0108-352 (BLDG)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
'Pfofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
733152 D. 0313112C,
Date '1 _Sjgnature of Contt4ctor ,4-.4.4;. 1• fE»l
i�
OWNER -BUILDER DECLARATION ;V
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.
(,.,1-• -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:. .
Cartier Policy No.
W.MDEMNITY Af?�U6 t1?'d.h
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: . Applicant°°f d d
Warning: Failure to secure Workers' Compen§ation cove rag611d6njawJul 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 th : 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 is
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 purposes.
Signature i(Ow4r4gdnt}' ' �' ' �. ; f :'�Date,/
i T�
Ed
/BUILDING PERMIT
DATE VALUATION LOT QiQ .�:!`Z TRACT
cI 4�1 J
JOB SITE
ADDRESS J
APN
QA. Y'ML --;)Y-
/
OWNER
OWNER f:.,
CONTRACTOR / DESIGNER / EN INEER
11GA ViM RVA%>l7151r11Al, AS30('TA110I4
D0.,.MAR PACIFIC C 1 N:IsT-R.l+. , ►";Ola 1TtAL" TCAR
PC) PA )X 1 r*0
46"! S'r!iEnfJU-4S ME;, #302
LAQ1Y12,1TA CA 92-M
80, .AIJABEAt:'}1 CA 12011
(85#)79A.�J500 C'`F31.tf 5:23
USE OF PERMIT
1.t?�'_At, CiFh'li:lr ftflr+�bZAd.�'1'H:`'t1
1.51f AI 5T. ('"I ARLls FIE..
,`;'i •f173,'!C• �^, ek 54.065 OAK !.ILIA,. RUILD11140 19, TYPK
IK'VOLUNTARY STRUCTURAL MOa)WICA1`.IOAP,,
VALUATION .�tf n'iifJ.Of3 f- i
Xb l',F:11A A'!" v C';OY'r d}F C IDN:iii!'d>`"i'IC 1:100.
20,000.00
•t'1L+:'ti:'sM.T':CYER SiJMM&HY
Ge;'N T1']t1A:''(1(JN FEE 101 -(}tiO-418.000 $20100
s�t"p Ei.CI>tJ .ib OTION FEE • RESID =101-000.241-000 $2.0
O
SEEP 0 2001
CITY OF LA QUINTA
FINANCE DEPT.
f T!3-'1 UTM. C(Jla1"1a l 1'C°I.�ft7N A'1) PTAN, t;'l��c".l:
$11109.00
7:L 5 i`R.Ttw 13LT� FTW
$0.00
r
TOTAL PKI? WT :Ir'EXS X) UE IgOWr
&7M.O0
r
RECEIPT
DATE
BYDAA
FL ��
S
SPECTOR
:i l
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
0. K. to Wrap Q�
Framing !/
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywa;l - Int. Lath
Final
_
Final
POOLS - SPAS
BLOCIiWALL APPROVALS . `". I Steel _
Set Backs I Eiectric Bond a
Footings j -�—;
; .y in
Bond Beam I
f jc �pproval to Cover
l
..—e-'-v-.—r---
Kr*.7t Location
.
j
. ,
UtO, R ound Electric
Undergro6nd Plbg. les,,
Final
Gas Piping - .
PLUMBING APPROVALS'---.Ele-;tric
Gas Test
Fina.
