0002-125 (SFD)LICENSED CONTRACTOR DECLARATION
1-hereb)-wffirm under penalty of perjury that I am licensed under provisions of
(Nt
apteiA (commencing with Section 7000) of Division 3 of the Business and
-�° rofessionals Code,*and my License is in full force and effect.
License # Lic. Class - Exp.. Date
0 0 11,201
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:
1, as owner of the property, or my employe6s with wages as their sole
compensation, will do the work, and the structure is not intended or offered for -
sale (Sec. 7044, Business4 Professionals Code).
1, 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 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, aisj provided '6r': by< Section 3700 of the Lab6i�,Cocle, forthe
performance of,the work for which this permit is issued.
I have and will maintain Work6rs' compensation insurance, as required by
Section 3700 of the Labor Code, -for the performande of the work for which this
peimit,is isiued...'My workers' comp ensation- in , surance carrier & policy.*no. are:
Carrier Policy No..;
(This section need notbe completed if the permit valuation is for $100.00 or less).
O I certify that in the'perfoirmance of the woirk.f6r,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 Calif6mia,, and agree that if I"should become
subject to the wo-rkerg'compensation/Proves ions of Section 370`0 of the Labor
Code, I shall forthwith comply with those, provisions.
Date: Applicant- 1 Z
Warning: Failure,to secure, Workers' Compensation coverage is unlawfullarid
shall subject an employer to criminal penalties and civil fine's up to $100,0,00, in
addition to the cost of compensation; damages as provided for in Section 3706
of the Labor Cocle, Intertest 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 pers*on'upon who'se.'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 6 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 purpose,
4tI -
2I# -OU BUILDING PERMIT. PERMIToz-ai A
DATE VALUATION _2&.SSJ,.00. LOT 76 TRACT 293 )6
JOB SITE
ADDRESS 45470VOPTA CAUIC0.
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
TO THIISERT DF.VEL0,'V-%1f13Kf
SPARKS 'CONIFIRTUOnON'
I
79.295 RANCHO LA QURNTIA-DR.
LA. QU(NITA CA 9225:S
LA QUPWA CIA, 92253
f760r, 7 1 - 041 CNIA, 2996
USE OF PERMIT
KNOLE. FAMILY DWELLING
SM.WT 210 PLAN E 1-1t- PFIRNHT 0085 NST INCLUD8 BLCv= WALLS OR.
CM
r M al,
0il, 41PA110
0ARAGFJCAkP0R.T W
USTMATLrig, 0 co.'41`4 G'ff COINSTRUCTI ON
220 S'11,194
10 J 17 1"'
NMIC-11U101 rCAL MEE. 101-00042.1- Wel $10 A
PLM1.81,N10 FE"E" t01 41004114-0010f 51799 a5
0
GIZADTINX F Ec, 00042003 0101 - -3, ';,2 C
DIAT U-0FIEr, PVERA.(�T l -EM
M-;Vr IN PUBLIC PLACV3 - R981C 701.-M1455,000 $302,1.3
T.
LESS TS
TYTA AIMITF M191AWN0W
It
RECEIPT DATE, DATE FINALED INSPECTOR
INSPECTION RECORD
r OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade ala—CSU
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 Wali 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
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 j
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final - Q�
Utility Notice (Perm)
COMMENTS:
� GS d!� G,-4 S--7 3
SE RVIC E'
SPECIAL INSPECTION
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
❑ REINFORCED MASONRY O FIRE PROOFING
O
O OTHER
JOB LOCATION , /j_ L47 if ^
`x`-11
��
��
REPORT SEOUENCE NO.
TYPE OF STR4TURE
ST -D vpkeu
��aGaNAD
PERMIT NO.
DATE
5 �S 60
DAY OF WEEK
MATERIAL DESCRIPTION
;nn S N �.
o)( -q 'Ic6e5 4945
ARCHITECT
4--y- P EVV'- e.2At3E
INSPE OR
'['Z"D,
NRS. CHARGED
ENGINEER
tC AM
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
__, CONTRACTOR" - �"_ _ _ �__e .- _ _,. CONTRACTOR r
5 i 5 a
O b s -e. V -ed
Of
QA' (
us�nr�iti
�a�
oxL,Bp.
9LlS.
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
r 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 IIINR I AWF
I
S NATURE OF REGISTERE NSPECTOR
ow ��d
ndTr nr RFP[1RT.- ocrocrco •n i..oco