0108-353 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of.
:perjury that l 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
73SI52 B t r 43.a"1 1 ?(
L f t1 iii 2, I �9 4,/
Date �d� � � Signature o� �oi��aot`or�• r� r � ,� � ���
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 '6y.'
'".
Section 3700 of the Labor Code, for the performance of the work for whien;fN6'
`permit is issued. My workers' compensation insurance carrier & policy no? are:
Carrier Policy No.
(This section need'nottbe completed if the permit valuation is for $100.00 or less).
() I certify that int the performance of the work for which this permit is issued,
I shall not employ aIs"
person in any manner so as to become subject to the
workers' compensatlaws of California, and agree that if I should become
subject to the work compensation provisions of Section 3700 of the Labor,_
Code, I shall forth- h comply with those provisions. t `.
Date:t t /r �� it / Applicant f! 1 n tl % %, .� 1 F i ,f t �, '
I>'1 7.7.4 let
Warning. Failure to secure Workers' Compensation coverage Is' unlawful arid
shall subject an employer to criminal penalties and civil fines upto.$100,000, in
addition t&lhe 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:Buijding 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 duinta, 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.l,have read this application and state that thi'e'above information is
correct. I agree to comply with all City, and State Imus relating to the building
construction, and hereby authorize representatives 46his City to enter upon
the above-mentioned property for inspection purposes.
'� 1 t �.
�Slgnat el�(Owner%Agent)t' 'yd r "' � `` Date`1/_� > C'
s
PERMIT PERMIT#,
{JBUILDING
DATE / ( VALUATION LOT 01,08-353 TRACT
JOB SITE ` �� _"""`
ADDRESS
APN
1
OAK 1-Iftal -7
OWNER
�
CONTRACTOR/DESIGNER/ENGINEER
KA -E& RypWAAL pJ7CTAryIO9
pM2Xp/p1tirLNY.RpL LtlpR AC -1 on
DEL
o BOX 1060
462 L AVE, 002
3 .� Q dli1'fA C�4 92253
t01;,AN A RE CI CA 2(1; 5
(Q58)792.=1500 (ML4. 5823
ATION
WCAJ, OFFICE INFORMATION
USE OF PERMIT
NITUCH
'35.160 ST. CHARL90 PL
IPMMF4.017, 54415'3 &31:•094 aAk ffl.LLt. HUF;f.A) AiII20'SYRE
70C.1liiT Uk4TA11Y, BTRUCTUV-i+.T. tAODIKCATTO14S
W-L-Fi ATltu?l ' 7tltt0 b#I L
-.
3 pWSM(b019q�nV 4J�e Gqq
+IGiJgifa:'{r'.iJf�'
010149`9':MiC' 10.1 i' FEE, 1101-000-418-000 $2G 1109
S?'d":RO140.4;iO'f"ION ze9k'u - REZ110 101.000-24• i •-000 $17.00
or
n
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
,;ice^°IO`I`A�. CC3&�F' f' iTl�"1�14 1y %) .f'I..,�A0 C.'I3�_A=
gi209.00
.1.03 PRF-PAM.�MUJ
"1100
1191AL, YK T P7'ES DUE' ow
$12091
REC€IPS 1
DATE
BY.
DATE FIN LED
r
o, I
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final p/
BLOCKWALL APPROVALS
Final`
•- 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
;t }leater Final
Water Piping' :; `r: RlUmbing Final
Plumbing Top Out -:,=c<: f
.Equipment Enclosure
Shower Pans •�-::-
O.K. for Finish Plaster
Sewer Lateral �'``'
,.K �, .- �;,
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)
COOM/M.,ENTS•
/2'����
;KO&A , moi/%0 ` 0401 `"
`
DAVE STEAVENS
I . Inspection Services
PROJECT-�,h UJES-T--PV0,Setg,
ADDRESS
BLDG. PERMIT #
ENGINEER-hu.po Spsjote- t "c --
INSPECTION TYPE
A I L I
OL. /q.
14
Page l of
t.
PROJECT # d2 vy 2— Q'S
CLIENT A (-J � S t-�O k-1
DATE ,2 3 A P R
ARCHITECT 5- L5 A 14 Zc- H
. CONTRACTOR'CL YhPOZ PAc-tFi
k
INSPECTION REPORT'
t L 0(. '10
-7
'A Z W L::" -Z
CERTIFICATION OF COMPLIANCE:Tb the best of our knowledge, all of the reported work, unless otherwise noted,
4.J(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.
INSPECTOR NAME J 'ILE ^ L� C Ii
CERT. NO.
