0108-349 (BLDG)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 k Lic. Class Exp. Date
731152 3 /.11
Date %� ' +� Signature of Contractor
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,+f3usiness &Professionals Code).
( ) t I" as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code):
(,) I am exemptunder 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:
r,. O I;have andtwill malntalnascertificate of consent to self -insure for workers'
.compensation, as. provided for' bySection 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
Section -3700 of:the Labor Code,*for thew
, performance of the ork for which this
permlY;is issued.4.My, workers compensation`'insurance carrier & policy no. are:
Ganler� ;:( �•w PolicyNo. `
�.(..�iD SidI:iit;�dN]!� � .;• k, kailUG'h1;4�r1 ,�
,{ (This section need not be completed:rf Ahe permit valuation Is for $100,00 or less).
( ) 4[certlfy that in`the pertoemance of,�the work forwhich ttiis permit is issued,
I shall not employ any person In:anyGmanner>so as to become subject to the
s'aworkers"compensation; laws of''Californla ;and agree that if' -I. should become
subject to the workers'.compensatjon provisions of Section 3200 of the Labor
r
Appllca'
i
Date f�t„ J f l ,_1:
ty` ng'Fallure to secure Workers Compensation coverage Is unlawful an
shall sub'ect an'em to er.to criminal enalties and civil fines ti to $100,000, i
add(tion::fo the cost bucompensation damages as provideii'fopin Section 370
of. a Labor Code, interest and attorney's fees. "
'.r •r'•• ,.
r� IMPORTANT Application is hereby made to the Director of Building and Safet
fff - '•'c
.6, for a -permit subject- to` the'+ conditions ,and- restrictions 'set forth on his
application.a
!••bus . ` ,�• y...,.. :,�:.'l,sf a -,mss:; : �.,.
1 Each person upon whose behalf this application is made & each person al
whose requesfand for whose benefit work is performed under or pursuant to
hz ':any -permit Issued as.a resuit�bf this applicaton agrees to, &'shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
s- 2. My permit issued as.a rest,IW f this applicationbecomes null and void if
work' is not commenced within 180 days from date' of issuance of such
Ylv permit, or cessation'ouwork for 180 days will subject permit to cancellation.
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 (Owner/Ad�nl)` '1 '? i�• :• ' �'' 't `Date
DATE • / , / VALUATION LOT UYOS-!S TRACT
.t•(y}r
I Qat (fir
JOB SITE
APN
ADDRESS
0AK RMT.
OWNER
CONTRACTOR ( DESIGNER / ENGINEER
f...f•'•,ti,_0.04TA is''. 's'?"i::.
;�f.'s1,hi3.r.33rt,,�:_a.+..
USE OF PERMIT
i.i:rt.':�.tI:?t'!+')t.it:-!.%6�(:3)'1.f:5.P.'!'!(i',•t.
'ttt4>.: 47:a.J...:f':a:•1'�t:_ (a�;
i�..!i(� ;1"i`.:'!,.t+t1?l.a,':�i ��t:
:-39 at�.Tr s1 Il', 14 .': 1-11'.1 +:)r'. L 10,.f:: • VUil 1'> i0 1ki. T7' -)d�
:
1;l'1'!?11/:"'It}:.111.A;r1C7!rlr.`.11;'il,y1, s
fa
` !.�;het"S.N�i':�!'ii'��.4?�i:r)c< f.'�t:►!'i;'�iR;tl,,"t'Rt:s!''f
:�t3,f.}t:+tD.tf<.7
it•'.1"+ t< �,� i A � 1 h'� ;� 6 f !+/����t,r,):14f x'
Y
c' ,3tJ!'};l+.t.ut, sl�').kx.!f!.'_^: � ]t.1't.i;jij(}..!S�>••!Ni!} �:::U'l,U:1
•`.ift.t'i;•;:, hAS:YI'h�?RJ'cti:E�• 1i�'SSti} .3t?�'I.i3(11�i•�?�tl•-{}U!+ t;..C+,1
'
SEP 1.0.2001
CITY.OF`LA.QUIN. '
FINANCE DEPT. ,
irt;}t:;•�t`?:''k'At, f..:i�td:it'.tti.L)'4''',!'.ic:ii••! .Ai,>'•11 'I��L:,1:'.1`3 C`f14t:i`.lr:.
`,)32/3`.•).13;.}
.. I.:i?�' r 1':k; }''s°•I`AJ.1:> F•'ls i?3
Wit), t}t?
;:NOW
/
RECEIPT
DATE!
BY
DATE FINAL D NSPE OR
�' _
s L -o
- '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
G.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.G.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath��
Drywall - Int. Lath
Final
BLOCK WALL APPROVALS
Final
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Band Beam
i Approval to Cover
I Equipment Location
_
Underground Electric
Underground Plug. Tes:
Final
Gas Fiping
PLUMBING APPROVALS
Gas Test
Electric Finai
—
Waste Lines
Heater Frnal —�
Water Piping
Plumbing Final
I
Plumbing Top Out
Equipment Enclosure
Shower Paris
G.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encacsulat!cn
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:
///
l7///`�V ��
�/ O y �!s�% �,/�
/
Page of
..DAVE , STE:AENS
Inspection r,Seroices
PROJECT ' 1 �) �S - l ifs ;E 1 PROJECT # v2 O e2 — .6
ADDRESS�5 N -` l 2 5 ,.1 a 1'. l h�, l 1 CLIENT (A -i-J r 5 T A/0 4
pA (:C N LL d �. �:/�Gfa�l 1.:' ' DATE a
BLDG. PERMIT # ARCHITECT 40e—A ARC N
ENGINEER .I)u CONTRACTOR'..D L. Al A `e Y)A C i r
INSPECTION, TYPE
r
-INSPECTION :REPORT
a
?�4 �v►� �J� N04 ►? D. ccl 2t:i..15. �,c'Lr9 '? �:a_.►, L t T c=
I LI ;e)2, icl u-rs `T� �7 tiJ� .�� ,y
1
.�/.2, S" � . J% 2r7 F:7`' STd �° c_v.►-t.>OLc-j r E �- � - , � `� ,
*3 AIL-" E"1� i7/�0.?"� ti't" C.y r►� _% [_ t Ti�.� / n ;
ko, rt
A 4 A T 1 C s -A 2 -&A r &, / ieJy- Co 12 LC T-dz-:'
, 95 = 4 SLOCil. `
' r /4 � D PL- / oJA+ ► iJ 6 — •y � ,JLC` T�
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.
