0008-093 (SFD)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 ate
B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Con6actor's
License Law for the following reason:
1, as owner of the. property, or my employees with wages as their sole
compensation, will do the work,andthe structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) l,'as o�wner of the property, am exclusively Contracting with licensed
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 herebyaffirm under penalty -of perjury one of the,following declarations:
( ) I have an , d will maintain a" certificate of consent to self -insure for workers'
Compensation. as provided for 6y Section 3700 of the Labor Code, for -the
performance of the work for which this permit is isgued.
-1 have and will maintain workers' compensation insurance, as required by
Sedtion 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:
Carriei. STATE PWID Policy No. 046-DOW71 . 38
(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 -sous to become subject to the
_workers' compensation laws, of Califd`r�ia, and agree that if I should become
Subject to the workers' compensation provisions of) Section. 3700 of 1he Labor
Code'I shall forthwith comply'"With, those provision . s.
Date:A"'f,/,f-,O Applicant— 7
Warning: Failure to'secure Workers' Compensation coverage. is unlawful and
n
§hall.subject an employer to criminal penalties and civil fines up to $1
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 ismade & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicato.n agrees to, & shall, indemnify
& hold harmless the City,of La Quinta, its officers, agents and d 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 herebyau&brize repird-sentatives oJ this City to enter r upon
the above-mentioned property forinspection purposig.
Signature (Owner/Agenty— Date _`_AIIA:.�
BUILDING, PERMITPERMIT #,
DATE VALUATION LOT /TRACT
60 29457-1
JOB SITE
AP N
ADDRESS
46-610 VISITA, LPFIRMA -/eo - a
OWNER CONTRACTOR DESIGNER EN6INEFR
TD WSliUld 1bF_VM01r'MW.1
7 9 - Z95 RAN 040 LA QMNTA- DR.
AYDOX 1716
LA OLMrrA CA 92253 LA QUfNTA CA 92253
760)771.15941 CDL4 2996
USE OF PERMIT
3FD. LOT:60 PLAN:M.1 r PERMIle- DOES NOT M10AID8 BLOCXWAW,',-0K
POOL - . ..11, !,
CUSTOM CONSTRUCT101,4 '048,00,3r.
PORCHIPATIO. 690.00 SP.
CARAGEM"ARPORT (0) t 3,582, so
RWYD"'MID, COSTOF C0.WSMVCW01q
CONITYRUCTION RX
101-gt. 0.4113.000
S1.23o
PLAN CHWX I=
101-000-439-318
'61,056
MECHANICAL FEE
101-000-421-000
$149
WEC
LTRICAL YZE
101 -000-4-20-000
$415
PLUMBDiO FEE
101.000-419-000
STRONO MOTION FEE • RE -SID
101-OOD-241-000
OPLADING FRE
101-000-423-000
mmmopm impAct.ml.,
ART W PUBLIC PLACES - R011 701 -000 -255 -WO
WB -MTX, W10YRUCT1.09 AND PLAN C%WY, $3,064.17
IM- 3 PRE-PATD FM $0.00
RECEIPT
DATE BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap�7
2 ��
F.A.U.
Framing
_ _ 0 6
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
Final
BLOCKWA
PROVALS
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
- Z 7 Lv
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
-7 Z
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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
Utility Notice (Perm)
COMMENTS:
-0
"
NO
REGISTERED INSPECTOR'S WEEKLY REPORT
JON-TANDY' }
37630 Medjool Ave:
Palm Desert,. CA 92211
Office (760) -772-7192
Faic (760) 772-7193.
Pager. (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY CiPOiC)or
❑'POST TENSIONED CONCRETE 0 ASPHALT O OTHER
O REINFORCED MASONRY O FIRE PROOFING
r.
REPORT SEQUENCE NO. _
REGISTERED INSPECTOR'S WEEKLY REPORT
JON-TANDY' }
37630 Medjool Ave:
Palm Desert,. CA 92211
Office (760) -772-7192
Faic (760) 772-7193.
Pager. (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY CiPOiC)or
❑'POST TENSIONED CONCRETE 0 ASPHALT O OTHER
O REINFORCED MASONRY O FIRE PROOFING
JOB LOCATION ^ � p . � ' q
U
REPORT SEQUENCE NO. _
TYPE OF STRUCTURE
PERMIT NO. - .�
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT w
INSPECTOR
HRS."CHARGED
ENGINEER /V~ q /
ASSISTANTS
HRS. CHARGED
INSPECTION GENERAL SUB P
DATE CONTRACTOR CONTRACTOR T o` ij e / 1
191f-7-
5-eAv-ed 1Qi--e~"7" p ' ? •E:A) 7/8" 4 Z &__.i41
�r ori :5-g%- -e ox: ele2�9.e
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ox i" -eco-1 ovV-.-
G, T'f 7/ A/- J/ ,' - 7 A/S tA� l 1 C Cl -e Q.C- 11 5)' t:
Do 0 4 k=_Aff"
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c'
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" SIGNATURE OF REGISTERE INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE `
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED Z/ZZ / B��
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. DAA OF REPORT J t REGISTER NUMBER
ov, s