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
3132 93JP3, I/
f41' f f•
Date f --" �P� � Signature of Confractri�oi 1
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(�-) 1 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.
CA -1, sND�>x��Y
(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
subject to the workers' compensation provisions of Section 3700 of the tabor
Code, I;shall forthwith comply "`'th those/pro Islons. ,
Date: `/I �/ /1"? ! Applica�it'i i (� !! a r. si,"a /,/
WarningrFailure to secure Workers' Compensation coverage Is unlawful an
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 Safet
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. 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.
i
Signature (Owner'/Agent)c 1'1 r • F AL" f �7. �i 'Date ' ✓ ' �
BUILDING PERMIT PERMTk
f, f
DATE., / VALUATION LOT TRACT
-1�i1
pp g{LryM
11
JOB SITE
ADDRESS
)
APN
OAK HftJ.4 15_�K_/
OWNER
CONTRACTOR / DESIGNER / EN (NEER
P(M W Err RESWE'J,1 V A L ASSOCW1,1024
DEIL M I R PACIFIC CO 5R"MR
ro :BOX 3 M
462 WnSVTIMS AVF_ W 307
].aA QT,i:�'--A CA S112253
SOLANA BEACH CIA. 92075
(858`Ar792_15 0 UBIX 5823
USE OF PERMIT
M C��L:LAN 01fIS
75-16r, 3T. CHMRd &S A,
P10, -121, 544117 &$4-11.3OAK. k RI, - BUILD=16, TYPE
' Cf3+iYARY STIZ C d°URAL MODIFICATIONS
VA-VATiON. At N0.00 La
JGc78 IM.G. M COSTOF CON911 UIV.7'rI .VAa
.20,w4Ynw
PIr PEE SUMAWRY
CONSTRUCTION PM IQ) -,000-418-000 $207:90
S't'3''O340 NOTION k'i Z: 10 .101-000-241-000 $2,06
e. Q
SEP 10 2001
CITy OF LA QUINTA
FINANCE DEPT.
4,11B.1 -O 'AI, Ct7NEirMU'M1011 .N►WD TUN CRECiC
LIM FRE -PAM M FET9
X0, 00
TeA'&AI, Pke.T.�k�''S11 J.t Atr•L'aNIA.E.lV'6NR'Y
RECEIPT
DATE (
BY
DATE FINALID
NSPE OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
I
Forms & Footings
Ducts
1
Slab Grade
Return Air
{
Steel
Combustion Air
f
Roof Deck
Exhaust Fans
l
O.K. to Wrap
F.A.U.
1
Framing
Compressor
I
Insulation
Vents .
I
Fireplace P.L.
Grills
[
Fireplace T.O. '
Fans & Controls
i
Party Wall Insulation
Condensate Lines
I
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
t
{
i
_
Final `j _
BLOCKWALL APPROVALS
Final 1
POOLS - SPAS
steel 1
Set Backs
Electric Bond
{
Footings
Main Drain
l
Bond Beam
Approval to Cover
[
Equipment Location
f
Underground Electric
Underground Plbg. Test
i
Final
Gas Piping
[
PLUMBING APPROVALS
Gas Test
[
Electric Final
I
Waste Lines
Heater Final
E
Water Piping
Plumbing Final
I
Plumbing Top Out
Equipment Enclosure
l
Shower Pans
O.K. for Finish Plaster
I
Sewer Lateral
Pool Cover
I
Sewer Connection
Encapsulation
I
Gas Piping
i
Gas Test
[
Appliances
Final
COMMENTS:
/
l�/� /
A10 40L`
j
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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: Page of
DAVE •STEAVENS
'Inspection. Services
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PROJECT Y(-. J S - r��-1,{ e R ''PROJECT # 6 3
s�: r• rr ADDRESS -7, CLIENT 4 e- c Jr57 A/0 4
OAKH1�L aLyG `/(� �CA';Jl' DATE -I'�P �iZ' Zoo?_ .
° BLDG.PERMIT # ARCHITEC.T< T1sSA A
.ENGINEER.1)LC , Y,J SA Jot > Al
CONTRACTOR-DZ?,N►A �2 i9 c �c
INSPECTION TYPE: t • I
INSPECTION- REPORT
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CERTIFICATION �OF_COMPLIANCE To the best.of our knowledge, all,of the reported work, unless otherwise rioted,
-�substantially complies with approved plans, specifications and :applicable sections:of the building codes. This report covers
�1 the locations of .the work.inspected.only and does not constitute engineering opinion or project control.
CEAT:NO:l19-59 PC71- � J D t
�I�N�SPECTOR NAME
DATE S Me/ L PMRSIG ��L
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DAVE "ST -1v
L Inspection Services
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PROJECT 0"SE t PROJECT # `oiy:U Z:-
ADDRESS: S-'�:-:7�5:`(2%t 7� �/3': CLIENT�tf1 c�J�ST b-pi�
fa�4clNic.'LLO�'�/� 1��;qt� f Z DATE
BLDG. PERMIT #ARCHITECT. AQC'-1 .
, ENGINE R),u .1 � A w� E / n�G , CONTRACTOR L
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 grid applicable sections of the building, codes. This report covers
the locations of•the;work ins ected,onl and does not constitute en ineerin o inion:or. ro'ect control. .
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CERT NO. O 8 S'. ! 3 `T �j S. (� ' 'INSPECTOR NAME `' NF1 t� .Ei�I �G ;
0
DATE INSPEMA SIGNATUR
Page of Z
DAVE STEAVENS
Iinspecuon-Services
PROJECT'�..��A \E sgt 'PROJECT
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BLDG. PERMIT # ARCHITECT G O" A
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INSPECTION TYPE
INSPECTIONREPORT
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CERTIFICATION OF COMPLIANCE Tothe best".of ourknowledge,fAll. of the reported work,_unless otherwise noted,.
-� substantially complies with approved plans; specifications and *applicable sections of thetuilding codes. This report covers
the locations of the work inspected.only`and does. hot-6 " 'tdute engineering'opinion:or.projectcontrol.
CERT. NO.INSPECTOR NAME "' -
..DATE' / • I / /l �` L7 i* �r j 5 `Pe ..•
INSPECTOR SIGNATURE
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