_
Waste Lines
HeaterFinal
Water Piping
i Plumbing Fine:
Plumbing Top Out
Equipment Enclosure
Shower Pans
_ _
-+ O.K. for Finish Plaster
Sewer Lateral
�� _Pool
Sewer Connection j
I Er.psJlatian,
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
/�y%
'l/��%�➢!N'
�y��
DPage 2-- of Z
AVE STEAVENS �--
Inspection Services
PROJECT G F SZ- _ ,.\A s l 3. PROJECT # Z o oa - o LA
ADDRESS 5y — 0-71,01 3 0�4. DGS CLIENT W ESQ b -k oLN
OAS( N ILL 3LOG "�-t9 ?iAj I I DATE
BLDG. PERMIT #
ENGINEER►_ ,3 SAJui r: 1 �J C—
INSPECTION TYPE
LO L,) W ALL.S
ARCHITECT (�,c7 L. 6 R -A e—cN
CONTRACTORL. M N d2. PPvL FI L
INSPECTION REPORT
11t 1-5-9 -- Q L.o ck/ nJ A «: J
4 A Ic S - SNe�,42 IVA1 L1 J6-; AA) 1) �LvC- LJ �
nLC7-e
,
i
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: -10. O8 �� p 3 T - �U INSPECTOR NAME IA,)c S7'Zr-1 L/C -1 -JS -
n �1 Pri
DATE Z['S ��/� �- o� VU Z INSPECTOR SIGNATUR ��,�
@Ea „c } � ''_'.c fi • ;i:i;: rpt' ,- '.',N! z -
• e . a � . - 1' ... � � •.kyr ti,-•,• _'^ 1M � :?' _ ..� x..��'S".. .i • . _
Page c f ! ;
DAVE .STEAVENS
Inspection Services
PROJECT�C, A t ST - l���SL. G tl
ADDRESS Sy- 07 7. o'7 3, 0C, q � S�
BLDG. PERMIT #
ENGINEER') L Wsj S A JO r E l J
INSPECTION TYPE
PROJECT # Lx:) 2 - (D'
CLIENT
DATE 17 A P R - L-
ARCHITECT Go L a A A r2 C t4
CONTRACTOR b EL M A 2 PA C*- I r i
INSPECTION REPORT
i1 S <j2-e4,J S A j L An.JC!401e A 'TS - -i i Gam/ T EAI,,�
2r9F7- s -f-4)005 AT C�4 Y5 - COOK ?LCT -Z
A7 -1c, t C -!S L-0ULl0C- t -Pr -W5 A -'3S-5 L--7425 ev„►; LT7-c-
1—,H
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 rep6rt covers
the locations of the work inspected only and does not constitute engineering opinion or'project control
CERT.NO. „Sir 3 T1s •�'� INSPECTOR NAME -.GAJ 0 S-tr /9._J'C_AJS
DATE d2f2e Zr
jNSPECTOR SIGNATOR GL,.._n-
DAVE S TEAVENS.
Page of
Inspection Services
PROAECT�6& wc---sT--?I4A-SC (j3 PROJECT # agVtOZ L4
ADDRESS �q-or?rl,0'71.0(.Ck,-o(.5- CLIENT I o
DATE /66 4,PAIL a, 'a -'o z
BLDG. PERMIT #
ENGINEER AJ —'SA do tc Z A)C-
INSPECTION TYPE EPoy--
ARCHITECT -6-ae-SA- Axc-w,
CONTRACTORyrsIMAd t)1qCf1,1C
INSPECTION REPORT
t�oC.Lo.Lii#J�, A T i o&JS t0ex V S ( Al jE: 7-r-, 0 -7
B?-"-ZWEZI A4JI QLCArttj QFIA'-geLL-�,
A J b -TJSTA LLATWJ AS C ip Y 7
L
-7/
-l"t - 013
0A Q
RE Wc-'s ? T H G 31, L,) I ok 17 o 6's - I 'T 4E 6Tr1 s AW 1)
I
CERTIFICATION OF COMPLIANCE: . To the best of our knowledge, all of the reported work, unless otherwise noted,'
substantially complies with -approved plans, spiscifications 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 EIJS
INSPECTOR SIGNATURE
DME
Page _� of !
DAVE STEAVENS
Inspection. Services
PROJECT P&A c.Jt--S r• SE /Q
ADDRESS / "7 4 / B Bt- � 's
BLDG. PERMIT #
ENGINEERIU00SAJO/L- iNL
INSPECTION TYPE
PROJECT 69
CLIENT �6 A we5T J_4o f}
DATE / S A2!
ARCHITECT
CONTRACTORl. 1"412 PA c C__
INSPECTION REPORT
5y=o .77 73,049 ac 1z' e--2AVNIt- 0�
Lr,,J C.
TE
�1--��• l
LA -n4 Art �' 5 rv� �1 r2c-� ' ►�
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. 40 S 93 7A —SO INSPECTOR NAME — A lJt )S
DATE S V /� �► p7y!� Z e
INSPECTOR SIGNATURE