0108-351 (BLDG)LICENSED CONTRACTOR DECLARATION
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
Professionals Code, and, my License is in full force and effect.
License # Lic. Class Exp. Date'
%3;41:52 : ; J ON I C.
Date r/r�' ' Signature of Cont`ractotf
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 by
ection 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.
(,'Al,IIJE>i:::, I41T" 1i3tN'tIi4.��.
(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 f9rthwith comply with •_those provisions. ;
DateV,hl. :Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful 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 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 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 (OwAsN-tierlt}t• .f 1 f l % �? ,( Dater ' h
PERMITp
^ } BUILDING PERMIT
DATE VALUATION LOT 0108-•331 TRACT
JOB SITE —�
ADDRESS C/iJ
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
l��tA.�iW�S'I'�Y' ; 1X3&:�31"tF�C 1�,5'3t7Clt�,liCtN'
DEL MA12PACIFIC GLWF. ALCO.N RACE
g'i 1 BOX 1060
462 MV 1W AW—e W302
LA- CIA 92253
801,ANARFf CH CA X2073
(838)798-1300 CB14t 5823
'
USE OF PERMIT
(ADCAL C)FMCF, INFORM.ATIO14
MISC ELLPME )IJ8
73-160 V. Cly RLES AL
r
+t�05j:i, �_ .f2ttSir_S�•Off.i c� 54.081 OAK' I -111.J.. HU11 A)II+G 19, TYPIP
¢C VOLUNTARY STRUC7•URA6 MODIMCATIONS �.
VAL(IATION La
Con o)), t`0;1511~1micnion
30,000d'f0
[ y y �,yyet •�, (� (�y�' �ES"1'0IATFU
11',df.,l,ldY.Q.Y.X'.Y���Ti14y iY6l.�J[Sb
PRE. 101.000-i 16-000
S"i'12.ONG MOTIC)H 'IrF,E RYS1.0 101 _000-ZI i -M) $1.tr0
ID 0
-
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
::t:.Tlt•• iYYf'/�1., t C�k�1�Si'1r;7:3t"1:t0$J AND F'i..AO' C:r-51ICK.
$tlCi9,Cll)
.LEM Y'R17-PAMM M
$0.00
t'0"dA1, PXfh'dtl$ff YKE S IDLE NOW
RECEIPT
DATE /
BY
DATE FIA D
I PE
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 I
Insulation
j
Vents
Fireplace P.L.
_ _
Griils
Fireplace T.O.
!^��
i Fans & Controls I
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_ _Final
Final POOLS - SPAS
BLOCs'C` JALL APPROVALS
I Steel '
Set Backs
--__—.__
, �!�
_.—
Eie%-*,ric Bond I
Footings
----
;oain Drain
Bond Beam
--�
+�
:approval to Cover
Equipment Location
_
Underground Electric
Finalrg
{ Underground Plbg. Test
i
PLUMBING
.APPROVALS
Gas Test
Electric Finai
j Waste Lin.s
( _
seater Final
Water Piping
_
Plumbing Final
Plumbing Top Out
j 4
Eauioment Enclosure
Shower Pans
_
—�
O.K. for Finish Plaster
Sewer Latest
I
Pool Cover
i Sewer CcnnecEon
!
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
;116*a _ /Oxtln�q,
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
i Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
j Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
DAVE STEAVENS
. Inspection Services
PROJECT�e A�g7-,5x-?j4ASr=,
ADDRESS
A--5 L[,3 Te--Ij
BLDG. PERMIT#
ENGINEER � tA t, 1 1) .5A- t)j Ic z-A)c-
INSPECTION TYPE
Loo
� L—'to L., 11.. LAIN
Page Of
PROJECT # aoa-a - 0 3
CLIENT t A
DATE 11,
ARCHITECT g4k0l
CONTRACTOR ,DCL Al A
INSPECTION REPORT'
04LZ HI L L— ,BL 0(.'VV19
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.
