0108-347 (BLDG)I hereby affirm under penalty of perjury that 11m 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.
Lirense. # Lid. Class Exp. Date
Date L4 Signature of C6ntri W, to;, i
OWNER -BUILDER DECLARATION
I he e a Irrhurn Foenalty of perjury that I am exempt from the Contractor's
License Law for the -following reason:
1, as owner of the property, or my employees with wages as their sole
compensation,, will do the woirk,;and the'strOcture is not intended or offered for
sale (Sec. 7044 Business &.Prbfessionals Code)...
1, as owner of the, property, arn`exclusively contracting with,
Iicensed
contractors 16.1consteuct 'the project (Sec. 7044, Business' & Prof6ss.ib"nals
:Code).'
'am exernpt'�'under Section 'B&RC. for this reason
bit
Signature d Owner
WORKER'S COMPENSATION -DECLARATION
hereby affirm Under penalty - of.rlodrj6l ry odd. ' of the following -declarations':,
11 rtifi f
-have and;'will maintain a ce cate.o consent-tobelf-insure.for workdrs'
Compensation, as: provided for by' S6ctioh'3700 of the Labor -Code, for the
• performance of the woik:for which thisperm it is. issued.
Ihave and.Will maintain workers' Compensation insurance, asrequired by
'Section 3700 of the -Labor. Code, . Jor.the performance of the work for . which this
permit is issued,, My wpirkers"compen.sation, iniu'ran66 carrier &:policy -,no. are:
Rl
OICY 0.
(This.section need not be 6ompl6ted.if the -permit valuation is for $100.00 or fess).
:pe ormanc - 'Ofth rk4or_.which'this permit is issued.,
, e e work
:f,I,s'hall not -employ: ',a'ny tO7 be, come* subject to the
personAn any manner so as
,workers' ccirhoensaiic)n;'i'av�§,bf;6il'ifomiaii;and-agree that if I should,bedome,:1'
'compensation provisto I ns :.o '6tion 3
,SLibjkll to the Workers" f Se 700 of the: Lab6)r-_'
odiij rs aill'orthwith-bomply vAt7 tho*s`e^A)'roviyibns
'ApplicantL44
Date fJ
arhing: Failure to secure Workers',Cornpens.ation coverage is 66.(&wfyl and
shall subject -i6bjelcta6'e'm'p'lo'y:erto;c'ri-mi-nal:oenalties�;�6d bivil-fines up to $100,000, in
'addlilon',to'the'doist o'f,compensation, damages "a-s'orovided foe in Sectio'n 3706
of the Labor Code, interestand attorney'd fees.
°IMPORTANT Application is 66reby-made to the Dieector-of Building arid'Safety
for a permit 'subject: o 'the conditions and -restrictions set,forth on his,
"app.ca ion. -
1. . Edch 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 applicator agrees to, &.shall, indemnity
& hold harrnless,�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.
A
Signature (0WnaVAgek?-
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
. ()AX Hall,
OWNER
CONTRACTOR/DESIGNER/EN INEER
PUt. WMTV R"DENTIAL MSCKIKHOk4
MAR PACITIC GENI'KRAU CONT
Vi E #'02
1,& Quam("Ilk 92253
80LANA B�.XN,7fl Cl% 92075
(t.*�5 (6)l 9 Z - 15; 0 0 031)1 5823
USE OF PERMIT
3, ci's K Inu. i-4 14, 'rYPF,
VALIJAMN. v%viaw I -s.
U%1ATE'D (XW:H)Y (X)1'W1J?.VC-T10 .7
C()NST 11 VIVI) U14, YKE 01 -( 00u4 1 C- - (W)1) S6,40
STRONO MOTION RE - RESK). '10149)044 1 -000,' 2.0(t
'SER10. 20 0 1
CITY-OFLA QUINTA
FINANCE DEPT.
$209,00
WI -AL BOW
M).00
RECEIPT
DATE - -j
BY
DATE FINALED
INSPECT,0AJ
IT
L - 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall '
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
sleet
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
FI Fr.TRIC_AI APPOM/AI C
COMMENTL.,
Ci "'
a
Page ( of
-DAVE 4STyEAVEN:S
Inspections Services
PROJECT �t,& A S.0 - I4►4s� `• c
ADDRESS 'S-' 19 3, I g / l l�; q, t z7 7.
