas) f < �� ELECTRIC L 4PPROVALS 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 FinalG? Utility Notice (Perm)