CEk1T.NO.,00?57-?7' ' S U - INSPECTOR NAME 1 ) C � t, � <51 '
(Prim-Clearly)
DATE , J �e/ L r�CiU' INSPECTOR SIGNATME ��..
-.�-,, kr"r'._:;.,_-.7.....-..,�-...-.�r.'+`%-'�f+tif'�.:in,� vf'tk'�`r�'w��+-';±.,.:r.iL"'��f..v+�iMi..r3ti--"tiir4'J�.i�jr.-.iU..vf+`.�.�'`Cj'f�.-:..%�t>vti.:y 4`w--•«.lurrr.r
Page .)I� of Z
DAVE STEAVENS
Inspection Services
PROJECT -44, u-') E,s i
ADDRESS 2 S•' /Z! 11 ' (/:3
.J4r1M1l..L RLL '/G Pt-A!)I Z.
BLDG. PERMIT #
ENGINEERJ�ur r,Nk SSA do(C WC,
INSPECTION TYPE
PROJECT # a00 Z -0 's
CLIENT-�>Ca>t c.J ST b�0 R
DATE 2v a Z
ARCHITECT (2rX46
CONTRACTOR/ CL t N C- , C -
INSPECTION REPORT
.-7-03
\ 1---t T, -_ � — � .'- . 3 1 �-1 /S - q - I`-� � r� c..bE � . � c _ .i4 w� n A - V C t�r� DLG TC=
41 �4 �rT l C 5 - f� Iz� M � ��� . �3��c� ►alp � -3 S � L P f- y s . L- 7 v ,
i
APs - 1-- /Z A Al C �
I
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. ® 8 S-9 3 `r i� - :5 0 INSPECTOR NAME"I -A J C 'S -'FAC71 aws
p P Cleary)
DATE A /Z / L x 00 2- INSPECTORSIGNATUR m.
k. N
.., .. w r «'r..+.e v_y[lr..'�iMRw"i•� W RI+�^'r".^"r�.Fr<'•.'art. RwYv`'-`v.-1+.... '+av�.�
{ "�..^tiw•TM+.'v 'Y'M�T.+SG ^r -.Nr �+}4�S-rM w'li� . _1
�•• . Page I of Z
DAVE` STEAVENS
Inspection Services
PROJECT_G,A �..� sT-�hlA.s� 1 ►'i
ADDRESS Sq- 1 ,;LSr / 21. I 1 '1 , 11 112�
DAviNt L� r`3wr *`lr., �t L0,6 12
BLDG. PERMIT #
ENGINEER.DL&tJLJ SAJo«- �Jc--
INSPECTION TYPE
PROJECT #' ,? a 2. -0 3
CLIENT + t "-*) es:r %-1 o P,
DATE Lt eR 1 L- 7100Z,
ARCHITECT G O 48 A 4eZ CrL-4 ,
CONTRACTOR S)CL 01 p, -,t ?Ac t fv-r c
INSPECTION REPORT
4)f_t_! /,AJ ( G..O cA r /0AJ'S Edo X otJ ETr` Ex 1? '7 -y 3
AePL(C_A-rtn„) 44)t) =,-JSTA oL-A_-r-iv�J As PZX Z e6o
5-44-115- n34 U "t L L. L-AL._J `4Q
kA *>T N u
Lo LW. -aLoos1_1z'5 - 0 brP-r 4 I tA,QOD5- 1`7 LrAk.-n-I '7/9 blA.
1 ,r
�� / 11
-�E-ZJ#.� - c. o c 5 - l -I o . z- 5 - l "a1 % �T�1 ' I D t A ko tb 5 - (-7 L t= L)6' TX 8 01A.
n A t4 4 1 LL +P LAtai 01-4
I?�Az CT_,_V-rgn - J Lo05 (0CCS -12 DF-trH /4"t i N e j) i
-� 1, ,1
-'42 Loc -s - (410u_; -S- kI- 'h aThl SLb-s • 1'7 Lf -Q TL -k �B � 1 A .
S y
(t o A ti P r LL
t, -r ►(
i-�OLG� ' I1 7r.�Tti-1 ( ��c� �5- I1 L��J`714 !B 17�r1.
t 3 11 � 1 ,,� .�
RODS- 15 L Gv, k tA � D A._
A 9<'i-4 (t -L. rP t -q tJ' L+ Q
fir✓ b� - uc-S- E-10 5- 1� u�+�?�cN I�(�(a . 'RoDS - IT i W �R tD(A,
.t
Gi,y-s f L l J - el; L o c-5 - i-� o�� S - l Z. D � w. '3/y stn. tZy � S • / 5- (� [- t. � 6� N �� , / D ( A
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.
BERT. NO. � -375- _.1 0 INSPECTOR NAME �JP.1 �� 5�1� F_ 05
,( (Print • learl
DATE
e/ q�el L�'� �Z. INSPECTOR SIGNATURE,...\ Q...