,CERVNO. 69sY-v1�- S-0 INSPECTOR NAME�-A JC-��ALJC�kJS
IMP")
DATE do 2— INSPECTOR SIGNATURE
-17
Page of o�--
DAVE STEAVENS
,
,'Inspection Services
:i
PROJECT LJ E s T -12H A S 0 c tb
ADDRESS S'4 -093,68q OeS-, U 8 1
Or¢clN l cry, L�c�OG "�18 y�o4� 9
BLDG. PERMIT #
ENGINEER�,Jj-) Sa Ja f E I AJ L
INSPECTION TYPE
PROJECT
CLIENT -t 6.A c,J
DATE P i2 I L .1-00
ARCHITECTGOL.dA AILCA
CONTRACTOR DCL M A J
INSPECTION REPORT
V.
LO Cie A)A i
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
V) the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. -VO. OT ' Sy INSPECTOR NAME`11 J C CiAJ S
'(Prm
DATE ff INSPECTOR SIGNATUR
Page 1 of
DAVE STEAVENS
Inspection -Services
PROJECT We ST -?�A,AS C t3. PROJECT # p .3.
.ADDRESS . f S L( S —c -b CLIENT tom- Ca tR �i_lC �jT �-lp IAr
BLDG. PERMIT #
ENGINEER u. &JJ S A J O I C= hJ L
INSPECTION TYPE
DATE to�f2 ft hoc Z
ARCHITECT (f -..,Q L r3 rh
CONTRACTORIfA,Aft.g Q (�A Li Frc
INSPECTION REPORT
-3�5
3..�y15-g--�L�,A c JLETc
y STT 1 L - 3 !Y ►l. 10 (� F 1Z A to t
S(4 109 10 2: rdr. 09 7 0AclN( L4— 3"e_
L,O�✓ W4 Lc. 5 - SWCA IZ /icJi4 i�iuJ /aAl h Y7 2 -i Le. r�
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. Q L5 .34A - VC2 INSPECTOR NAME. I =
DATE-/ flt°�1L' 0 00 Z INSPECTOR SIGNATURE
1 �14
DAVE STEAVENS
Page / of Z'
Inspection Services,
PROJECT -�t:,A PROJECT # a1-0 S
ADDRESS:5,14 - b9 3 n18q T, oe k CLIENT 5-1C tp4 r)p, .
-04'J_w4tL1__ 3ae� 110 ?(.Ad'? DATE /J. APR /L a eo Z_
BLDG. PERMIT #
ENGINEER1v_Qy.),S6J6x9_ *=o,-)C—
:INSPECTION TYPE 9 -Po
ARCHITECT A A aC LA
CONTRACTORILL MAit
INSPECTION REPORT
W0,11WA 'r#M
M •Ir
F M.
-VU 0 UA
e4IL-i-
0 _Beb 3 '2 LOLS - 00't -r -s be PTH Ro Ds —I S L E oc:;-T H - % "b I 11
IIl-
.CA& 7
5:4 -DEQ( niAwj4fL_L_ 4)LA&�' IQ
17
QAC Q_z!3Tz.(1 • of LQL5 - H&L*C.6 -19 90-66 IV# /_C06T0 !41i" b1la.
q'I L L- PLA,J.' f 4
-Y
A I7/6
�tA IL 0"L�'rctt - wx�s- 1:1. 314" 1)
2A -a Ulosr- L IA - 14.0%-C - 12- ZFV,-TA A -10-, RD145- -b
39,
'7
2!'bI, (>rA t fA
CERTIFICATIOROF COMPLIANCE: TO the best of our knowledge, all of the reported work, unless otherwise noted,,
substantially -complies with'appr'oved 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 -5*4 Ile &-)5.
-CERTNO. 0.
INSPECTOR SIGNATI:Z::�
JO
DATE A R/ L_ LIRE X�u