0108-351 (BLDG)p��yN t F hereby affirm under penalty of perjury that,I am licensed under provisions of
,Chapter 9 (commencing with Section 7000) of Divislon 3 of the Business and,
fj 4-W ` '+ ti.',Professionals,Code, and my License is in full force and effect: t
License # ! ' t Uc Class 'Exp Date ` t'
' ter
f� Z;�Gate f , ,S3gnature of.
O Ci' OWNER UILD�IR DECLARATION
aW I hereby affirm under penalty of perjury that l em exempt from the
Contractor's'-
U) License Law for the following reason:;
-' Z ( ) .I, as«owneroMhe 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: 704'1136siness & Professionals Code). ' { • , '
I,aas owner - of: the property; am exclusively contracting with licensed
contractors to 'Construct the project (Sec: 7044, Business & Professionals
`Code).
I am exempt under Section CY
1 ; B&PC. for this reason
x� N 4Date;r;rxtt �`'_'_ }Signature of Owner €
U:Q WORKER'S COMPENSATION DECLARATION
o tZ I hereby affirm'under penalty: of perjury one of, the following declarations:
ur, Q' } f' t • I have and will'maintain a certificate of consent to self -insure for workers'
X lJJ � �:; compensation, as •provided .for by Section 3700 • of the Labor Code,- for the
O - t .—i • 4performance of the work for which'this permit is issued.
CCI
JQ,V.titis
` . - I have and will maintain workers' compensation insurance, as required by
action 3700 of the Labor Code; for the performance of the work for which this
tl �'d 6drmit is issued.!My�workers' compensation insurance carver & policy no. are:
v _ ?Carrier . ,' " Policy No.
co a ' ra't` t : t:Al. �141d1 01'f`Y W3062174A
f e� ,(This section need not be completed if the permit valuation is for $100.00 or less).
' ,t( ),I certify that in the performance of the work for which this permit is issued,
f shall notem to an person in any manner so as to become subject to the
,workers' compensation laws of California, and agree that if I should become
" Nr•n ; Asubject to the workers, compensation' provisions of Section '-3700 of the Labor
,,Code Ishall f 'rthwith.00mply witp those provisions.
t i Qate,/>%A ,'AppliCantj,� �! .r (�f Jj ,f✓; e' %r ` L .i
r' arning: Failure to secure Workers' Compensation coverage is unlawfuland
��she'll subject an employer to criminal penalties and civil fines;}}++p to $100,000, in
addition to the cost of compensation, damages as provided.:(or in Section 3706
►4Anot the Labor Code, interest and attorney's fees. S.
'IMPORTANT Application is hereby made to the Director of Building and Safety
;i`,• , fora permit subject, to the conditions and restrictions set forth on his
. 'application.
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 th4khe 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 propertty for in pection purposes.
Signature (Owriei4ir I)i A ! i 7 DateM"
04UILUINU F'EFiMI [r.
'? R
DATE + VALUATION LOT r �lOS-oYS1i . TRACT
l .
JOB SITE
ADDRESS,� ,��
APN t
OWNER 4 °t / , .; s _
CONTRACTOR /DESIGNER / EN (NEER
PdA.WV ff ' REMM4TU& A30=AnON'
DEL MIR PACOC" OLVMZ& COLPO
PO BOX 1060
462 UMVM, AVE 0302
LAQUJNTA. CA 42253
SOLANABRA1.^H . CA 92073
(858)792-1500 CRIA 5823
USE OF PERMIT
1.0("AL OFFICE INFORMATION
I iscr ,Z.,P,1'&OUB
73«160 ST. CHARLES P1.
GMWXWN9.54.495 &54.081 OAK HILL, • lW11,DING I& TYPP:
' AC VCDLMNITARY• ST4? JC7'URAL M01D tVIA`fIONS
VALUATION 20,009.00 LS
1.+',SM! TED COSI' 01V C01+fivi73'PC''t' OX
20,(Jomm
i<'ERN. rF WE HITtVDAARY
CoIRSTRUC TION FRE 1011 -WO -416-01M.) $107.00
S TROAICI MOTION FEE - RE51.O 1101-000-241-000
� a
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SUR-W!AL CONS'CR,DC310W AND F',LW CFTF,(!K..
$9.09.00
LFM PRE -PARD FM
$0.00
TOTAL PMUx FUS DUE 14OW
&�t>R�.i►tl
RECEIPT
DATE
BY
DATE FI A DI
PE
` INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Duds
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 s' �-
Drywall - Int. Lath
Final %�i _ - — _- --
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
Heater Fina!
