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
Date' , /-r iF� ' Signature of,Contractor•"-•�f / f 111d.t
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: 1
( ) 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 & Professional's Code).
( ) I, as owner of the property, am exclu-iively 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.
(./ ) 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:
Carver my 1 7 9 ;y Policy No.
(41,L N3062
7e
(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 to the workers' compensation provisions of Section 3700 of the',L'abor
Code, I shall forthwith comply withfthose:provisions. U , „ f 1/ r
Warning: ilure to secure Workers' Compensation coverage -is 6nr wful:and
shall subject an employer to criminal penalties and civil fines up to $1 0,000, 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 cf 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.
Signature (Own.e6,A64n0i1a �' �f�i% - :-Date`/
BUILDING PERMIT PERMIT#
DATE ' VALUATION LOT 43,il"1AtBf7 TRACT
JOB SITE 1 "^
ADDRESSOAKH�M
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PGA tlFAM REMI►1,A 83001KNON
DEL MAR, PACIFIC G&NIMAI, WNMR—AS' TIR
�O.4a�CJ.SC ? C
462 MEW -145 AVE. 030 ,
I:.AQC311.11M CA 92253
SOLAMA. IMAM CAS 9205
LOCAL OFFICE INFORldfA'I'ION
USE OF PERMIT
MMCIA'[.f3.MEMS
73.16€4 ST. CHA WAS PL
54432 4, -A-129 OAK . BtJILGING l i, 'I''v'ti`L
.i3:VIA,
100VOi,lPI9'ARYST UCTURAJ 6fiOd.)I.i<I'CATIONS
VALUATION I's
EMMA= COUr OF SC:ONFrRUMON
201Mi -00
Mfff FERMT&WARY
C07h3ITHIt1'iMOM FEE 101-000.418-000 S'a'tf7.00
"! 7 5> 4 itr50 I'lC7s�i l�F 1tL:li1�.. 101-OC1Cir-241-000
rSEP 10 2001
NANCE DEPT.
-;lids-'TO A I, CONSUR`il'MION F►91) PIAN CliLeCl:C
U09.00
LESS YW-PAM 1I
$0.00
RECEIPT
DATE 1
BY
DASIN4SE `
SPE R
9,1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
'INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts t
Forms & Footings
Ducts {
Slab Grade
Return Air 1
Steel
Combustion Air [
Roof Deck
Exhaust Fans [
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents I
Fireplace P.L.
Grills [
Fireplace T.O.
Fans & Controls ' [
Party Wall Insulation
Condensate Lines t
Party Wall Firewall
Exterior Lath��1(�f
Drywall - Int. Lath
[
{
{
' t
sinal
Final _ _ _
POOLS -SPAS
BLOCKWALL APPROVALS steel [
Set Backs
Electric Bond 4
Footings
Main Drain
Bond Beam
Approval to Cover I
Equipment Location - [
Underground Electric 1
Underground Plbg. Test l
Final
Gas Piping [
PLUMBING APPROVALS
Gas Test [
Electric Final !
Waste Lines
Heater Final {
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure 1
Shower Pans
O.K. for Finish Plaster 4
Sewer Lateral
Pool Cover [
Sewer Connection
Encapsulation I
Gas Piping
[
Gas Test
Appliances
[
Final [
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS �
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
I Main Service
1 Sub Panels
Exterior Receptacles
I G.F.I.
1 Smoke Detectors
I Temp. Use of Power
I
I
Final
Utility Not (Perm)
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DAVE - STEAVENS,
Inspection- Services
PROJECT 4e. A O -E ST — PYAS C 4
ADDRESS I32
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BLDG: PERMIT #
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INSPECTION TYPE CAVY
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ARCHITECT 6_�040.4 AtC_s41T-&'e_7'k1C
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INSPECTION REPORT,'
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge; all of the reported work,
rk, unless otherwise . noted,
substantially complies with- iporoyed"plans, ppecifications'and applicable sections of the buildinig codes. This report covers
e locations of the Work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 3 713 5�0-k,'. INSPECT911 NAME
`DATE 4 A Ple l L INSPECTOR. SIGNATURE
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Ins Pon, Services
PROJECT P U.) t-s i - �! +-SSE ` l 3 PROJECT # :. - 02,0
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CERTIFICATION OF COMPLIANCE To..the best of our knowledge,, all of the reported work, unless otherwise noted;. .
--1 substantially complies wifhlapproved plans, specificatrnons and applicable sections,of the building codes: This report covers
the locations of the work inspected only and doesnot constitute engineering opinion or project control. .
a. .
CERT:-NO. e—:S `7 -3 �S -Jy ^INSRECTOR N1AME� . V E A oiT
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DATE INSPEC rOR SIGNATU
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Page of ,,,� I
DAVE.: STEAVENS
F Inspection Services
. ,PROJECT a ' t?N ws t /� PROJECT # v`y: a 0.3
;ADDRESS=S (1-'d 1. f'S1; 133°'11.q CLIENT
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`:BLDG +ERMIT'# ARCHITECT _ C- ol_,6A :A le C i_4
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-.INSPECTION TYPE
INSPECTIONREPORT
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CERTIFICATION.OF COMPLIANCE To.the:best of out 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
the locations of the work inspected only and does not constitute.'ehginep'nng-opinlon;.orproject:co_ntrol:
CERT. NO. O 3 5-91_6 R O' INSPECTOR NAME' 84u
' . DATE o2 /APR 1 L20,02_-' j :.. �r . raeanY)
INSPECTOR SIGNATURE'. r `
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DAVESTEAVENS
In,nspection Services
' PROJECTP1., A Li ST - 71f4 A5 E t l?, PROJECT
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,•ADDRESS ' (�C OGS //- / S- fi. CLIENTS i,J ST 1-t or4
DATE RAL 0100 Z
BLDG..PERMIT # ARCHITECT_ 66&L�M A&cw
ENGINEER L,-" SAI o f '�vJc. CONTRACTOR. . NA c ►
-' INSPECTION TYPE
INSPECTIONw 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 of the building codes. This report covers
_)the locations of the woik inspected only and does not constitute engineering opinion ocproject control. .
CERT. NO. OSS 7 3 T15 ' S D INSPE SYCTOR NAME �' J �� 2 �4Je
DATE - �I L OO' ;INSPECTOR