0108-348 (BLDG).a 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
733152 l:s. / 1);V3Ii2O
^Signatureof.CCnlrctod
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
( ) - 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"(8e6.•7044, Business & Professionals Code).
( ) I, as.owner of-the•property; am `exctuAvely contracting withAcensed
contractors to construct the project' (Sec. 7044, Business & Professionals
Code)y^ -
O I arn,.exempt under Section' _, B&P.C. for this reason
Date °*>` " Signature. of Owner `
t '"? .WORKER'S COMPENSATION DECLARATION
I hereby affirm- under .penalty' of'perju�y • one of .the following ;declarations:
{) I have and�will maintain a certificate of consent,to self-insuie.for workers'
compensation, as provided for by' Section 3700 A' the Labor Code;'for the
`performance of the work"for which ,thi .permit Isy Issued:
,f have and will maintain workers' compensation insurance, as required by
<Skion 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:
11',Policy No
'. ' ". 9 •v.P1 �s YdYl,d:nMli;f1�"f .:: '`. 11 s1��:1, t';'4.,�,, ,.
(This section need not be completed:_If the permit vaivaiioriisfor $1.06.00 or less).
( 5) I certify thatin the performance of he work -for which this pe[mit:is Issued,„
(;shall not employ,any person in-anymanner so as to become'subject to the
workers' compensation;laws°'of Callfornia,'and agree that:if I should become
n subject to the`workers,compensation provisions otSectiom3700 of thel bor
j. o e- 'P shall forthwith comply with thoseiproy signs.. c
(lure to secure Workers Compensation acoverage is Lnfawful`and
an employer to criminal penalties and civil fines up to $160,000, in
e,,cost of compensation, damage's as providedJor in Section 3706
ode; Interest and attorney's fees
.,Application is hereby made, to the°Director of Building'and Safety
subject ito; the, conditions and restrictions set forth on -his'.
r r
1 ,person upon whose behalf this apPlic.ation is made & each erson'at
Whose request and for whose benefit work is performed under or pursuant to
t anypermit 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
X' 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
r' 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 (Own.er1A9gH' ,; •+' i. t . L % Date /�' 4 J
/// BUILDING PERMIT
DATE / VALUATION " LOT
��.( Z, TRACT
rr'
JOB SITE `
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
!';l.A'WIV. il: itF5!'.1':!kat4'i'1Ai_ AS;, X".j:K110).J
1)£.f,:4,AAP.3:IAC3.1,"K! CxH;k�F3{AT,�'�,�►TiLf,r"^ t#3
1060
462 `.11,1!X131-;t2,fW.. if 302
i -A
81_,AC1:f i`A 92075
85 S
USE OF PERMIT
Q I*Ica? I'r; 9•'O1f P• A'} 101`41
�sr4d'tAF;'0�;•I'i"A, "'J, 13 t;'H AK ii?;,i. - F. J I_Nt'I 15, 'I Y'I'I;'
li,t' V0t.11iI1".(i)P'.Y S11 1("fUliAL.hht toff lt'f".7')taPi.�
►r.'�1,�?s`•�Tlt?!d
'l.G,ililh.11l? 1.::;
N ,� °?Wt��i?� b'1!:I) f", (:'�� .t' v7' +'�.' <�),f'•iw T�i.l i S"A'f Ck.N.
:? t),f lt.3i D,i'i'{)
- S?:( Oifdrilt' �I`0'�..':Eil.E�llirs,tllc �.
•
j01 {);gCt..'11
6100
?41i:)'t'ION Y i? .,MS'iU 10 t (!(3%.4- ,ri � •.(i
�: f:l.i�(?
a , .
LrI %a
SEP l 0 s 2001, '
f
CITY OF LXQUINTA
FINANCE DEPT.
