0008-094 (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 .Exp. Date
674,974 7d �:- r " 07/31/2(
Date 4, Signature of Contractor k,1
( - ,._._1_ ,"'Y J -. ..o.�
OWNER -BUILDER DECLARATION "
I hereby affirm under penalty of perjury that I am exempt from the:Contrktor'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 isrriot intended or offered for
sale (Sec. 7044, Business &Professionals Code).
( ) I, as owner 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 hereby affirm under ,penalty of perjury one of the following•declarations:
O I have, and will maintain a certificate of consent to self -insure for workers'
compensation; of 'as provided for by Section 3700 of the Labor Code, for the
performance 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 F'U14D Policy No. 046.00W335
(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 s to become subject to the
workers' compensation laws of California rarsd agree that if I .should become
subject to the workers' compensation provisions/of Section 3 000 of the Labor
Code, I shall forthwith comply with hose provis ons. -I
Date fl', A'plicant �)
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.
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 s'. .
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 p rposles:.
Signature (Owner/Agent). ate
;-BUILDING PERMIT PERMIT {J
DATE '' VALUATION LOT' O�Q+1 TRACT
2.945 i-1
JOB SITE w
ADDRESS $S^dIALir►
APN
9 -fir }
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
PO BOX 1'716
79.295 RtMGYl3C1 T�'�QCi]D1TA7a7 ,
LA QiJ'.iAl`CA CA. 92253
;L& QUINTA CA
92213
(760)171-1941 CBL/-
2996
USE OF PERMIT
Swo. LE 1�AML3� iilll' .,Y 1 i3
SM Ld T:6I PL NW 1 - PERMIT DOIa NOT i1dCI..i#DE F; Lo ;iC•WALL.'s OR
POO 95{Yo PCSEi?1 H :Ci ISE t I;1LiC'('I t;,t FOR. MULTIPLF' ik7 UMICK Off''
SAME PLAN TYPE.
M'fOM CONSTRUCTION 3,3�3.D0 S1�
PORCH/PAT10
0ARAGUMPOR.'P (SI) ]:x,382,80
•
cosi' or cvrvS-�_ tcrr;uoN
292,106. 00
77��gg�+�RR//,,�tig�•�;11qp�'seyyTT �nf r�y�•p� ,�•�1w:S'g7FI�ATIM
1CA±aRt4l.7.�L..O1FS til LtlYiDlJCA�R
COAdSMUC. ION PTE -101.>CI00•418p0U0 $1,230,00
PLAN CHI= FEE 101 8 $264.23
MWC'13MICAL FM 101.000.421.000 $149.50
ZLIWTRICP.LFEE 101.,000-420-000 $815.04
PLUMBIHO FRE 101.000.419.000 $20125
f;3
STROr70 MOTION FEE _ MID . 101-000-241-000
C1 to IPlt3'I� W 101-000.42.1.000
DEV ELOPER 94PACT.Ifft,
ART IN PUBLIC PIxACES - RES11 7018000-255-000 $203.2`7
s
• -
s.f.n.Y 1MK•`
�rr
'1 113-TO'i�1i. COIeT �`�'RL7G"1'iU1+T Al 1 1. r`i�ECK
4,_71.50
LESS PRE-P,sAID ITMX0,00
RECEIPT .
DATE j f
4 it"`moi
BY
�'• '"
DATE FINALED
INSPECTOR
,
.
I i !�
1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
Set Backs
Forms 8 Footings
Slab Grade—!ry
L2�
/_—
Approval to Cover
Steel
Equipment Location
Roof Deck
Z
_
OX to Wrap
ZZ
PLUMBING APPROVALS
x
Waste Lines
Framing
Water Piping
Plumbing Final
Insulation
Equipment Enclosure
Shower Pans
Fireplace P.L.
Sewer Lateral '., , , ��
Pool Cover '
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drvwall - Int. Lath
_
1
OPERATION DATE I. INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Compressor
Vents
Grills
Fans & Controls
POOLS - SPAS
BLOCKWALU APPROVALS
steel
Set Backs
Electric.Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
i
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
x
Waste Lines
Gas Test
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral '., , , ��
Pool Cover '
Gas Test
Final
Final
COMMENTS:
ELECTRICAL APPROVALS `
Temp. Power Pole
Underaround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Notice
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
,SPECIAL' • Fax (760) .772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
❑REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
k
❑ OT ER
JOB LOCATION 118--b3o � S 1—Cc `e S+R:e. I f C /LA Q, u I �q
/FJ
REPORT SEQUENCE NO.
TYPE OF STRUCTURE
5 PI> 1--0 T ?A
PERMIT N0.
DATE -
1-2-17-2-Y0
DAY OF WEEK
MATERIAL DESCRIPTION -
ARCHITECT
INSPECTOR
HRS. CHARGED
ENGINEER
- Q t..\.t f
ASSISTANTS
HRS. CHARGED
a
INSPECTION
DATE
GENERAL - - SUB �� `
CONTRACTOR CONTRACTOR
12 22
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7b' ° 4-1 ! `i iI �c
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2-2.
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-
` COPY SENT TO CLIENT O
CONTINUED ON NEXT PAGE O
PAGE OF /
CERTIFICATION OF COMPLIANCE //( J e�J,
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY V "� SI NATURE OF REGIS RED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE /� ` [ /
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED %!i °LZ 60GBD J �l 3Z6 — 7 9
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS. DAA OF REPORT REGISTER NUMBER
J