Loading...
0108-347 (BLDG)I hereby affirm under penalty of perjury that I -im licensed under provisions of Chapter 9 (commencing with Section 7000) o1 Division 3 of the Business and Pr,ofessionals Code, and my License is in full force and effect. License N Lic. Class Exp. Date Date ' ' `,�" Signature of ContraEtor OWNER -BUILDER DECLARATION -" eere6q 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),. ( ) 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 704,4; Business -& Professionals Code). ; O I am exempt under Section B&P.C. 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*37.6 of the-,LaGod' for ahe performance of the work for which this permit Is+is'sued. I have and will 'maintain workerscompensation insurance, as required by ection 370Q 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 !l�li i th's°la s1" f1J0 174A (This°section need - not tie completed If the permit valuation is for $100.00`or.less). O I certify that ih •the performance of therwork 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'Callfornia and agree that if I, should become subject to the: workers' compensation provisions of.Section 3700 of the. Labor Code I s0all jjorthwlth;comply with those/prows!ons. Date +f I s l APPlicant G�arning; Failure to secure Workers Compensation "coverage Is un(Awfuhand ,.:.shall subject an employer to, criminal penalties and civilfines up to $100 000, in addltidmtoithe 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 p'ursuant.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. Signature (Owrier)AgelSt)' •^� ?� i !� iDate ZE WILVINU IJLKIVII I � DATE .:� ' / VALUATION- LOT t)1.�l�1-;i6C'� TRACT JOB SITE APN ADDRESS 0 A:1i.1 ff. J., OWNER CONTRACTOR/DESIGNER/EN (NEER M. Wlti.rl' 4?:[:«;lt): tJ' LE,:� �� C.r:°1�s'i'i�!PI DEL 1AA'K 61; :11ER..AL, l;ON'!'KACi:rN 105 a �N l tN i1:511f;"ZX iC I ..1_ f7.l �,li �v i(�. (.'A u2&) ('tstiis}792.1500 (1710f 5821; USE•OFPERMIT 1.fit":.r"e?. C:i�E�lt"I! iltltt.:iE*;fRa,'lfi�iYd. :�41i:;C'l��;i.�:.i•11�:';'f;kf� :rs..lni➢J'!. C•i:J!?�`�.•N:S;�I: -- ._ 56E:I1t:1ti, "�til, :��.•:icry �k�k�5�rit.fa,'•:.t?;t,t. � ut.tit:ziir;Ct:ll;, 't'"�';�h; fit:' `1 t:,t:t't!'1`r°bFt`f ;;+'}12 U!"t'l6{'{d11; 1�tf73.i1u11.'hI'1i.%PtEi .. `J .PS 1.•fJ%'!��%1.1)v A;CF, IIIlE), (it•� }.,a) . i • f.,�:L:R��,+?t"F'.�:�:s . �!�z��b' ca.S;' c:° ,:1@ 4.i.`£L•I tr : `f`TC.)1^1 i ;?2),tn"si,�.83it . '� �tv�a,:1 i`C ! Il.at 1 f't;I: '3 i.11 �()C,iC)..'t i C� (++ �:) •fi41+x.00 ._.,:.;ii'c:,t;t'3 t�hC)�ii;"►Id IT:k? •- k.I:5tl:.i.. lY:fl�(,i;/.').;��$I-4?4rq). �� $:«.00•.. BSEP, 10,2001 CITY OF',CA_QUINTA FINANCE DEPT. 001.1 AM.)1'Y..h R }_`1AYY.'1rX. S209-011 `lXY P'.AL k'KldIV 171' 11.71i :t3 UE .N OW r $209..00 RECEIPT DATE, / BY DATE FINALED INSPECT7R7 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 Final BLOCKWALL APPROVALS POOLS -SPAS steel 1 Set Backs. _ Electric Bond j Footings Main Drain Bond Beam ' Approval to Cover Equipment Location Underground Electric Underground Plbg. Tes; I '� Final Gas Piping �— PLUMBING APPROVALS 1 Gas Test Electric Final 1 Waste Lines I-lea'.er Final i Water Piping Plumbiaa Final i Plumbing Top Out Equipment Enclosure ! Shower Pans _ O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation ��— Gas Piping Gas Test Appliances .. - V Page of DAVE STEAVENS Inspection Services PROJECT �& As : - N t4s� PROJECT # oo1 - o 3 ADDRESS S''/-19 3 �, / g / • 1(.q 14/67 OAKHIL.L ScO`z'lY AA►J !1 BLDG. PERMIT # ENGINEER`bv---tJ SA Jo r C -= k1C- INSPECTION TYPE i7 PO x Y CLIENT ;�e.R t.,)ZST HpAt DATE -d"7 M A 2 c.P4 -yu Z - ARCHITECT G04 -6A A (Zcv4 r CONTRACTOR DC(. 1y1r 4 PALI r (L. INSPECTION REPORT L-ocATev,,JS 4PaXY Stmoo5a,f rt TF, r*=zP. Y03 -7d 376 HoL s 5)EPT# Cf -IC CKk 1), ZeaSj4eb ,, A'0 b C LEA rJ ®F ' •6EA0e/S , Sy- f9',. q ,.I?;cA So "T" Lttr - LucS - 9(,)LCS- l.1'r.DC7,fTH 5 3/y„ DtA .Roos - )-!5 J "4CLT+-4 �g s/�, rr "4 a JLo(.s - JAOS&5 - �� bC".-1 D,0 , tubs- I t -cu (.Trl B -brA . "7 rt CD :2 oZ LocS 0Lt: S ePTHI�abS- I "j L-Cig(-7�.t �LAa C V-0-rC(Z - .1 Lug -'S - 14UL r -S ' t "j)CPTt-1 -344" b t; . -14 0,5C M ilgr+�r� S 4- 1ig q Uri hC H 1 LL P L.A rJ 1 Q S'f- 15.1 0AKNPL_AKJ c4Q. V, � r r „ 3 a - Lvcs f -f vL.s'- /2 JtH 1y(A< 3 t� „ 5 r, *t2 ACL. LIV IJOAXH.- 0 LO CS ` l-�DLZ - /2\ .L)C PTN 14 Pt 0'. aDl� - 15 L�y�?r( 7S oiA rt ' 1&oka L,J `5vt-:VA I LoC.S _I-loLCc • l�.D�PTH (rt �rA Om. ��r L�tJL'7j•l 'lid D, A., 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 work inspected only and. does not constitute engineering opinion or project control. % ,CERTNO. ©L� 57 -3 � �✓ - Sy INSPECTOR NAME �/7"J ���14d ajs ` (Print Clearly) NATE 07 "/y %�� �G%i �UC� Z� INSPECTOR SIGNATURE INSPECTION TYPE o W A L.. 'S SNr;A2 .:,^ �4 I L t -464 A �Jy . S-�`�e-A P -PP, 132 / 3 -3 y A-iC /-L- L L � M t 1j .,' r� ty z � - ,or 40 CERTIFICATION OF COMPLIANCE To the best of our knowledge, all of the reported work,unless otherwise noted, ,. ----,substantially complies with approved:plans, specifications and;appllcable sections of the building codes. This'report covers ,... the locations of the work inspected' only and'does not constdute,englneecing,opmiori or project:control::. r CERT. NO. OiS 3 g Q INSPECTOR NAME �J ti *t /fr✓� �, . DA'.E�- �R� L OQc Z' INSPECTOR SIGNATU