0108-346 (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
.s
Date /. Signature�J X^1
,of Contractgr.(3.,
OWNER -BUILDER DECLARATION
I hereby 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).
( ) I, as owner of the property, am exclusively co,ltracting 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:
Cartier Policy No.
(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 Labor
Code, I, shall forthwith comply�with those provisions.
Date:`/ //• Applirca/nth•
Warning: Failure to secure Workers' Compe•'nsation coverage is unlawful'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.
f
Signature (Owner/Agg'nty/� 1Y11 Date
BUILDING PERMIT PERMIT#. «
qtr
It' + . f ,• .
DATE ` VALUATION LOT *TRACT,
`
JOB SITE ' - ,, - .. -
APN t'
ADDRESS
0A1 Wal.
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PGA WEVer d'EMIENT,%AL ASSCtCTATI( AT
Dri-L MAR PAC IRC GENERAL CONIZd..P:a''Wli
o :i -M 1060
462 LURVE S AVF 430.2 • -
LA QU11TrA CA 92253
350t.Ai+1ABEACS CA ,
($58;792«1508 {.'`L?1'.R sen
USE OF PERMIT
LOCAL OFFICE WtiF3.MATIO'K
Ad's£ k+.I.i.li 8 :t iJ
45460 ST. CHARU10 FAL.
"�4�, 411531420, i& -?A 7 e- 54,21-211 OAK HILL, - Sf, ILI)INO 13, 'Fyne
0C" VOUTOTARY 8TRUC T4fRA), MCaDi.MC&TiONS
VAIXIATION 2000.00 IS
wVAnA0.) C09OF (r'0Nbp RWqr10,K
,, �•�'p•,ry , .
Ming r FRN 913UMARY
CONSTRUCTION 11M 401.000-418.000 $fid -109
S'6.` 0140 MOTION FEE- F:3 SID '101-000-241-000 $2.00
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SITS -TOTAL., .".ONKiRDL-11014 AND .l'I.,+%UCMCM
$". 9.00
I.Ess PRA -PAID FRE
�...:
$O.00 t .,
TOTIMIMIUM. ME PS DUE NOW
1.
RECEIPT
DATEBY
DATE FINALED
INSP C OR
1__
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 �jOZ
BLOCKWALL APPROV LS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring,f/0
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMME rs:
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DAVE STEAVENS
nspecti-onj Services. ... ..i
:-.,PROJECT jr�& A
ADDRESS'N
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BLDG. PERMIT
ENGINEER))".a,J' 'SA Joi�:
rucu�n�rrni►T �rvnz+ .
PROJECT•. #. .c106..-2 - 0 3
,.CLIENT: t -C o A . .
DATE M 06'LC.�L 2 -
ARCHITECT 6o. LS R
CONTRACTOR-'DEL M A4-
CERTIFICATION .OF�COMPLIANCE To tlti9'b est:of our'knowledge, All :of the reported work, unless otherwise. noted;..
substantially complies with'approved plans,specificationssand applicable. sections of the` building codes. This report covers
,__,,).,the locations of the work inspected' -only and does not constitute engineering opinlomor.project control
s-� '
CERT. NO. S t, 3 `�Q " j Q INSPECTOR NAME_: ' AJ:E . ;J /►4 (A5....
DATE 077 hi A2E 4ori UO :L INSPECTOR SIGNATURE.
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Page of . v2� i
DAVE- STEAVENS
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE To'the best'of our knowledge; all:of the e.ported work; unless otherwise noted,
substantially complies with approved plans, specifications,and<apphca6le sections of:the building codes. This report covers .
,_) the locations of the work in pected`only.and does not constitute engineering opinion or project control
.
CERT. NO. INSPECTOR.NAME E S'fGA t/g nJS
DATE Co m p 2 6 W INSPECTOR SIGNATURES
Page of
DAVESTEAVENS
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spec n ervices-----.
PROJECT ?641 U')Z'�T PROJECT N o'o 2 - 0 -5
ul
ADDRES9't�q 1-29 ;�xl' z 0 T CLIENT
Q�AK�l LL' L -AQ gLbe- t 3 DATE.,,.� 5 0 c)o2_
BLDG. PERNUT #
ARCHITEC A (2 C-4
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INSPECTION TYPE
INSPECTION REPORT.
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CERTIFICATION, OF COIVIPLIANCIt-"T6'tfie, best of our knowledgei.all of the rep6rted work, unless otherwise noted,
,\substantially complies with p0l5roved plans, -specifications.ii3d applicablesections of the:b
uilding codes. This report covers
.-.;the locations of the work inspected only,and does hot c'o; hstitute erigneering opinion or project control.
N"A"-
INSPE6D ME "Ps -01C :'�- 5-tc
CEqT. NO: S23 49-'5-0
MPECTOR SIGNATURE'
d".
DATE
Page i* of j
DAVE: STEAVENS
Inspection Services
PROJECT FST PROJECT # a�vo 2 - D
.ADDRESS CLIENT" (.jk
21.D G # 3 e-1 Y
BLDG. PERMIT #
ENGINEER
INSPECTION TYPE
DATE .20
ARCHITECT 90 -L6 0c ,4W-,-- u
CONTRACTOR6 C.': YK � c2
INSPECTION 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 work inspected only and does not constitute engineering opinion or project control.
CERT. NO. �9 S"" / " � INSPECTOR NAME _ { 1 A 1J Y' to U a LJ S
pp (Pri I Clearly)
DATE Z� I� /4 Chi �00 Z INSPECTOR SIGNATURE