0108-350 (BLDG)�I hereby affirm under penalty of perjury that I am licensed under provisions of
�+�r `�z yChapter.9 (commencing with Section 7000) of Division.3 of the Business and
. Professionals Code, and my License is in full force and effect.
p, M ch License Jf Lic. Class Exp. Date
1` ",t31A',;
W
bo Z,r^. `Date'!',��r �� y Signature of.t ofalctdr 1 6
OWNER -BUILDER DECLARATION
FW- LU I hereby`affirm under penalty of perjury that�l am exempt from the Contractor's
IL . N License Law for the following reason:
Z ( ) 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
g Code)
O I am exempt'under Section B&P.C. for this reason
v N , `Date °x{ " Signature of Owner
:� U �ftf WORKER'S COMPENSATION DECLARATION,
y
ar ',— �f'' � r �^l :; .y . d Sww',2 a .• ., ,.�.. y
� CCerey�afflrm
t1ihb;iunder penalty of:peryury one of;the f6l'lowing4declarations:
Oyl have and ;will maintain a certificate of consent to self insure.;foe workers'
LL„
c .
X Ijj —,� compensation as provided for 6y Section 3700' of the Labor Code, for the
;J Q FA iperformance of the work for which this permit Is issued. �t
L I Piave and will maintain workers' oompensatlon Insurance as required by
Q U,y S�6on 3700 of the Labor Code, ;for the performance of the work.,for which this
pinnit Is issued. -My workers'.compensation'Insuiance carrier'&'policy no. are:
y ZCarrier `. �� Policy No
°' ;- CAL 1 DR -Mt TTY
K(This section need not be completed rf the:perinit valuation is.for $100.00 or less).
if 6ertlfy thatin the performance of the work. for'which,this permit is issued,,
5if%shallnot employ`any,per`son in any manner so:as to become subject to the
workers' compensation laws of California; and agree that if [.should become
� subject to the �wo' kMrs compensation provisions of Sectlori' 3700'of the Labor
� fi jl Ai4w,1'.Rknll f rthwith rnm`nly With'thnca nm% icinne '
`t vase , , Hppncant ^ r x , .
IA nrng :Failure to. secure Workers Compensation;coverage' is Ufilawf(11, nd
haII subject an• employer to criminal penalties and civil fines up to $100 000, in
' addltion'to the cost of'compensation damages as provided for in- ection 3706
„of the Labor. Code, interest and attorney's fees s,
!rIMPORTAN-sAppllcatlon is hereby made to the Director,of Building'and Safety .
yr c for a ;per`mif subjectito-the, conditions -and restrictions set forth on;yhis
r! :;application`
z =� 1 -Each persoh upon whose behalf.this application is made & each person at
r I:qwhose request'and for whose benefit work is performed under or pursuabt to
..any, permit issued -as a result of this applicator agrees to, & shall,.indemnify
& hold harmless the City of .La Qumta, its officers, agents and employees.
•`2 -.?Any permit' issued as a result of this:application becomes null and void if
I work is not commenced within 180 days from date of issuance of such
F, i permit, or cessation of work for 180 days will subject permit to cancellation.
1T4l certify that Lhave.read this application and state that the -above information is
' icorrect. I agree to comply with all City,:and,State laws relating to the building
;,Kconstruction, and hereby authorize representatives of this City to enter upon
':the above-mentioned property for in action purposes.
:Signature •(0WneLA Fht$ ,� a:� ! ;`/r,r . Date
-BUILDING PERMIT. � ' ;:
DATE VALUATION ' s LOT •0108-350 TRACT ^
/
`Z ,' 4r $2civ.tp y.
JOB SITE
ADDRESS
APN
17
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
T`1'4A'1><1'E 7 RF,a"1D br17AL A380'r`IA ION
DFL MAR PJAXI.i O GH)&KgiAL C`.C.►ITTRAf"'°F'E."SI
PO Sit% X,
.162 Z:P,Ls"V04111 qVF, 403 i-
(4A 92253
SOLANABFACH C.A. 92075
t;€itit?j791�1;5U(i CLI..1� :SR?�I
USE OF PERMIT
.M, WEILPA L.,O S
-:3.160 ST. CIl1:RLYS PI,
Q;*I' Sd-10.q,.? M., 101 re.54i;V47OAK 1.111A,- 131JILDINO VTYI•r.
1!t” �rt:>.f;ll'�{'f',F1biS',.:1TI;1.jC:'I'ttle.Al., f�At;�17fI-IC:t�i'lctihl;;
f!:;y) :h'm cioFuX'.�;T+' (10l`dti'.1R17C7170N
201st C1CI.U0
PERM1.1, 4111MIMARY .
€ Uf?:` f Ii'ljt"1'I4A► F!?.L 1 (,11 Fkioo It►'): tl0
ST.R.C)"leis'! PAtlTICIN FEES R VIAU 101-000-241-01.30
SEP• 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
:3CJ13-�!'O�AC: C'C�ItiI; J'ftI)'t 1C?tF AN.f) l'l:,eW CIiR.:'!
9:2(1�`.gtl
RECEIPT
DATE/
BY
DATE FIN E
I PE OR
INSPECTION RECORD
OPERATION
DATE INSPECTOR OPERATION
DATE i INSPECTOR
BUILDING
APPROVALS MECHANICAL APPROVALS '
i
Set Backs
Underground Ducts
-
Forms & Footings
Ducts
Slab Grade
Return Air
i
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wrap i
j t..0
Framing
! Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
i Fans & Controls
!
