0108-352 (BLDG)LICENSED CONTRACTOR DECLARATION
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
73;11 S3 B fIWtl112(
Date o
p
Signature of Cottktr
..:i
OWNER -BUILDER DECLARATION
I �.
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.
C-._) AI 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 °!' Policy No.
C'A1..1t1.4�C+,Dr1c1 t`P :PI90fi1.1:�t.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 �' r;,••
Warning: Failure to secure Workers' Compensation coverage'W6,iaw1ul•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 iof this City to enter upon
the above-mentioned property for inspection purposes.
Signaturel(Owrl�#A'gdnt•)` ;� >` %� ( Date';%
BUILDING PERMIT PERMIT!!
DATE VALUATION LOT 0106.352 TRACT
"� •'! t! '% ' &2d'1,Qfi'lSD1IDtd
JOB SITE -72
• ADDRESS
APN
4Jfbfl..Y�� iJAA
� ..
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PGA V4°&gT.RYA`UDF11=11K1, A:MC.IA11014
IM, MAR PACIRC" OWERA CWT AMO
PO WXX 1060
4 62 MVENS AVE #302
LaS,Q INTA CA 92233
SOLAN•ABEA�'.-H CA 12.075
(1858)-192.1500 CRU . -I 5623
USE OF PERMIT
IAC--A7401?hlC.'>7 [t11�Ca,�2Rd1',71C�1t
IVIMC:'•i' LL AM'OUS
ST. rftRL-0 PL,
.%wrl,�(1773u wig a ia.-oo aAK mi.,L • YUII.,Ulua 19, 'TYPW.
I t CV OL1.114TARY STR iCTi RM, M0J)1Fl:ATI0)8
'it.l�y�l7.AxEn1,I .t1,0itf9,00 1_.�;
:Kla T1! AT :A) i'OTr OF CONFI'[>':i7M.10H
20100D.00
1✓YR:ft rf76'&!k RJT!!±MAf2.lrr
1rE2 101 -000-4.18 0100 $207.00
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T
D Q Q
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
ISI:iE;-7"�1°CAL,i"C)id�rCI'C'I.ION A,NI t'Fy�aN C'}I:krC T:f>6►.00
Y .33 T1PZ' ?-PA1.r_) TAKES,
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YOT'AL PKft1iM' :er'RFS DUE POW
RECEIPT
DATE6Y
DAA FL `��YR
TOR
PLIM2:191
OPERATION _�--DATE
INSPECTOR
OPERATION
DATE
L INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade j
Retum Air
Steel
Combustion Air
Roof Deck 1'
Exhaust Fans
0. K. to Wrap /Q/ �y i
F.A.U.
Framing / 9fo��iG• / Or�Y� —
Compresscr
Insulation i
Vents
Fireplace P.L. R
Grills
Fireplace T.O. I
Fans 3 Contro!s
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior LathDrywall
- Int. Lath
Final
4—In✓
EFinal
�L
-'- -
POOLS - SPAS
pp r'� g j 9
BL0CiiZ,F44AL .. A' PPROVALS
r
~—_ —
j Steel
Set Backs I
j Eiectric Bond
_
Footings �; j —'
j ;.lain Dram j
Bond Beam j
i Aoproval to Cover
j
Equipment Location
j
I Underground Electric _
—
t
Underground PlbG_..3 est {
--
Final —
as Pioiny
PLIS3�. UNG APPROVALS
Gas Test
Eiectric Final
Waste Lines ?
Heater Firal
Water Piping
j Plumbing Final
t Plumbing Top Out
Equipment Enclosure I
t Shoveler Pans
O.K. for Finish Plaster
Sewer Lateral
Fool Cover
Sewer Connectien _
Encapsulation.
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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.
1 Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
(...hY.�...5.. �:.. c, y:, s•:. �-t!d-7•^'..e .�-:t;P:�-ry r� ,p�N•'��+""';ri,..�::xi—,... ..
Page of Z
DAVE STEAVENS -- -_
Inspection Services
PROJECT.,�G6
PROJECT # r�oGbZ -off
.ADDRESS 0-11
� 0.-13, O(,R. p(o
5
CLIENT tai, fl W t✓ ST b-ko Ij;,t
6A M ILL
3L0G
?iAiJ I I
DATE 2yo 2 -
BLDG. PERMIT #
ARCHITECT Go L
ENGINEER ti. ►J
SAJo I c, t /J
L.
