0108-346 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of p6fjury.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 ig in full force and
uvm�e# u�om, ' ' Exp. Date
Date Cohtracior
. .
DECLARATION. ' .
lhereby affirm under penalty 'of perjury thatI am exempt from the Contractor's
License Law for the followin6��eason:
1,as: owner of the, property, or my �employees with Wages. as their sole
compensation, will do the work, and the structure is not inle7nded or offered for
sale (Sec7044, Business & Professionals Code).
1, as owner �8f::the prop6*, am exciusivbiy co-itracting, with licensed
contractors to coristru . ct the p�oject (Sec. 7044, Business &, Professionals
Date Signature, of Owner
I hereby affirm under penalty of perjury one of.,the followihg'declarati6ns:
compensation� as provi�ed;lor. by Section 3700 of- the. Labor Code, for, the,.
perfor 'man te of the work for which this permit is ded.
lihave-6ndwill maintain'w�orkers',com'pensition insurance, as required by
Sectiorf 3706'bf ' the Labor.Cdde, for.the performance ' of the work for which this
Carrier Policy.
(This section need,,not l3e!6ompleted if the permit valuation is for $100.00 or. less).
I certify tha I t in th;'�—erfdrmance,oi 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 Calif8mia,' and agree that . if I sh I buld become
subje6t to.the workers' compensation provisions, oPSection 3760 o.f the Labor
Code, I sh�ail forthwith comoly with those provisions.,
WArning: Failure to secure Workers' Compensation coverage is�unlawftil and
shall i6bjd6:t_3n-employer'to criminal penalties a , nd civil fines . u , p 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-tomeDirecto,of Buildingand Safety,~
for a, permit subject to the conditions and restrictions *y forth on his
application.
1.Each person upon whose behalf this application ismade & each person m
whose request and for whose bepursuant to
any permit isouedosa,aauxmmioappnoamnag�ooto, a shall, indemnify
& hold harmless the City ofLaOuinta. its officers, agents and employees.
o. Any permit issued as result of this application unnomoo nun and void if
*mm is not commenced within 180 uuyo from data of ioovanoo*of such
ponnit, or cessation of work for 180 days will subject permit to cancellation.
| Certify that | have read this oppicahonand state that the above information io
correct. | agree uocomply with all City, and State laws relating tothe building
oonotmohon, and hereby authorize representatives ofthis City menter upon
the above-mentioned property for inspection pum0000�
/ ' ' '
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER EN&INEER
USE OF PERMIT
IFORNIKYK
E Op 2001
� =1
CITY OF LA QUINTA'
FINANCE DEPT.
RECEIPT
DATE
BY
DATE FI ALED
INSPrCJOR
1i It
1�15PECTION RECORD
OP p_;1'1t!GN _ ! —� 11"ATE
LrINSY_CTCP
OPERATION
� DATE � INSPECTOR
�:: t» :r 7 ! `1 +� �•� : ;'.'�.�i i✓
�.' lea s. �
MECHANICAL P V ALS
_--_--^--__-- i
Set Backs I
1
—
� ; 1ind_ergrcund Ducts
-~
_
Forms 8, Foc mcs —j
!
---- 7uct'
Slab Grade — r—i---�—
-- --r Rzturn Air
—
fS;� w1
Gas
'F
—
i Comocstion Air
..lacl:OX
'.Vrn
t �r.^,C;r'C} tCaO:.t
!{
to c
t?Enclosure
L.�—`--
j r%!; ;Cf Finish Plaster
'�
1 :•ren :,,t�:ra!
-- -----
j Framing
?^�i Cover
Suver Co,r- -za�n
f
Insulation
— �---c
------
----Y�—�
Fireplace P L.
