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
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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
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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, 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
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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
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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,_ 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, `