0108-353 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
I Chapter 9'(commencing with Section 7000) of Division 3 of the Business and
Wrofessionals Code, and,rny License is in full force and effect.
License # Lic. Class Exp. Date
73315; 13
Date ' ` `� ' Si nature of C/eyi rOO of r�: '`T ri'l i; j"
t 1
4
..✓' 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.
,J ., I have and will maintain workers' compensation insurance, as required by
�Sedon 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 Policy No.
C.�AI.1t50Riei?il'!"Y' Tt:4i�t.:".f?�iFs
(This'section need'ndtbe completed if the permit valuation is for $100.00 or less).
() I cgrtify that in t I performance of the work for which this permit is issued,
I shall not employ al person in any manner so as to become subject to the
workers' compensat, n laws of California, and agree that if I should beco(ne
subject to the work s' compensation provisions of Section 3700 of the Labor•
Code, I SShall forth h comply with those provisions.
Date: :'r++` 1 Applican4j;T_
Warning: Failure to secure Workers' Compensation coverage'`•is unlawful a' Ad
shall subject an empldyer to criminal penalties and civil fines up to $100,000, in
addition td the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at .
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La QUinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that 1, have read this application and state thk the above information is.
correct. I agree to comply with all City, and State 14s 'relating to the building
construction, and hereby authorize representatives bf'this City to enter upon
the above-mentioned property)or inspection purposes. .
A'`'.A.� v.�' j ! -1 Lel_ L-
,Signature'/
, (OwnerlAyenty Date ,
+,
BUILDING PERMIT PERMIT#
DATE J VALUATION LOT 01W3&4 TRACT
r
+
JOB SITE ' P "`
ADDRESS
APN
t ).AX 1111 J$
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PGA AB► i )C fitly 1014
ISII.. MAR P:AMIC OHNk:E AL C0M RAC
PC) BOX. 1060
462 01'M,N0 AVE #302
1,A £1UINTA CA 92253
Eii:3LANA 13F"11i CA 92075
(956)792.1500 CBL#. 5823
USE OF PERMIT
IX)CAL0WIC.? INFORMATION
75.160 ST. {.`{-IARLP0 PL
i+i>"61�Sd•tlS'7, 14,053 &M -W9 OAK HILL • HU1I.01MU 10 TYPE
10C. VOLUNTARY 15TH.11c;;TURAI, hg0DI1'/I",TT01q8
1
V.r:L-VATION 21000,00 LeU
'EY11"AlYD 0081, OF G'c bNS19fY.{.X "IF)"ON
20d0W.00
!r'iK:kflEll"I.'F I+TSWA&MAaRY
1;'13•:ty 101.000,418-,000 S2G'/.00
YCR,9140 A40'! I{=:+ta i+'i~L' .• RESIU 101-Gt)tf-241 ••CMO �it.00
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
C�°f.'�i►,('X)k;1S'f`K1C`,'1' A—'J AW) 111M ON-IE+:i`K
$209M)
PRE4'AID:F-722
$0100
TC7'j'ttL 1'E:3.I:A!!rf F-FI,Ki:IME .INOw
S2{��+City
RECEIPT 5
DATE
1 /
BY
DATE FIN LED
PE O
+ 'i!
✓
INSPECTION RECORD
OPERATION I DATE I INSPECTOR
OPERATION
DATE
_ INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum 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
Drywall - Int. Lath
i_ � �
Final r`"��
BLOCtCWALL APPROVALS
Final
a POOLS - SPAS
steel —1
Set Backs
Electric Bond
Footings L_
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-
PPR.OWALS Temp. Power Pole
Temp.
Underground Conduit"
Rough Wiring
Lav Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)'""tyz�
COMMENTS•
4111elv
, /D�f-,�v I v
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Page ► of - - .:
DAVE STEAVENS
Inspection Services
f: _
PROJECT - Y WE5 i - P1.4N-se (a
ADDRESS .