{ ,-nils
I '
%irep!Cce 70 ?
t
i :ars ContrcIs
—
i
�r&rid
! Final
COMMEN IS:
v �� pn </��,�X�f� ✓ 0a
lir V� v`
�C
J
/ 1/0j /w
G
saV-- neti
--�—
LFinal
I 1
—
i int. ! atn
—
----_ _�. —
—_— — . ---
Underground Conduit
Rough Wiring
Low Vokage Wiring
1001
?nal
�—
PCOLS - SPAS j
el �!Vuxs
3oad Beam
iv _—_..........
cover
Plba. Tes
-as p -Inc { 1
Gas
'F
t �r.^,C;r'C} tCaO:.t
? J :c'•s8r Fans v_____ __.`_.._—_--
t?Enclosure
L.�—`--
j r%!; ;Cf Finish Plaster
'�
1 :•ren :,,t�:ra!
-- -----
?^�i Cover
Suver Co,r- -za�n
f
=nc, csuraticn i
Gas P?cmo.
----Y�—�
Gas `est
Ices
{ -- --
—
i
! Final
COMMEN IS:
v �� pn </��,�X�f� ✓ 0a
lir V� v`
�C
J
/ 1/0j /w
G
a
LFinal
j Uti{i#}' A(otice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vokage Wiring
Fixtures
i
Main Service
Sub Panels
Exterior Receptacles
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
e -' •. O ,-. ...o. •a4 .. .iiC v. v,a�'-TAsi.`;✓�+C4-.r�`.�E....ryh-:�.;3Sexma, `C.T--4^--.-.
Pageof ;�..�.
DAVE STEAVENS ,
.. ._,11 ` •41'1''_1. ./ :• r. _ .
Inspection Services
PROJECT IT. & fl PROJECT
ADDRESS =��1'I :� �9'. 2 1 ?'. 2os CLIENT�A' uJ EST' tr-1 o
QA
-PLA-0.9-:' B[OG 3' DATE dl',r
BLDG. PERMIT #ARCHITECT . Go L$' ok .. A 2.C-H
ENGINEER "Ib U:4a SA J O t �2. =,sc.- CONTRACTOR CL.: w+ A & . " t?A c A �= c_
INSPECTION TYPE
INSPECTIONIREPORT
r'-t Aj L y ,"
A—rrtLg.— -'---A4e-NZ J A 1 L I Q (� A &3 l# Z �ocll N A
.
r
CERTIFICATION OF COMPLIANCE To the best of our knowledge, all of reported w1.ork, unless otherwise noted,.
substantially complies with"" plans, specifications and applicable' sections'. of-the.,6uilding codes. This report covers
,)the locations of the work_inspected,only and does not constitute•engineering opinion•or project control.
CERT. NO.'S"4 INSPECTOR:NAME A J.E�A f%S
DATE 077 /i'1 A2G 4 ota `Z INSPECTOR SIGNATURE
:., p x. �r •., c • �- t su s3.,i: wrJ. . a Z;zx4s•av,:a
0
page of ;Z,
DAVE. STEAVNS
Inspection Services:
. ..
PROJECTPGA w�ST -.�N. +�s� f 'PROJECT I#-%260,2 -co 3
ADDRESS ,S'y-,:241F'aack, A. , ayS - •CLIENT AA4-A.
CAk 04 i t L � c.�� "r3 ��A.J �� • DATE. X i+ ,4.2cs4 41 o
BLDG. PERMIT #-ARCWTECTC--,o 4&A A aCH ,
ENGINEER ui,J ,.1 S-A Jot E: T'j L CONTRACTOR .4 4-4 ol A 2 P.4 a rt C
INSPECTION TYPE.:.� :�,,
INSPECTION REPORT -
C, TA
f.
CERTIFICATION OF.COMPLIANCE To the best Ubur, knowledge, all of the reported.work .unless.otherwise noted,
-1 substantially complies wit, approved plans, specifications and applicable sections of the building codes. This report covers
the locations of the work inspected'only and does not constitute..engineenng .opinon'or project control.
} y.
GERT NO. 40951/ 3TA �O INSPECTOR NAME E<i�-F—A l%4—til�
•: .. •, 7� - � � �:-. , c �e iM Cleary) .