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior LathT—
Drywall - Int. Lath
_
i
i I
t — — Final
Fina!
SLOCKWALL APPROVALS f Steel
POOLS -SPAS I
Set Backs
I { Electric Band
Footings
h4ain Drain
j
Bond Beam
Aoaroval to Cover
j i
Equipment Location
Underground Electric
_
4
Final
Final �L
i
—,
' Undercround Yiba. Test-
est
Gas Piping
PLU104113ING APPROVALS
Gas Test
Electric Fina!
s
;.'ante Lines _ __.T r _
Water Piping +� -
Heater Final
I Plumbing Finai
I
Plumbing Top Out
Equipment Enclosure
I Shower Pans
O K. for Finish Plaster
Sewer Lateral
_
_
Pool Cover
Sewer Connection
��
_
Encapsu!afion
Gas Piping
Gas Test
�—
Appliances
Final
COMMENTS:
/ Ila, 6 wo,
Ga
/1
V,
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)
A
-D n
INSPECTION REPORT
rr
Dew
f4. tL
--'a LoCL�g
u� C.�'( L L`-led.!5
j2r
'71
e-76 L0
L
L A- StRI A 1P P i J
F
CERTIFICATIONOF COMPLIANCE.
To the: b6tt:6fou'r kno'wled-g*e,. a"11 of the reported work; unless otherwise noted,
substantially ' coniph6s Wth:a"pprqy?'d.,Lplans,
.06ec
iiions-�andaoplicable sections of the build ng codes. This report -covers
tci,
he locations of the work iiispedW
-,brily'A '.�does�.Sno constitute engineering opinion orproj
ect control.
7_
CERT. -NO. CTO 1
E>�i'��nl`
PATE IL INSPECTOR:SIGNATUR
x
a
Page of
DAVE STEAVENS
Inspection Services
PROJECT�(Jk Qt; S< t�NASC. 1C�: PROJECT # . mod -03
ADDRESS 54f- 10 4. 10 15111 lot I D q_L
BLDG. PERMIT #
CLIENT ?6A t,J `- 5' N o A
DATE 3 dY G' L Zo n 7_
ARCHITECT 601-&4 6 2 C_t4
ENGINEERI lA.613 I C .5Oj L CONTRACTOR% F L m A R, 6 6-1 E C
INSPECTION TYPE '
INSPECTION REPORT
A&M ALJCk ld- ,yK7-S - -7-/C ,_, - Wk,11; A
H 4k—1 rt c -S SK tZ Lyc,rt
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 bot constitute engineering opinion or project control.
CERT. NO. 09&5�7.37 `�rD INSPECTOR NAME I S Z q 77V��.
ll�A%SDATE INSPECTOR SIGNE� ATUQ0. �
.. - .� •�' - ,"8 `i a .. .'3. �l 4'r :s = � �•i ar r .•�. .�:�=z t � k>..a i`.,>,{� .4: -w�` '� �,.:'�•�e:::,:;-vv^^•.. ., .. t .v . .
Jj
Page �_ of • 2,
DAVESTEAVENS
.. _ Inspection�:S`er`vices
L
PROJECT "# 0?002 0 3
"CLIENT 1404
DATE A?01 L --
ARCHITECT
ARCHITECT 6o.t_ 3A C_q
CONTRACTOR I A A rZ YPq ei Fi C.
INSPECTIO&REP.ORT
�2 lwiCSt NZ IL eLJ `S./g .r�rfq
CERTIFICATION OF COMPLIANCE To th`e best.of our: knowledge;' all of.the reported work, unless otherwise noted,
substantially complies with approved pla6s,.60ec0ications and. applicable..sections of the building codes: This reportcovers
the locations of the work inspected bnly.�and.does not.constitute engineering opinion or project control.
,CERT.NO. pJ 9.3 7 sr :INSPECTOR NAME
Q s p r P(Uii Cle
DATE O AP,e I ( "760-z-
INSPECTORSIGNATUR�� A's 4
-T/of r4 ii I.>
18 rp. L[.AT U4 A-5
pig 74--wo 4/94-/5
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i
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RQ 1)5 7 cEJC. Z'"N .'�t:3 bAA
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No�zs
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5/0„
Roo-.s - iL'lt> Ik
L/ -10 5
e3Al 6�1 N I L4
LA sJ:
VA, I 1��f\.v75 - I1 "C.E��T►-1 h IA I
/i}'�,
�. �U�S= 1'S LGa,1ivT H $ �% A
• � 1f - t o l
/DA�4 µ LLL_ -
�.A►J t O
..
Ce'S—N
, Lbws %i6LZS ��' !L11 Dj?T r13�'t' lJ l � 1�5 ' lrJ BTW SFS”
t-or_S P0' Lr-
12�C,PTw J` h'IA
!�
Ky 65 - 17'' L CLJ4 744 ,��D..1 A
r�
�2 lwiCSt NZ IL eLJ `S./g .r�rfq
CERTIFICATION OF COMPLIANCE To th`e best.of our: knowledge;' all of.the reported work, unless otherwise noted,
substantially complies with approved pla6s,.60ec0ications and. applicable..sections of the building codes: This reportcovers
the locations of the work inspected bnly.�and.does not.constitute engineering opinion or project control.
,CERT.NO. pJ 9.3 7 sr :INSPECTOR NAME
Q s p r P(Uii Cle
DATE O AP,e I ( "760-z-
INSPECTORSIGNATUR�� A's 4