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0202-092 (GRES)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 Dated "" ' �- Signature of Contractor -4&L 4•_• �� •tea pT--"-�-"1 OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that l 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. 7044,1 Business & Professionals Code). ( ) 1, as oJher 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: O I have a idIwill maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the tabor 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: r My workers' compensation insurance carrier' & policy no. are:. Carrier ;STATA FUND Policy No. QN&OD-rs 6579-2G:1I (This'section need not be completed if the permit valuation is for $100.00 or less). O 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 l should become Subject to the workers' compensation provisions of. Section 3700 of the Labor Code, I shall forthwith comply with those provisions. r Date: 'T Applicant NV / �"`✓ �,.� _ Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an.employer to criminal penalties and ciyil,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.' z 1. Each person upon whose behalf this application is made & each persorf,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 property for inspection purposes. ZGign6turo (Owm&, gent) ll+-:! C�at4:y BUILDING PERMIT PERMIT# 0202-092 DATE _)VALUATION (y LOT TRACT // ! JOB SITE/ ADDRESS 4tJ-5&i VJ&Te,� CtdJC0 APN - OWNER CONTRACTOR / DESIGNER / EN (NEER MEW & AMMAR& STORWI , CYASSC BUILDERS WC 48.565111'FrACAUCO 45.2,70 01A DR?VE Lz°4 Q1 -NTA CA 92253 INVIa'i.N WRI U4 CA 92210 (760)772-1011 G'iVI, 4999 USE OF PERMIT GO1LY CART (fA'R 0[? -AX 01T1(3'k2 (295 SY) 01Jl9 C:tkX7LV0€tI S? t w t 3'k` I) C >'o 4 7t�' `.:S'lt�Tti Ta"&t ` <3 4,018e . PLAN� ��i,/N • - tfyf�y:,�1��E(.tCK!`F���p7Palp'l7y qi/016}t'J�Cygtp0-43�9--'2•�l;8 Q�}S?p �/tE.@ W Qh�(.M'+1 11✓lY...B'.Wl�b 1'.Y—{./ifF4`•'°1 d &.000 M WHANICAL PEE 101. 00042'1-000 SUN Y,I,ZC"t 1c1CA 1. F?'•X 101-000-426-000 $V. til C t3Pilaf3 (1E 01 -DOG-423-000 .0.0 ,w 1 9'101RONC7`Tedii,bCONR1`1;i.1:1�"'i��iC39Al!1•���,){{„„T.("T.-AT1�1��°:r�yy'.CK �2..����t.:/�L�S+C) p,/I. �yy�� •,: -- • • '"r ,.... _"— d,.,d+:.M MVPAV, aV, Cwa��,'eA]�i i Pliluff'r 111M _S OUTi., NOW �Y16h 00 ' MAR 0 7 2002�� CIT 0FLAQUINT a RECEIPT DATE J BYE DATE F ALED INSPECT N l/ / r -� INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION T DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings ^/ — © Ducts - Z Slab Grade Return Air -3-z Steel Combustion Air Roof Deck -j, Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation' j� Vents _ _ Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath /O' y - Drywall - Int. Lath _ Z 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 _ _ Shower Pans _ Equipment Enclosure O.K. for Finish Plaster Sewer Lateral_ _ Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances - Final COMMENTS: Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring 6 7� Low Voltage Wiring Fixtures Main Service Sub Panels _ Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) v 1 �SPECIAL INSPECTION -SERVICE, 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 ❑ STRUCT. STEEL ASSEMBLY O POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING ❑ , HER�� {�IG r (—.A 111 REPORT SEOUENCE NO. TVP Qb.STJ�UDECTURE�� . P.E MIT () � ` O DAY OF WEEK MATERIAL DESCRIPTION 3 ARCHITECT HAS. CHARGED . - ENGINEER ASSISTANTS HRS.CHARGED INSPECTION DATE GENERAL — CONTRACTOR' " ♦ SUB = ^CONTRACTOR l �-r i COPY SENT TO CLIENT O - CONTIN ON NEXT PAGE 0-11 PAGE OF CERTIFICATION OF COMPLIANCE '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 GOVERNING BUILDING -'LAWS. L., sVGN T RE OF R IST!JE ECTORL,� DAT OF REPORT REGISTER NUMRFR --_ —1 ..i