0108-350 (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
7 r
Date ' ' : ' ' f ' ! Signature of-tonract�IrTT:
• r,r''`r OWNER -BUILDER DECLARATION r'-! ,�• f
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&RC. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
1 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.
SI have and will maintain workers' compensation insurance, as required by
ion 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 CAI 124 DEMNITY Policy No.
(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 3700of the Labor
Code, I shall forthwith comply with those, provisions.
Date:,,-,, .;. ; Applicant—..,
'— VM'ning Failure to secure Workers' •Compensation coverage,islUAlawf(Jl•�ntf
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose.request and for whose benefit work is performed under or pursuabt to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
:work is not commenced within 180 days from date of issuance of such .°
permit, or cessation of work for 180 days will subject permittocancellation
I certify that have read this application and state thafthe-above information is r
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives ofthis•.City�to enter upon
the above-mentioned property for ins
ectlon purposes
Signature (OwneY/A t r� r/�'r`} '` I : ,' C i rf % i i `.Date 1XV;
/f BUILDING PERMIT PERMITq - Y
DATE / VALUATION LOT 0108-350 TRACT
JOB SITE
ADDRESS ,/
APN
0AT lln.,tD: J�7
OWNER
CONTRACTOR/ DESIGNER / EN (NEER
P(.'IA'i! M- T II:L,`xi3 �WIIJL "11001A'rION'
DEL A+1Ala .laAt` C -1C GENIMAL Mi3'r1iA ciR
PO B0>1" 1 Of to
462 3rRVFNhy AVL. #302
Y„kt UINTA CA 92253
SOLANABRA.CH fk
(S5#3)792.1:500 C' Y:d#< 11821
ra
USE OF PERMIT
1..c31°AL Cyit6'.= MFORMATION
�41W%L,LA1~7NOUN
75,,140 ST. C -1i1 RLM PL
:ti4•xII$IM.1ti�,��%.,1bi54-097 OAK HILL- HU11..1)INC1 -1, tYpx
I IC VOLUNTARY ST'RiJCTUkAL WDiFIC:AT IONS
y
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1/•AIAJIAT'ION! Ls
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.r-sy A;7.1l►nt co cro CimirrR1Cl(mon:.
;gt10,1061 ''
f'.it 1'2.WiI'r.' PIM Sl1 MMARY7'.
0040'1'RUCi° IMI FEE 101 -000^14) i3 f:100
iT.12.tJy"OMOTION .FEE -1:ESiv I01^,0001•241-0(30
SER. 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
RM -TOTAL C ONSTRU'=011I A91) PLAN CME X
' $209.t1Q
I. EW PRE -PAW FUS
$0.00
TMAL PLIt11 Dr IMS DULP DOW
S209.00.
RECEIPT ry, ';
the +�P�k
DATE
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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
( I
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
i
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
1 _
Final
Final' �_..
BLOC"IALL APPROVALS steel
POOLS - SPAS
Set Backs
���
i Electric Bond
Footings
_
j
Main Dram
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
Underground Pibg. Test
Final
_
Gas Piping
PLUMBING
APPROVALS
� Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster.
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
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:
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. .. � DAVE STEAv�N�S
Inspection` Services
PROJECT e -:-5'T- - A C 1 t3 PROJECT #_ ayo 2 = t> 3
ADDRESS _ L 0a CLIENT't w;A t.4 o p
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CERTIFICATION OF COMPLIANCE To the best of,our knowledge,:,all of=the•:reported work, unless otherwise noted,
substantially_ complies wrtfi, approved plans, specrfications and applicable sections 'f the building codes. This report covers
the locations ofthe work inspectedo`nty and does not constitute.engineering opinion or project. control.
Vit' .. • : .. c .. S
CERT:-VO.OS1-93 4R r S�CY IINSPECTORNAME: •1 • ).!i c%� Jf��`t(cI�JS /.
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t : Page of
DAVE.STEAVENS
"in S`0” edfo'n Services;
PROJECTt7(�i� u-) rG ST - t� �1 f�S� �.. PROJECT # ` .:.
ADDRESS -5,4,r 16'4 . I:u 5. I o D R 1. CLIENT N46 C�
BALI+-t�,��_�'c# r1 �(A�•11 DATE L Zon 7
:.BLDG. PERMIT # ARCHITECT r; 0 L &4 - A R
- ENGINEERlu-0#3 SAjp,g x5oL. CONTRACTOR%,(.' nn,AR- 'A c., €
INSPECTION TYPE
INSPECTION. REPORT
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CERTIFICATION OF COMPLIANCE To the bestof our knowledge, all of the; reported work, unless otherwise noted,
substantially complies with approved plans; specficatbns and applicable sections"ofahe building:codes. This report covers I
the locations of the work inspected only and does not,constltute engneenng opinion or project control.-
CERT-NO. ANSPE&OR NAME =lQ L%6A%S
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DATE INSPECTOR SIGNATU (+:
b t DAVE :STEAVENS
Inspection Services
PROJECT 1-��,1� i s i �YHi�15 /d
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PROJECT # o2'002 -.O 3
CLIENT -PG�4 . W C57- No 4
DATE; g AfR r(- 9vo Z
ARCHITECT ,6o 4 3A, ' 14? -(::q
CONTRACTOR . ,Cc A A r2 PA cr X-1 C-
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INSPEC'T''IONYREPORT
CERTIFICATION OF COMPLIANCE To the best of our knowledge, :all of' the reported work, unless otherwise noted,
substantially.complies'with approved +plans, specif-ications'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. 057.3 INSPECTOR NAME ;';� A iI� 5�)'I �'t.�✓�..::
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CERTIFICATION OF COMPLIANCE To the best of our knowledge, :all of' the reported work, unless otherwise noted,
substantially.complies'with approved +plans, specif-ications'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. 057.3 INSPECTOR NAME ;';� A iI� 5�)'I �'t.�✓�..::
DATE G r(„ -
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