! C -48,1"!? Krf).Ct:tl d:ta'� i':E.AM C .U.11,l!':`K
{ 2409.00
7 c c1
7i.��a�i� TY1t.E;,1�1•�11? �'I°:F1,�1
v'!(�, �i("i
"1'MAJ., 3:s1r:R-Ni I.., ;S 1AT11; NOW
�?.t�►.4DU
RECEIPT
DATE /
BY
DAXIN4hEJ
PE
i
f :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 Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath �.
Drywall - Int. Lath
_
Final �� _ _ _
BLOCKWALL APPROVALS
r'inal
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam _
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
Encapsula"on
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)
COMMEN"S:
V we
l� G
O
`
'
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_ '•i.-_,-!l} y. .�� !i%' HT _'.a.'r.r nil �'�'.,'tHw`ai•''L�A•: �37'�•f y! Ya�_.__j'�.�r^_.
# . Page ( of
DAVE .STEAVENS
Inspection Seryces r
PROJECT�Jt s i - ►-aSE t 3 : PROJECT
ADDRESS`$S`Lr. 141, t' 31 t 3.-3 I Z :. CLIENT: �A:.WST I-y r4 i
66 4r, , �4a�c� t'S• � �1 w DATE 3.'.64Pt2(`�. aw0 2-
f BLDG. PERMIT-# ARCHITECT C,1DC dA A r2c,-4
ENGINEER c.� c� 0.1 S t� Jr�� =,J c CONTRACTOR L �^'' 2R c L
INSPECTION TYPE
INSPECTION REPORT
L v Lj. L J,4 L L.S.. JOA (L WL— A ►J-Jr• SrgA PP /A.)6 .;
i
S S SC 1�i=�S iA Jl i ��1 iZ Imo- U:T.. S 1' 1 Com: W Yr _ ►,� t.
Z+�M e, HAi?l(JAi2C
Co rv% l L-trr : .
iA
CERTIFICATION OF COMPLIANCE To the best ofour knowledge;; all of the reported work; unless otherwise noted,
^� substantially complies with approved plan's, specifications an'd'applicable sections"of.the building codes: This reportcovers.
Me locations of the worWinspected'only and doe`s not constitute engineering opinion or projectcontrol.
CERT0: S7 3 g'' C� _ INSPECT
R NAME ')
�� -14 J.E. a,: A .E% ' 1� g
I
_ NSPECTOR SIGNATU • ' � v.L. •
36 r ,j x . r� Y
IQ
4-1 A j c_ LOP^
.SrT�tZ �T_AZ A=� 13?3t 12q�
'5'4- 13 1 OAW N..sTA L C,�- tE Zcao 44 Y's'
_j<,) 15 W .i-1 LEU.G N LA
IRKr— -- 5To CN i M.at y 5 ` �J:r; eE`` e) M ; L> re-. 7 M A 12 cN' C) Z
CERTIFICATION OF COMPLIANCE To -the best of our knowledge, all of the reported'work, unless otherwi§e noted,
--. substantially complies with approved plans, specifications and'i pplicable sect'ons of, the building codes. This report covers
Attie locations of the work inspecfed only and does not `constitute'engir eenng:opinii or project"control.
CERT: NO. , INSPECTOR NAME
l
' eery) •E ..
DATE A PR I L -06 Z_ INSPECTOR SIGNATURE `
Page 1 of .1
DAVE4' STEAVEjNS=�
Inspection Se"r-vices
`J
,
PROJECT 6 A
f{
k: s i.,' P7N 15 E l� PROJECT ,# v 99 _ 0 3.