DATE Al A 1Z C 1-1 000 Z INSPECTOR SIGNATUREL`�
�oii
Page Ar,
DAVE,STEAVENS.;--.-.-.-
I ection, Services
nsp
PROJECT
ADDRESS'�'14 -k k -1-2-9. 2XI. 'Z o T
QAK"��l LL; LAQ 9
BLDG, PERNUT #
ENG NEER. k,. -W
INSPECTION TYPE
7'�Jc-
PROJECT#
:aoo2-0-5-
CLIENT
NoA
DATE,,,,�
Attr-q
oo 2 -
ARCHITECT
6=0-44
A Q C'q
CONTRACTOR 6� L f*"
4
A R ;)A C_ 1 .1:7/
INSPECTION REPORT
E PO)e y -5 1 rA so S.0A1 E 034A 4 e��
-)1r-9'rt4 �- Qi+'EC-KC Ll LA<, 0 e:) 7- (C Ari 0'Q
E: 12
Q 0 1) T KJ fn7- Pt U A MY fJ A 5 C- (4-, 9 L+ 57 -
At=) A �-,/ t4k L
If
-t- Log- —go C Pi- t -q -1/14 710 b L C. U (,T,,4 43
2
-7
DiA
lLo C, HOLE7, /S.
Re AjZ Cr-,�-r k - d- L 1�f=?T* 1-7 L e 0 (,714 0 tA
Locez -64-C% H, I A.- 1 -7 L G 74
'S24 QA V- �4 ?L fi, Q
SX
1/4 S/t- -
LES D CPrq V'% A L IL,0 L -'T -k
2'r
CPtq-' I.- 'b; A. Ri0t)
.10 5' gf>A�e w I Lt- LA�Q 20
L C tA
x4k (L o..c-r o4 LA L o go L C' /J." 4)E0jrP4 Ro 6 - 1-7"
ALoc� - �.OL.C-S-
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
�substantially complies with approved p . lan6, specifications and applicable sections of the building codes. This report covers
ithe locations of the work inspected nly and does not constitute engin'e'erinig'qp'finionbir project control.
0
R NAME
CERT. NO. 50 INSPEM r4tj� h:6
NSPECTO NAT E.
DATE R SIG UR
MA eC-)-1 ;?0 2�d "
.. '^ .. "3 :iz! s. ,. . `:�•'3 •3-.?ivL+a-.-J.d=.a.-•.2 u'.o r4.: :•�!'.r:4a • ry .. �aw,j�.:.-..e,.:: i.,%;�=c.u•.. = c.�__i:,%.`^.:=,.
Page
_L of
DAVE,.•STEAVENS
,
Inspection .Services
PROJECT �-3F ST -'"Sc- C�) PROJECT # avo 2 - 0 ,3
ADDRESS
..:CLIENT C-� �A (rtJ-CST v d4 ,
DATE ` 1 � M ►q` 1z< r-1
, ._ t i
BLDG. PERMIT #ARCHITECT Go. C,&Ac
ENGINEER _� t.-jj A) Silo I. CONTRAC
�TOR �. C.` ,/'►� {�:.�Z C7P� �.� C:
INSPECTION TYPE
l
INSPECTION -REPORT
e-ly,kN iLL t? �4�J 9 Rc. d e-$� I
Logi k N its, > .-- 5 � 1� ►, � � c..• � 3 A U S T le A Ply. �1
�' -O r✓r L
-q3
*' Arrl c S A�:',;�,
14
L oLi w A Lit — t-R'�1 M 1 w�( X1.2IN W A Q�. SiJSi L ATl 0.►� C. L'4 �,
S s C i2 c,,.j S A- u T S - hNY EiJG .
CERTIFICATION OF COMPLIANCE To the best-pf our knowledge, all;of the,reported work; unless otherwise noted,
-�, substantially complies with,approved plans,.specifications!andapphcable,sectlons:ofthe building codes. This report covers .
the locations of the work inspected_only and does 'not coristitute engineering opinioneor projectcontrol.
CJERT. NO. INSPECTOR NAME
DATE I�/4 eCl�l aOO:Z INSPECTOR