0108-348 (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
7331.13 t i?�. I% / 0°3.132Px(
Date` Signature b�,;,CCrsctl�d�t
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: t
( ) 1, 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)., r;
( ) 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&RC. for this reason
Date - Signature of Owner ,
WORKER'S COMPENSATION DECLARATION,
' 1 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 4
performance of the work for which this permit is issued.
I have and will maintain workers' compensation insurance, as required by
SeUion 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, t
• •try�ll.,Ya�l%'lr..�i!•il�'� ld3t�2t?�,F�
t ,
(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,
shall not employ, any person in any manner so as to become subject to thp.
workers' compensation laws of California, and agree that if I should becgtne
subject to the workers' compensation provisions of Section 3700 of the L'a'bor
Code, I shall forthwith comply with those;proyisions. ,.
Date:-': App!icant. 'r �r , � i i lI� ! : `• _ 7
•-War ng: Failure to secure Workers' Compensation coverag;6ils Gni Mu'Kand
shall subject an employer to criminal penalties and civil fines up to $190,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
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 tiff•
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
` It a • ,, �`sr r;
41414
lg
Signature (OL 1 �n�. ,! . , / .. , ,1, , h J Qd A1:,'bate''f J •<
PERMIT[ -^ �+� ' � :WjLS+x�h
PERMIT' -
.BUILDING
DATE VALUATION LOT U1O#i :�4TS c TRACT
{
JOB SITE
ADDRESS�i
APN
OAK HU.L
OWNER -
CONTRACTOR / DESIGNER / EN INEER ct�w�••�) s;.l;ti'
PGA WMT RFHIt Wf1AL ABSOCiAMN
DEI, MAR; PACMC ti'Mii ,CONT '!�0
PO DOX 1060 � - ' -
462 9MVM .AVB, 0302 U
LAQUINTA CA ''92253,
i�?IL�WABim')K �;F CAS'920x?S'.;�,g
�- •; -w
t0S�j75� 1540�� l�' t:��,Y5��3;k�-
;/yo - 'r"?yk f?rjjtl `t i. �6°1f.kkh
`tlfnOCAALd�OFi+'�ty(;R
USE OF PERMIT• - ..,
- M`l�i�FORMATIO1I 1p � •� ;�+�� i�-�i'a
• , 3 ���'�'r�r
'�►fi�rr
J\ 41•1.��J�p�r ' #�`;'•'i+
..
'i` IJ+�V61 •�1. �t7,f9.lWiil�Yl.'ly' a,•a F* 1C'.•,'�fi�
' � '.4, �1I-V ,'s'! �,yjt'i' ,! ;•� f1 'R ki yz{y�'",`,`l".� ,l k.
54-i4't,Sid"�'!.133 54•ttBO Nl1iJL,=�UILiD13dCi!
` 10C VOLU'NNARY 8TRUC'TURA,I; MOD11IGAZ IONg
•�*w
- - - t ♦ r-X,�'i *' :y"�'r ,'r �L o�'}:, ,�.t �:^^�� �7 ��'R•-w.. �7-�'cF-.i
y - r..! •' -!'� '73pt'. b,,, d -.; .+f - (t�?
• re r�5,t r ,c .;-'rri.
a r VALUATION1 � � �' 's � ^?R00b 00`1,
37
°s�
e&�!
.61
fiat 1
j f-
�t ••
-,?TIh�► e
Xglu"T.ED COST OF CiiJN5 i7G'liO1V'
x�\
�0 „
Parr t» UARY :
C/t 1413TRUCTIO)4 PEP- 10) tgD0.418.000. s
' `t
SMWO MOT104 BILL • RZ51 J, . t 101 -MG -2A I =(TOO Sx.00:
s r'
' - • �� • t�• e >
L
*,,.pf 3. roc. ��. .r�
D r
A;
{
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SUB -'91Y rAl, C'ONVIRUC110N• AUD III" C M
$209.00
11=1 M -PAW FM "
$0.00
TMAl., PE X F"=— DUE IiOW
$209AM
yy�'
REC�EIPL , :'
DATE
BY.;
DAXINq�E
I'
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
Part' Weil Firewall
Exterior Lath
Drywall -,Int. Lath
-
.=inai
Final` j _
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs It
Electric Bond
Footings
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
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure -
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMEN S:
j
Final
V
Utility Notice (Gas)
ELECTRICAL APPROVALS
O�
U/ll ,ola Da, 44W&,.1Temp.
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
ry
Utility Notice (Perm)
Y'.,,•,.5�t°.!>.??. , i > - .. e•Y.`'•i� �,.� Y'' -'� jiJ^ i � 1 'Ti+l• ts� �"_._' 1 ro a
_ . _-c-..�u• : �s„ � �:... �f� yT� ..a� �Lr� ��y�y �rt,'•ci ;,aFv�«�'-.�a,�{ .��s, �;�ss.�sx"�:e:•.St`--�` ,t..
} , Page ( of
k DAVE .STEAVENS
'. ..
m
Inspection Services
# C
PROJECT dbo � ►-aS c 3 PROJECT o
wtS"t E 3 i
.
ADDRESS'S`(:=' I y . 131. 11 2. ... CLIENT GA . uJ 'ST too A
6A t4r���`�c °IS ���1J w DATE 3:: i34P�2iF� : C;1
BLDG. PERMIT: # ARCHITECT G.,0 O R �4 02 crl
ENGINEER u1 l S i4. �x 2;,� CONTRACTOR 6-L /'''' A 2 'R c �,= L
INSPECTION TYPE
INSPECTION -REPORT
L � �j iJA'rL iJ?6.STa'A PP /06 --
em E
�'31 � ���=. - •C,4s-I'• •1' N �: • • ,mss � a�- W j'S
.a.