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
0 K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encaesulation
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)
COMMENTS: // L
�'vW�A�I N"�j
AO
G%`
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F _
Page of
DAVE STEAVENS
Inspection Services
PROJECTP�, A wF ST t?N A W I, PROJECT # - 20o a - D 3
ADDRESS CLIENT i�G A u3Ef
L _1;Z- DATE
13LP12t t_ �v• 3
r BLDG. PERMIT # ARCHITECTQG.,BI`j fIQC�
EN
GINEER I� S� Ue iE CONTRACTOR ,J � M A 2 crr iL
INSPECTION TYPE
INSPECTION REPORT
Sf�%' -'Q QM 3 U i� � O i3 S� !� � t Or4�1 i -{ILL.. � L• 0 � � l g
LOQ c.w��L� - WIN, �zZ)��Ae.
' S�5 �GRE�S A.�'> AUC�c�2 tJ �'�-�<►-4Tir 1�� -
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. QR5'�'_3 41,q- SU INSPECTOR NAME �I-AJC � A JETk1
7,77
DATE _ oft.'. .2 00 Z
r .'..
�� INSPECTOR SIGNATURE . '
1
♦"'Q
♦ -1.. �.�'*.y,�,Eti�. �.a. �i:.r �r�-. ,, 7.• ai%f :.iti 9Ff�+a.''••-i`�.: -�:4.. ..•?'_.r'F.'iiNf •"v4.. ^i.s-.h�•:.
DAVE STEAVENS Page ;-.- of
�` Inspection Services
{
PROJECT �& A W E s T -17H A S i tojS
ADDRESS S�-�3Dies. 0 A (
r
Aa&,')8 A.4,J9
BLDG. PERMIT #
ENGINEER L3k) '!�A jo l E t A J L
INSPECTION TYPE
ZTavmw
q
PROJECT #_ � v o Z- 0 3
CLIENT _�,A c,J 5T �rlcj
DATE j / APIZIL ;Lcx»
ARCHITECT G0L 6 A 2 CA
CONTRACTOR DCL lM A J
INSPECTION REPORT
AJ ,71
V.
LO C f"
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.g 3'T ` SGS INSPECTOR NAME�C'�,�5
1prn
DATE �� 19i�r�I C� aUOZ INSPECTOR SIGNATUR
r:•,� "r:+.•7: ".•�-,.'l-" - _, .`r ;<; ' x•.e .. ` •• �..toi„?;-.�--a-_., 'a+,.}:i:�!. _WF"
DAVE STEAVENS Page of Z�
Inspection Services
PROJECT�A w�sT-�Nq�E l �^
ADDRE95514-098�,00%08SI 08 l
DAI\Jb4l t_�
PROJECT # 100;L -
O '�
CLIENT p_{ n Pt
DATE � AAR/L 2vo Z
BLDG. PERMIT # ARCHITECT C=pLA A A 2.0 lel
E.NGINEERJu-00 SAjm r- CONTRACTOR �L wt �4fZ }7t4ct r -'i L
INSPECTION TYPE
INSPECTION REPORT
40 L L o, S " (� l� C 4Z[atiL5 6_7 Ao k Y S i ►MI v�S ETF X t� '-7-03
y L C- _S ip r N e .t -d E C t1� 1 R i 2 U A1•-1 L) AtJ N A PJ O P I
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fill 'Its-
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�.� ter � t J • E-loi.E • 1 �1 �Et�'ct►-1 I ' 1��P , h�D�S- l l t,.E►J ca -c b-1 8 � � f+. -
S:4 -'OG rLAk3 3q
F� 3 - a Locs f� s- t 2. -Prr� 1 �; t, �O�S- t1 �e►��TN ��� �� A
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
-1 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. IJ RZrQ%3 g/J9 - T-0 INSPECTOR NAME /l`V I
rim Cleary)
DATE , I A AkI L- INSPECTOR SIGNATURE
0
PROJECT J)6A UJ e
ADDRESS,
Page I Of
DAVE'STEAVENS.
Inspection Services'
BLDG. PERMIT N
ENGINEER�u&jj 'S#4NOult-
c-
INSPECTION TYPE
;-T-T
A-
PROJECT # 0.2 a
CLIENT
DATE (c) APR itmoo Z
-
ARCHITECT C2c),L ib p4 -A YZ C-Vk
CONTRACTORJf,j,,�,e��F-,
INSPECTION REPORT'
t 51 S LZA< bel AJc, A - 3:5-
IJ C1.
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.
INSPECTORA
NAME.
DATE—/ 2, INSPECTOR SIGNATURE
5(4— 1 OOY /OS
lol. Qq 7
IJ C1.
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.
INSPECTORA
NAME.
DATE—/ 2, INSPECTOR SIGNATURE