0302-088 (RER)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 c# �j +y ypLiic.. CllYass,, Exp. Date
ell
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P,
ate._ Signature of ContractorT,• -"
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 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, 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 rat *d amploye"'iev Policy No. `:br1m1040404
(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
subjectaoi—A-1 e workers' compensation provisigrfs of Secti n 3700 of the Labor
Code I sh forthwith comply wit those provisions
Date: 7Applicant%•//�F
Warning: Failure to secure Workers' Compensation, coverage'is unlawful.and--_
shall subject an employer to criminal penalties and civil fines up to $100,6;n
addition to the cost of compensation, damages as provided for in Section X70
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Say
for a permit subject to the conditions and restrictions set forth on is
application.
1. Each person upon whose behalf this application is made & each person t
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 aut orize representatives of this City to enter upon
the above-mentioned propel{y for.inspec iion purposes.
'�, > 1
Signature (Owner/Agent) ., u f•f - Jr Date'
BUILDING PERMIT PERMIT
DATE VALUATION LOT TRACT
t3;�./,��'{: 4 ;�t�. � 11401 TRACT i 14B
JOB SITE
ADDRESS 56-336 IYEBBLE AWA.C_1
APN
n11M.!4.3. 431-00
OWNER
CONTRACTOR / DESIGNER / EN INEER
'MIR. suteam #
W.13 EVIATP.RDS COMMtrCUOl.
56-336 14"BIBLEBRACIT
'79-M
I,& (,)TJ1N-YA CA 92,253
LA QUIWA A.. CA 922513
CL 4 .1212
USE OF PERMIT
P.it~ib!lODiiL COLT? CART QARA0ZAI rXN0 0 SCS d VIS S? PATIO
COVER PER :REMO EEMD P3.<, W &C'AXflr2001 CDS.
VAL13AT1014 39,tlQQrOt La
MkRAGEdCAiQl ORT 6R tiff Sia
POWUWATIO 225.00 'IF
ESTIM.M.0 MST OF CON1711RUMON
YFRWr FEE S3TAAWARY
PLM. GFnc:y1 Tin --; S01-000439.318 =Mg
CMIS a RUCTION .MY rj 101,..QW4.3 84�=l W9150
J'T1WNr3 MOTM4 FEE: 41D 101-000-241-000 DI U `
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T01410 FEMIrr :9f ER.S., DUE ;Now
08010
RECEIPT
DATFFEt.
p;
B�
DATEFINED
tJ O3
INSPECTOR
F
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
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/ D3
Drywall - Int. Lath
03
Final
Final S7
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring 3
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
YES
Young Fa>Igiing Sim ViCES
77.804 Wildcat Drive, Suite C, Palm Desert, CA 32211 • (760) 360.5770
• Civil & Structural Engineers • Architects • Surveying
• Code Consulting • Building & Safety Services
Telecopy Transmittal
To: CITY OF LA QUINTA FAX No: 777-7011
Attn: ED Date: 3/24/2003
From: ERIC FRENZEL Project: PC #'0302-088
Phone W.O. No.:
No: (760) 360-5770
Description of Document:
PLAN CHECK FOR 56-336 PEBBLE BEACH PC # 0302088.
Comments:
PLANS ARE ACCEPTABLE UPON PROVIDNG WETSIGNED,
STAMPED COPIES OF
CALCULATIONS.
THANK YOU
Original to be
Mailed: ❑ Yes
❑
No
This Material
Sent:
❑ Your Files
Your Review
❑ At Your Request
❑
Please Call Upon Receipt
Other ❑
Copies:
Total Number of Pages (Including this 6
Transmittal):
Note: Please call and ask for Telecopier operator if you did not receive the. total number of pages
or cannot read the pages transmitted, Thank you.
CWE7b 5/98
r
Z0 39dd 3S 9NIN33NI!)N3-9Nn0A
6TL909609L 80:Et E00Z/bZ/E0
,SPECIAL INSPECTION SERVICE_,i
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
❑ REINFORCED CONCRETE O STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
❑ OTHER
JOB LOCATION.
_
1 � , W -
REPORT SEQUENCE N0. �
TYPF.�OF.! Q TORE-
- - - ' '
'•`
PERMIT N0. _ _ } 4 -
D�
DAY OF WEEK
MATERIAL DESCRIPTION
ARCH C,J
HRS. CHARGED
1
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
"GENERALO ;Q wC�� - SUB-, - -
CONTRACTOR p� Z -CONTRACTOR
-
l�
N -(o S
Pe
Sl v1 S
COPY SENT TO CLIENT O
CO TINUED ON NEXT PAGE O
PAGE Of
CERTIFICATION OF COMPLIANCE .
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV
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.
IG T E.OP REGISTERED I PECT R
L kb
D TE OF EPORT REGISTER NUMBER