SSS Sc_►tcwSs ;.Au1 �Jc_Mu2 N uT`s — T vwt- ►.�t:�
FZA�•�, � \� N A -r? �) J A mac'• ..� IJ S rc_� �4 T- i c� �. - .�U �y L �T t
�a
S7" Z ►'t_ 2 y o Z
4•
CERTIFICATION OF -COMPLIANCE To'.the best of our knowledge, :all of the reported_work-. unless otherwise noted,
substantially complies with approved plans, specifications and.applicablesections of the building codes. This report covers
the locations of the work inspected only and does not constitute. engineering opinion or projectcontrol. .
CERT.NO:S��i'ST 3 �g- J .C) INSPECTOR NAMEi4iJE S Ayi j.y.
• DATE .� • ��L p?!%D L
INSPECTOR SIGNATUv-1..' '�
. .. ..y�....r•..-h 'yam. "!+' '`i'L• .. .,.. ..:.;5`: .+. •ri'9c«s,� 'icer., d'.,,�,;.Cu:e,'}e. d: i.ai+,'$' .. ., .. ,... .r. .. :',�
Page. of
DAVE .�STEA ' ENS
v Inspection Services
PROJECT"�A w sT •t7NW5� l� , PROJECT # d,c)-a
�__'ADDRESS'T.'i (q.( I2s-1 133 f 1 c CLIENT A
OAK fit e L ��Oc.*`L� Pc AO 10' DATE .1 AL, `.moo 2
R.
BLDG PERMIT # f ARCHITECT: -A ieC 1-1
ENGINEER'�,� CONTRACTOR .LD EG WrA i2
INSPECTION TYPE
INSPECTION REPORT
- C_4C2;. 6,.e T C
N�c i4ccIVcuT -Ti NZ �s��.
O -A I L ,:J t,. A t:2 _�Lo G Ii
C'ow► QL e r fw
j F_ Tk t L-!5 - 3.14 S - q - . Lp cil JAf t'r. eJ
.������,c_ — CSM J��T� - •
� �2 t2z.A1Z
1 M sa" ETP s
131 OAa! _ .STA `. 4-;r t • L3 0 'f4'fJ� -
i✓ZJ
SL. , oi.zs - I �E.� �.�� �:. '12:0 >= ..3.
554 - I q3 v- -S'� - I S 1 �� .1 1 � � r, • t. �{: .
IZia�: 5To�S AI CNIMaty5: �a°t_'�E �?m�t�f.L..� �a.g. MA2Cwy.Z
e
CERTIFICATION: OF COMPLIANCE:To.the;best'of our knowledge, alLof the reported work, -unless otherwise noted, :
-� substantially complies with approved plans, t 'ifications and applicable:sections of the buildind-codes. This. report covers.
'the locations of the work inspected only and does not constitute engineenng;opipion or project control:
CERT. NO. O53 S
-93-L/ R ' �O 'INSPECTOR NAME ?fE`�_E J A JEkjS
DATE APRIL .2-'0' C Z INSPECTOR SIGNATURE u r
Page of
DAVE STEAVENS
Inspection Services
PROJECT G A Lii sr - PNASc /-R-. PROJECT # c;2opZ-0_3
ADDRESS `S''t/ Y to Lq 71 /33 /ate_CLIENT ;)&A uJV_rs-r Hc, A
6AkH1U_ klfo to DATE I AM#L_ cPoo2_
BLDG. PERMIT # ARCHITECT 6OLOOr Ataw 7le-e-rkle
ENGINEER: lijj SAdb.,c -nic CONTRACT . OR
X 4..4c- I F1 C_
INSPECTION TYPE C)00)(Y
INSPECTION REPORT
(A I A —7 1e) EPeYY PS & J C)L P, 7 -v3.
aieuSkeCQ A&M CLEAN51 QJ= �)a P_ IV,
il PPL ICA _r/ QrJ A -7-&JS 7- A LLA. -ria., A5 P QZ ZC6 0 7
d11rq-.;1q1 InAiewiL.-i .4
. . prkwv( ./;L4bfl. , ef I
b 3- CP we -S - O'Les - e?-rVA b I'A I -A, OV S - I LE06T-4 A.
Tq- /3-7 OWN I c.c. PI-OAAJ
517
Te Q. A Ltx_5 o Lcs - '06 IbS K* LCLY77 P4elf R 6 1
Lr_
- �9 -1-1 0 * 11
!4
lecj) J*Z -,,7 WZ'Po 7' rAleo 7A4
_5 14.9 L
it
J 1%
�.eA-JZ Q. QTCa - -.1 Lows 71 1 i�P.T 4 Rom
JA)e5l- 1A It
c — po*CZ. - 1.2 jbt L C1JGT*4 U) t"Irk,
-b
T4 - 1-2.q = 04k t4 I LL WPLA&J. 3 4)'
rX
'17iI 31.- 1:51 CAJ(-.Tq .9 0 #A.
D5 7
-r,-4
jLoc-5-�ko t
CERTIFICATION OF COMPLIANCE: To the.b6st of our.knowleqde, all of the reported worik;lunless otherwise noted,'
substantially complies with. aporoy6d'plans,L ications' -and applicable sectionsofthe building codes. This report covers
e locations.of the work inspected only and does constitute 'engineering opinion or project control.
CERT. NO. 3
INS'PECTQR NAM
CIA E
DATEej
-
i L cv. �ov: INSPECTOR SIGNATURE E