ADDRESS'S/ °-j q I
IS. -I, 13.3 117c( CLIENT
y O A'K {-I I
S L 'J Q c,'l �. �c A �1 I .l�' DATE' ` _ A Z i a 7
BLDG"PERMIT #
,-
L ARCIIITECT ' _C->�AA '.A ,2c w
ENGINEER�'��t, )_��
,= o, . z , ,,. " _ CONTRACTOR'=1� EL !'Yt W i2
INSPECTION TYPE
°INSPECTION REPORT`:
�w (L)A4_L�
- �.zaM�►�r,r ,Z J,J,sL;L,AT;o,.1 -�
�Z2,Lr-Te-
l4 T T I 5 —
S H E 'A .'L . ►J A 1 � ,.a [� 64` rJ �a roc % , — I
l� owe
36 r ,j x . r� Y
IQ
4-1 A j c_ LOP^
.SrT�tZ �T_AZ A=� 13?3t 12q�
'5'4- 13 1 OAW N..sTA L C,�- tE Zcao 44 Y's'
_j<,) 15 W .i-1 LEU.G N LA
IRKr— -- 5To CN i M.at y 5 ` �J:r; eE`` e) M ; L> re-. 7 M A 12 cN' C) Z
CERTIFICATION OF COMPLIANCE To -the best of our knowledge, all of the reported'work, unless otherwi§e noted,
--. substantially complies with approved plans, specifications and'i pplicable sect'ons of, the building codes. This report covers
Attie locations of the work inspecfed only and does not `constitute'engir eenng:opinii or project"control.
CERT: NO. , INSPECTOR NAME
l
' eery) •E ..
DATE A PR I L -06 Z_ INSPECTOR SIGNATURE `
Page
DAVE STEAVENS
Inspection. Services
PROJECT k A LJE ST PHA$ E' / B
ADDRESS S df -/y %, L371 /3.3
'6A HILL p'11A)s—
BLDG. PERMIT #
ENGINEER 1, JJ SA do tC S,1J c
INSPECTION TYPE EAD X y
PROJECT # �2 6 o 2 - o,
CLIENT _SGA Litzs7' H'o A
DATE l A PR #'L- a oo 2
Of
ARCHITECT &OZO.4 t! leGK/ T'eGT�c 2G
CONTRACTOR.L�"L M,4,< AAC_1ep1 L
INSPECTION REPORT
�L'. 'tiC_ lQLi4;Ie)J5 EYovxY 51M166 6J �i�'' C)kP. 7-o
140c.4!!�5 DtPT�q C_ l cwy, Rjec t5i-1 Ey A&26'., C4EA rS O t- c) a 2 ( S
PPL /C A T� O n1 A rJ .TtiJS T A [1 r9 i' iy ai "
A5 - P L 12 Z'65 y 9 4.S
Sy- l 141 OAk H 1 L r✓ %'�G 4'rJ 3Q '
0t��A2 t'.� r1 - l L�c - l►I
DC. E • l ;- tie rrH 1y.
I R ' Rob - 05
ED 3 • o� C.V�5 - �-ioLzS -
2 �i£t}TH 1 1�' A ,
i�ObS - '11 Le, *JG.T,-1 ��$n
� � A �
Sq— /3-7 OA<1HI"
A -Ad a49
.I
A E
hD� ���5•. S G£ 7
�l��l
Ale N -,41�1 ttkla'Q
_BCS ` Z -,t,7 LOL5 140LC5r��" PTCI r!' ��,g po 65'.k7* 4eAleo '/It
g/r�i i
�1` Q Tf2 - Lc�c.s• - .� (..�s 11 DirpTiq. 3lv)�b12y6 -1'5 L : 14 Ild
N .V4. I 14 ROt" t-7 Lcbt-,'-n4
�r s/ n
� R L �.� • 1 Loc - �cx� i !� tt'r"►-1'`3�`f t� �A: ?o�� /S LeU TH
3 - .2 c. acs - I-�u�r` S - w , �,.. /�_ . � (g v� �• .
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
( 4,e locations.of the work inspected: only and.does not constitute engineering opinion or ' *ecf control.
CERT. -NO. 03,513 �8 ' S .�> INSPECTORNAMEV lci�)
DATE l I �l� (L aZ��'• r INSPECT99 SIGNATURE