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0108-349 (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 `D331,..52 B ; , , CDyrllr2i Date %!p-�`�„ g � �, � Si nature of Contraci!or r 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. y(�) I have and will maintain workers' compensation insurance, as required by Section 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. CAL INDEMNITY '1a 406a 174A (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, 1 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, 1. shall forthwith comply,wjth thotse provisions.., Date: ''� '' 7 App., r 9 _VmfnfnT.-Failure to secure Workers' Compensation coverage is unlawful anD shall subject an employer to criminal penalties and civil fines up to $100,000, i addition to the cost of compensation, damages as provided for in Section 370 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safe 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.. l 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- (Owne�Ag�n)M I'!• ?` '`� fig IJ)A-')Date BUILDING PERMITPERMITq DATE / VALUATION LOT 0106-3110 TRACT JOB SITE' ADDRESS APN OWNER CONTRACTOR / DESIGNER / EN (NEER WA WWr RMID J'IMI, .ASSOCW1014 DEL :MM PACW1C crEwa Ai. CCti'ii�°LACT0 PODOX l t't o 462 �+d M Avg #301. u.Cdti'WTA CA 92233 SOLANAB)EA+L`H CA 92075 (858)792-1500 C:E" 3823 f LOCAL OMCL+ INFORMATION :A ;;: USE OF PERMIT 1AWC LANEOUS 73a160 ST. CHARM PL M , 12 W5_4_aa1, 54.119 & 54.113 OAK Hill, . DUIL,01W 16, Type' • ,N , 12C VOLUNTARY 8TRUCTURAL Mr DIFICAT10140 _ iiAldaPt`PlON ?Q00 00, l.s .. •4,L iii ISF1tTA!IAI'M C08P OF CORYIN.0 MON <. 20,000W'<, 1"MUrr VER SUMMARY CONSTRUCTION Flay, 10)-000-418_000 $207.00 STRONG MOTION FEE- REBID -_401-0001 241 -OW $3.00 fSEP12001CITY OF LA QUINTA FINANCE DEPT. wI.1'E3• 10TAL. '.0)QTr. RDC V1OW AND PLAN G1160e. $209.00 LRBS FR,9-PAID FM $0.00 TOTAL 7PMUT .VIMS DUE NOW $209.00 RECEIPT DATEBY /v c'' DAT FINA D NSPE OR ;�s INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. ' Fans & Controls Party Wali Insulation ' Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath _ Final_ _ BLOCKWALL APPROVALS Final POOLS - SPAS Steel Set Backs I Electric Bond Footings I Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test .Final.. i Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Neater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) -• ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: /7// _ Page ( of PROJECT # w0 e2 - .C) 3 ,. r v CLIENT..' 1 A . L. Jr s? 1-10#4 DATE :S'.e L a vy'Z• ARCHITECT`"4oc 3A 4i2c q CONTRACTOR, J)t L /M A rZ V)i9 Cir."" K A L 5 - ( 14 �s 9 BLo cel ` .a ,J D' L `/ . o✓ "� ► 6 �ti ,2 L� r CERTIFICATION OF COMPLIANCE,To the bestof`our knowledge; all of the°reported,work, unless otherwise noted, substantially complies with approved plans, sPecrficafions andapplicable sections of the building codes. This report covers the.locations of the work:• inspected only and does not constrtute engineering opinion'or.project control. CEAT.�VO.� S9�71'1 �: D L MNSPECTORNAAAE \ t„/j -AR 5h DATE rt/elL" eJt,O' 2 INSPECTORSIGNAT� ALY � ., _ _.. ' ;` .'r'..., !,, •:rs ��,»: .• �:t�$� < -:er f's. .; �<. r+ s _vVe .. .,. � ... m.. ,. � —� Page of ?� DAVE .-STE.AVENS Inpection Services ;PROJECTi\ E:S c :W dS�c." •t PROJECT'# owy Z - y 3 ' ADDRESS / 2 5.../ 2 ► '/ 7� i./ 3 CLIENT � 1' (JJ e ST b40 R gclN� L L ,BOG / G Ad / Z DATE 7 ft �i�% �- .ZU o Z. BLDG. PERMIT #ARCHITECT ' C-%tiJfi Y4eC'--) ENGINEER �) .� fi ��/ E ►J c. , 'CONTRACTOR ' . rv►tZ �� c 1 , INSPECTION TYPE i INSPECTION REPORT �,. - 3 1,,-, 3 kLA �S'g_A.)A A: .4T71C S. - rRAMikk, 1jell ry. Ai- i ,212 TT -G. ::Tr/ 2`(;vl-// i CERTIFICATION OF COMPLIANCE To:the best=of our knowledge, all: of the reported work, unless otherwise noted, substantially complies with. approved pans, specifications• and applicable sections`of -the buildir g7' odes. This report covers the locations of -the: work inspected only;'and does not;constit4,t ngineenng `opinion or project control. CERT. NO. D 5/ 3 7 .� 5 (� INSPECTOR NAME/e ,DATE 7 rT7 /�/L C)00 : INSPECTOR. SIGNATURE`"j^ .y„ Page of Z D.A.VE �STEAVENS . Inspection Services PROJECT -PROJECT # ADDRESS: � aS 1 21 t 1 CLIENT S �} �J �. ST' N o 1,2- DATE ,If o4?R!;L-awvZ BLDG. PERMIT # ARCHITECT a ENGINEER,)c&,J J SA Jo 1 SSC- CONTRACTOR L wi a iC ?a c �f c INSPECTION TYPE _ INSPECTION REPORT Yr6e-LQf.Aj , ai e G a cA r iv:J S EAo x Y' �Si �.s oti1 ETi'-` 6-x P, -7-03 - j4ePL(C_AT/d„) AA)y =J57_14LL,A_-r/ZW AS PZ-,C .1. CQO Sy - 1t L.A 1,) �ll W. '� LAGS �-1oL 5.: la 1�C 1t7r►-i F i Lr��-t'bl (� �� A. �LAN- of of 4Air_wrz C'r_, j_-Est LUcs-.40LC5 /217t �Trl `. �4 D VA. ISLE ISS 1`7 r� ►� lv,•! S LC v .��:, oDs i,Y, �. D � •A e) A ht iL4 (LL La &j 49 s oc.iU (Ai 4�S r L t J - et L c.5 �-I u �;: S L Z, D L? 3/ v i n ; IZv S . l S� � . t: t. J 6-T N .. 63 , D l 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 ofthe,building codes. This report covers the locations of the work inspected only and does not constitute engineering opinion or project control. 4 CERT. NO. S` ��- St INSPECTOR NAME fi NS DATE _f rel L ZW Z INSPECT6R'SIGNATl1RE, `