(Pr' P• ea
DATE
INSPECTOR -2 E
Page f of I
DAVE STEAVENS
Inspection Services
PROJECT4(_,fl u),Z—: PROJECT # : oo Z -c) 3
ADDRESS -'Y -off,eDs� A o y9 CLIENT P6A L.,Jt gT P4.0 A
C>AW1 if -L ►o DATE A?2 r �ooZ
BLDG. PERMIT #
ENGINEER 71k �� Q tj :Z,j c.
INSPECTION TYPE
LoLJ LJALt-S
ARCHITECT A r2c.H
CONTRACTOR �)C 4
INSPECTION REPORT
ZrAJSl c.c_RT
2 &A IL -1061, Ay L) Lo C_ie
A)AI LIAIr — CDM ®LE 7 e5'
Co.1 10 Lr_ 7-
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.
^CERTNO. OQ� 9 37 g- �U INSPECTOR NAME
DATE Z I L �.C.Xi Z_ ..i..
INSPECTOR SIGNATUR
Page of
DAVE STEAVENS
Inspection Services
PROJECTI C=,IN %.J E sT- Wko 5 C 12).
kDDRESSSZ/ - OG If O S -q. n S 3. D yq
0A(4 L.L. 3��� 10 t�Lt�r•1IV
BLDG. PERMIT #
ENGINEER��,,�,,,� SAJv « 1,,J c
INSPECTION TYPE
PROJECT # o? v v 2- 0 3
CLIENT -i -
DATEC q AP i2 (t.- aoo .Z
ARCHITECT Go c- S A A t2 C-4
CONTRACTOR ZI)L r A ,Z pAc(F► g.
INSPECTION REPORT
F z, AA- 3SS i'_t�7- 45 L- 7c)5 ---r-,JSc�L�4 iOR1,
AA, o aL��K ,,�� - c�M C.r- T t
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. INSPECTOR NAME l tAkj C �C/4CJC A,J 5
p (Prim Geary) ,
GATE I / A/`a/2 /L a cV , INSPECTOR SIGNATURE
Page ( of �.
DAVE STEAVENS
Inspection Services
PROJECT;�, A knE T - NQS C I %S PROJECT # '7
ADDRESSS�q-60 t .90,5-7 10 05'3 0 0*9 CLIENT --�GA Ls) 9-s -t— M o #4
ngLe IL(r ��Pu� /e)
BLDG. PERMIT #
ENGINEEIC% . JO „) S A J a i E =-jL
INSPECTION TYPE
DATE 118 L ,:z yo Z.
ARCHITECT (So C. 13,4 tq oec -I
CONTRACTORJEt- M1q ? I -)ACD C -
INSPECTION REPORT
DLt-.,)ujtt-A . /QC -A -r oAJS GPak Y Sc) 7- r x 0 L
4 h-tC t+-r10A1 46,11) XAJS7'A 1-L AT / Oil t45 t
Sy-(oo1 aAKWL-L_ 3q
1,
0_2LD Loc --n - 4oL-Es w 1 JIIA-C�S - 1 -1 LtUc:.T1-I
LA %K UA -SI Li - ( Lac- Not -r I2.' c-)LQ'704 ( (SIA (204- 1 I LE0GTt-! /6 , I,ct
26a elks-- L %Q - Loc - 4�0�.�.- 11 �z!}Te-1 l ��� IZo J - I'1 L.��JC.Tr1 , A
:qcfl\2 L'E1JTr,Y2- ;LLuc S-N0LeES-nz?T'H 3/H &A ROD 17�LEaJ Thl $SBI, l�IA
"
S'q-053 QA'I�[ 91 LL
QEDbC-P-t►-k 1'I4\. 1045- t'1 L�►acoT►-t �8 �r�
►PEA4L CE0YE2- LOOS Zc13ITH 14 0'%-f\. 1�' DSS - 1-7 LE►JGTI4
,� I► a .T �1
2�A.tL �...1EsT L, k il - 1 LvL -Ido - (1. 1, pT AI7 t_�►J�TW �g 1� c�
S'L4-0'(9. OAK N1u- -�>t-N'3 3
hA0- Sr#�'-r 1 SOIL- 1-kolx.- 1'I. `bGeo'TK
3). I A ,. ZoiD - 1'7 I/ LC"T'1r-1 �t:3 1� � A ,
-8CZ'3- lLaS - tl" DEATH 1° 6I+\. Za�S - j't"LEJ�T►-I 'T(g"�r►t
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. C>e 34e- INSPECTOR NAME
MATE 19 YI P914— C2O Z Q„ C1e ,ry)
INSPECTOR SIGNATUR��-�.-