OA04I L:L. S cL)c_ 'd/ y ?iAy II
BLDG. PERMIT #
ENGINEER %+- .] S A. 'o r C _ iJC_
INSPECTION. TYPE"- j O X Y
PROJECT
rd
' •CLIENT, 4 & -L.J zs-r- ' r-1 c)
DATE' o% '% w1 A 2`Lrr c>u Z
ARCHITECT -"Gac 6A- -A (I c.�4 ,
CONTRACTOR D C AYl A 2 PPA'C-
.INSPECTION• REPORT
- I Ij C� 4-c-) CA faJS x -Y r►mdSotii art: Az3-?v37�
HaL 6-5 DEPTH CHC Gees )• .aRctSN� ti ,.'�1 rJ:i� C'LEA aJ .�EE3215;,
L1c.A��Oti1���—r�STA'c-I:ATtn� AaG:d�
S q 0Akl14:1 L_L_ r " rpt O
Qo'f'74
L� —t3 /
(��eAR SOTr-� LOC -5S - I-�v�cs.' /� ,D S ..3/�" ori ,• ,. �5 _ �,.�„ L cAjLTH S '
t44ED"e1 o1Lr�cs - NOg.c. -:�t2 fle�t�-t �'' po", l r,�EU(1-rH /8f, ,A
G 17 a - oZ LoeS l-ioSi� 1�e.PTN l��A -Robs (7 L�►J�'i�-► /�, �►A
a vZ C, e o -r c= t2 - A L u c S:- 14 U;,G b4,. rizD 6 S t S c. t Vyl ti -1
S - 1G PL -A. �►, I..Q
(-(op. cca/B
5 `f- ISr7 OAKN ILL }�LA,►JJ . c ,:(
3414a �vc5'TH .lyiA. v�j'S - 7 L,tA 4.:� k-!
*T-_1Aca; Lf'y jido-rH - qP Lo CS - /46L� -,/Z .IycP.TN 31
14
:� D.��.. Rpt: -:15 /�.wS�g,10iA
*R,i'Ra L,J5��,:�a r c .s —�/ore:- la ,D .�i.-t ,1 ��a r2v�. 1�' Ls_J X8 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`constifute engineering 9plrnon or project control..
MERT: No: INSPECTORrNAME, �' • ' '� Sip' �tJS
�i •
DATE / f%% 12614.. o�UO.,INSPECTOR SIGNATURE, C S�i`1 aim AJ
.•
1' < r : t/. • i .:11..,`(�ib4��i u .A`itTf �cfl> �....ii'�"iC'.r'�'TR. 'lith-+`ii.'�+. .. � ..F.i. ...i-�'Si Ate... r • ';.laf"': �.. ... ..
Page of Z
DAVE STEAVENS,
Inspection, Services
PROJECT, &A- hT:E ST - 0 v4-
PROJECT.
t ADDRESS _CLIENT.`G�' t.._i.ST t-1 cwt
DATE ' i2i t:
o2vo 2
BLDG. PERMIT #
ARCHITECT ` -OC -aM
J4
'ENGINEER SAi 1 o-1
c Lv—)c- CONTRACTOR .Z CL
MA k NA c - r r fe
INSPECTION TYPE
INSPECTION. REPORT
5. = 143 /81 /fig, r S7 0,4 K/ LL ,. �.0 /.'-/
f�c,g l / 1
C., ra` i7, L0 C-1,1
rJ A Lt
e--
L.0 J Uj A cam- ST C
1-} a i TI c5 r tiZ i�yi of G.. r'� tic -+..1'►) w �A - 36 S L ?r �t 5 L-
�.---
0oM.it-STN
k4j4 S PrA /z
!X - a -- 7)e lw
CERTIFICATION OF COMPLIANCE To the�best'of:our knowledge, allpf'the reported work; unless otherwise noted,
-� substantially complies with approved plans, specifications,and applicable sections of the builtJing",cones. This` report covers
the locations of the workinspected only 'and does riofconstltute engineering opirnonyor projecf control.:
CERT. NO. 5 7 3 S h INSPECTOR NAME `" �> u1
DATE�—_, SRI L DOk INSPECTOR SIGNATU R