CONTRACTOR !> L Inn 1t R. P R c_% F i cr
INSPECTION TYPE
INSPECTION REPORT
Lo W A��.S
S f-1 r fltiZ L) A A J S f,Pf} PP 1,1--) G-- '� M ,D L E i t
0l�r. (4 Z5-4 — QLoC-k/ /jAiL.IjAJ D PL�f
NAILI„)[- A, rC
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:AIO. O8 � p 3 T � SO INSPECTOR NAME .LJ1 tyc 5 AL/C:JjS
n Pri
DATE L INSPECTOR SIGNATUR a
'�(;` .. r.i ,}...E,. ,. .., .,,t•,-:. v,-. t- . � v.,c.' {a x ,!M"'� .r 2-s's_} r Fv.:+„4b•ff -
Page of
DAVE - STEAVENS ;
Inspection Services
PROJECT'�G A ez 5'C- N�L. t�
ADDRESS 5y-077.'0173-0GS�UCS
BLDG. PERMIT #
ENGINEER ti> l_►J►J S A Jo r C w c -
INSPECTION TYPE
PROJECT # v" 2 y02 - c A
CLIENTwe S i
DATE 1'7 APP_ (L -Z -
ARCHITECT L a A A t2 c t4 .
CONTRACTOR b EL M A (z PR c
F- tiZNam r )�j�t�}�Za��RJZt. SrJ Sit-�gT 1�� >til - C-0,' 1 4 C -F_ ?E
�.�- Su2r-1,JS �4� �� yQ,.Jc►,r�� QTS - -7/
D 7.7 OSS- J)�/I 'S iv 5 A C,j6 YS - Carr?LC—r
T fit S 1 3 1-4/5 pr e)c_ke r,-)(" A-3 :S; — C'nw ac-��'
y Amt C. -S. _ ALOC'W_10 q s A - 3 Ss L - 70-5 _ w64o%: Dt e7_
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 rep8rt covers
the locations of the work inspected only and does not -constitute engineering opinion or project control:
CERTNO. �57 3 7i�-S� INSPECTOR NAME
�,�� : 5�.�,q.czs
DATE 7 07041 Z INSPECTOR SIGNATU�GL..:n
Page Of
DAVE STEAVENS
Inspection Services
PROJECT �eg& W iDs-r -NA 'S C Q3
ADDRESS �q-&'71,0-7 3 oug, p(.5-
BLDG. PERMIT #
ENGINEER IL, -6,31J fsAa-016
INSPECTION TYPE F—
PROJECT# ad9o,Z -4=)
CLIENT IN uDia:-s7 ' 4t -kc> p,'
DATE 44 A"PAI L al a0z
ARCHITECT Aecw,
CONTRACTOR
INSPECTION REPORT
t'g L L 0 Z-12 e A 7-10 &J "S Pe X '7-63*
4a- r- S 'bep-r-A (2141KQ44 Z) R,)L-) QLQAnJ OF -Ot--82.Ls'-
l0t,.) AJh -Tr,)S7-AL4.AT10AJ 4S 1%fZ :7- C A!5 Q q qS7
01 1 QA k--'" k L L-
11
RIP- �� 2. LaILS - iAc (- e "U, r- r- - x VA ti I A,
,Jr- rH
it
mart
F-Porr Lit) - a LOOS - WOL I NE FIT,
ZY - 0-7 3 L401 N-1
12AZ� 1) Lv C-
wo - uC)Lcs• I ZI>E eT'A 'N"A\A. QDI)C--,- VS"Le-AJ (0-1 H
`51
- ROB - 17 L /e
L0CS �kO 12. bc PT e- I- 6i -A : it U (,rk4
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
QATE JW- INSPECTOR SIGNATURE
:t•7ts
•• .. DAVE STEA [Page � of r
YENS
Inspection • Services
,.-PROJECT (A (�PHASE /8
.ADDRESS.
BLDG. PERMIT # C
ENGINEER IU O O 5 A J I nJ L
INSPECTION TYPE
PROJECT # 32- o0.2
CLIENT ?GA 0e-sT t-400
DATE 15— APS 1 04- L vv z.
ARCHITECT C_=VLB4 2 C4-1
CONTRACTOR.se-z' ^I to PA c ,cC_
INSPECTION REPORT
Sy=o .77 n73 , toe. 065 e:�AL/1.41L
AM r I- NJ ` A &jc)
0
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. .
CERTAO. O8S 7 - SD ' INSPECTOR NAME ►� L/ t;:j_s
DATE /S� �P,��G, p� liU Z_ -
INSPECTOR SIGNATURE e