_�C_O G 1'R-+ Z. 0
BLDG. PERMIT #
ENGINEERSA Jo z k tj,_
INSPECTION TYPE
PROJECT # ,2 o v Z — p
CLIENT ('6, A LJ e
DATE Q? 3 �1 P 2
ARCHITECT (�'ay L 6 A ✓LC ►-{
CONTRACTOR'! C. ^ A 2 'PA e1 E L L
INSPECTION REPORT
oAWF-i IL L0e. Zv
SN�A2 SAI L I ► 1[-, STi?A PP f JC it:7C
y
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
—� substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
the locations of the work inspected only and does not constitute engineering opinion or project control.
'CERT. NO. 0 INSPECTOR NAMEJA J t. �.V C ►J S
n (Pr
DATE %Z / L _2 uy-) Z INSPECTOR SIGNATUREam - - .�..
Page ( of I
DAVE STEAVENS
Inspection Services
PROJECTPROJECT # :200Z-0-3
ADDRESS $5► - OC. 1, o S-17Tr p y S CLIENT PGA
12 �c��do r'641,j10 DATE ,72 A -?/Z r a -L
BLDG. PERMIT #
ENGINEERI - Q. ►J .S A J0 I t_ :Z�J e
INSPECTION TYPE
ARCHITECT 6,64-6#4 A ,2 c.H.
CONTRACTOR JbC4 m Ao2 �Ac� F i c
INSPECTION REPORT
LO LJ (,JALL5
1-E 7-C
S S Sc�EL-Js
4/L-5—
LY A),4iLIAJr -
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
J the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT.NO. OQ� 9 3' 6- 50 INSPECTOR NAME
DATE
f INSPECTOR SIGNATUR
QA
d L a Lo c! -
4/L-5—
LY A),4iLIAJr -
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
J the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT.NO. OQ� 9 3' 6- 50 INSPECTOR NAME
DATE
f INSPECTOR SIGNATUR
Page of
DAVE STEAVENS
I ti S •
nspec on. ervices
:"J"�
PROJECTk'i,
ADDRESS--T7� - 061.0 5'1 l Q S *5,014 q
OA_FiM I tel_ �3��c.� Zo t�(.Ar.1 Iy
BLDG. PERMIT #
.ENGINEER 1.4",,.1 SA,�y,Z i.J c
INSPECTION TYPE
PROJECT # oZ o �'2 - 0 3
CLIENT �,p,
DATE t c( A? i2 t L Ivo Z
ARCHITECT Go c- 3 A A r2 C 4
CONTRACTOR I e L M A 2- PACs Fr
INSPECTION REPORT
,AA� �LOGK is - C -0m
JE.T'A k4 S-9
CERTIFICATION OF. COMPLIANCE: To the best of our knowledge,' all of the 'reported work, unless otherwise noted,
-�, substantially complies with approved. plans, specifications and applicable sections of the building codes. This report covers
�; the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 0,9 S9 3 `fig - :S�-y INSPECTOR NAME )14 C tcf4JE "i 5
(Print Clearly)
DATE / 9 A,�a �� a z INSPECTOR SIGNATURE
DAVE STEAVENS Page 1 of
Inspection Services
-PROJECT b E- Os PROJECT -# o? Oda _01
ADDRESS54/-60 1 .9 OS -710 05'.810 0*9
BLDG. PERMIT
ENG1NEE1E%)u_%3L3 SAonic' =,ic-
INSPECTION TYPE
CLIENT �A LJ 6-5
DATE /6 Mel
ARCHITECT.6oc-8,4 Afeci_4
CONTRACTOR,]) C4. Mlqff ,-),4C-1 1-1 C_
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers*
the locations of the work inspected only
and 4 does not constitute engineering opinion or project control:
CERT.-NO.0e5'1?3qe_ 5D I . NSPECTOR NAME IN L) 0
imc
DATE/7C20 2 -
INSPECTOR SIGNATUR