0108-347 (BLDG)LICENSED CONTRACTOR DECLARATION
I'hereby affirm under penalty of perjury that I -tm 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 Signature of Contractor l 1 4' " (((-''
OWNER -BUILDER DECLARATION
1't�er"eby affirm unde�`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).
( ) 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&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.
,h 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.
Carrier Policy No.
CAL Mis0011TY W3062174A
(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 subjectto. the
workers' compensation laws of California, and agree that if I should,becoma
subject to the workers' compensation provisions of Section 37.,00` of.the Labor .
Code,;I s all orthwith comply with those,provisions,-
Applicant%! .. I! If / �•,
tlParnmg: Failure to secure Workers' Compensation coverage is unjjWful and
shall subject an employer to criminal penalties and civil fines up to $100,000, 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
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owrie0Agenty `2� -• •f / Ll.: Date
BUILDING PERMIT PERMIT#
DATE J VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
P -0h. Wlf;.TC ;da ODEWItAL M-30CIAMR
I:s1 . Mit PAM. C.' WREML LOWR ACT.*OR'
FID WD3a I W
462 !'I'.�'�J AM 0302
.Uk COVIN A CA 92253
SOLANA BEAM CA 9207.5
(858)797,-1500 MIR 5 823
ION
£x C.'AL O"WE INFORMATION
USE OF PERMIT
C1313RIM PL
Pr�e•ld1: � Q--g�F� Ric,qij.11s64Wir54..,i3rif4J�r`�,.k HILL, 4 14, TYPE
.s3pIIJIL,J.ry�M[U
ddi.• *1"V�.fSY Pd�R IL5�.7 13 �1;�,V�.Yb W�16k1A�!Y3�L'.I�WvfT.�dV�13
VALUATION I's
- - 7.frt�'rWIX (110g �" OF svMITSI UC-1'�0N
2IP4".00 -
�y�y �ycy y��t�r�7 g N
P?'..4S.SY'.RY Ji' P JiL711 l�J ii: owz .7,
CON 1'RI,?(;`3 Y014.dr'E1: '301-000-410-41" MUD
STRONO MOTION tom.. RESW.._ •101-000-241-000fA
s
SEP 10 2001
CI y OF LA FINANCE DEPTQUIN
S B-110TAC, �wG?.#°iJ4�iiT its i3.A � PI 42 "`
$209,00
LM I'',I01•PAW TIRES
. W
` " AL 71 E "st OkEr YXTE DUS HOW
$20S).00
;w•
RECEIPT
DATE /
/; /
BY
DATE FINALED
INSPECT R
yA�
o
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 i
Party Wall Insulation
Condensate Lines [
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i
. t
i
Final <- '-..
Final
POOLS - SPAS
BLOCKWALL APPROVALS
{
Steel
Set Backs
Electric��Bol d
Footings
Mairrt-Drain ti
Bond Beam
A "royal to Cover l
;:^x
Equipment Location f
Underground Electric [
Underground Plbg. Test [
Final
;;a;, 'Y �;4',
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final j
Waste Lines
Heater Final
Water Piping
Plumbing Final I
Plumbing Top Out
Equipment Enclosure {
Shower Pans
OX for Finish Plaster I
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation I.
Gas Piping
I
Gas Test
Appliances
r
Final I
COMMENTP:
Final
Utility Notice (Gas)
l
4 1al42"
ELECTRICAL APPROVALS
'� �" r—
Temp. Power Pole
Underground Conduit
1
Rough Wiring
+
Low Voltage Wiring
j
Fixtures
1
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Page of ;I . ....
PROJECT_
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.ADDRESS. Je 1(aq -IS 7 CLIENT L'�c.ST raa . t
Ok&i B L e- 1il' Y AAJ It DATE d`7 t"o4WC_k--;( 02.0cl Z_
BLDG. PERMIT # ARCHITECT GgCbA
ENGINEERCONTRACTOR C_ MAPt C_ F(r-
INSPECTION TYPE je7PO XY
W SPECT
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CERTIFICATION OF COMPLIANCETo jk6.L6esi of our knowledge,all'._of'.the reported work; unless 'otherwise noted;
substantially complies with ap'p'r*ov"4'id.'plans, ,'specificA'tions.,Ari'd'dpolic-6ble sections of_ the buildii I i port covers
g codes. This re
-and:dbes g
the locations of the work, iftpeictedonlyn6tbons constitute e n' g-ineenn opinion or project control.
Q r1
CERT.NO. , ANSPECTORAAIVIE�
P" pwrty r
INSPECTOR SIGNATURE
DATE 02 `7 14: aoz..
A:)5
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Page _ of
DAVE:STEAVENS
M . ; Inspection Services
- PROJECT f U�aST .W ,SC i 46PRO'JECT '# oZyO 2 -'p. 3
.ADDRESS y CLIENT W-t:ST vfy
DATE � ..� �''� &Z C,14 ;Lo 0 2.._
BLDG. PERMIT # ARCHITECT two L'6r4 ,4►2Cu
ENGINEERj,, A) CONTRACTOR'S � L. rn R -
.INSPECTION TYPE
INSPECTION. REPORT
n
.,. �.y x'14 � .Z �.� ei l 1 �:O'� - ��11�d-�'11.L �P"L'/4� • �—���a � � �
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(110 Alt
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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'-ec ions of,the building codes: This report covers
Ji the locations of the work inspected'only,and does not constitute engineering opinion or project control.
\.
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CERT. NO. S / �g ' S INSPECTOR NAME: 4A• 1t: ✓ S
DATE J9 /h A e C/^L INSPECTOR SIGNATURE A _ .