0108-345 (BLDG)I her affirm under penalty of perjury that I am licensed•underprovisions of
1lChapter 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
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. 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
.1 hereby; affirm under penalty: -of. perjury one of -the following declarations:
O 1'6a4and'wlll maintaina ;certificate of donseri66 self -insure for workers'
s compensation, as'provided for by;:Sect(on 3700 of the Labor Code, for -the
performance of the work for which"this permit is issued. ,
1 have and•wiil 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.-
z
CAI, xrJT}EMW IT Y N',(►:in 1744
.:(This section�need'not be;completed,if the permit yaluatiori is for- $ 100.00•orless).
O -i certify that,in ttie performance 'of the work for which this permit is issued,
I shall not empioyvany person inany manner so as to become- subject 'to the
workerscompensation laws,of Califo iiia, and agree that if I should -become -
11%u6ject to the workers compensation provisions of Section 3700 of the Labor
G01 shaII f rtFiwlth•comply with/those prowslons.
Date l:li Applicant'
Warning. Failure to secure Workers Compensation -.coverage' Is unlawful and
`:shall subject an employer to criminal penalties and'civll fines' upto $160;000,, in
additiomto 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
7.applicati6n..
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 ins9ection purposes.
c � 1 ;
_Signature-'(Miiie 7Agent)' /' ' ; Date
BUILDING. PERMIT -
DATE ./ VALUATION LOT TRACT
l
JOB SITE
APN
ADDRESS 0A HUZ
9WNER
CONTRACTOR/DESIGNER/EN (NEER
F'tt.F WHIM,-!k11f3U:)1l+�'.1"!TJ?i.,.1`.ASSCPC.1fli:"((:.`Y;f
D.Ef., MAR
1 v GFf►
LA�.?ilLri'1:A. l'.ai '_ 2111, '3
iif?I..k.�i:?l !.F'i r, 'd1 %'A cr2ir/5
(IMA 5823
USE OF PERMIT
. .
!.c'e:; 1t: c;)!'( iC.'i. !Pi?'fE?P,rl.:,'l�?3•i .
M488, !Vt-37 y 154, 't03 [C r=y=lJ{).45: HIIA, •. iii.; lJ. i i.f;°40 f, TYFi?
1pt' �/:�;1� t!'r-I�!'►z,�'Y:Y`l'€Li.sr�"!"tf r :t►-, eJ;i 11�t�,t � j�.i'1c1P!;i
' `ION 110
. _ i?S'"G:t�l'fS�Ai�:d! i'{ s{ti.l, �).t/' t°t:1?V.� 1���'�{C.'I•[C)]�I'
,2t''<,Cati).(if,
J."T 1t9fi 1'11 _ @i.Kk SO' lbil.(4AKRY
?:+�rs;li:}Z.l9C::'y'}fPY3 M�?h , �+�p•)..(;�f.�i,.:,l�rr i:7t?(:t ��(i"1.(tir
••
SEP 1 0 2001
CITY QF:+LA'QUINTA
FINANCE DEPT.
AJ14'! i I,)IXA} c.`I:. ECX,.
1$1?0Q.00
RECEIPT
DATE
BY
DATE FINALED
I INSPEC
T
INSPECTION RECORD
OPERATION _
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Retum.Alr
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
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 Piaster
Sewer Lateral
Poo! Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Poleooq
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS
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Page of
DAVE STEAVENS
Inspection Services -
PROJECT + A -\)A0.ltd, PROJECT # o? 00 4
ADDRESS 5S4 -Zgq 2'1-1 25.5 2.5 3
BLDG. PERMIT #
ENGINEERy-0 0 S60o tE :z o C.. -
INSPECTION TYPE .
CLIENT
DATE
ARCHITECT GO c.8 A A 2 Q -?A
CONTRACTOR I EL `vl A 2 f i� C ► C_
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.0eS 9 3 419 - S d INSPECTOR NAME 4N StE A t� s
(P.ript-Clearly))
DATE INSPECTOR SIGNATURE
•H�.,.1"-"�.:-�.hi►s�..1c:,FliW tir*.Y-.*5.:trt+�J:i"e�','.+.li}i)s�`+4�1';+r+Flc:';%:'"i�rt!{'atew:"dx:..�..'�"vr.�:L.�,=1�:-ril�4.✓;
r Page of �..
DAVE STEAVENS
Inspection Services
PROJECT '�)(� ?14^5(Z f PROJECT # a 00 Z -y `'F
ADDRESS S'-/-2�q,� 7,di�S�S3
DAA -HIL(_ !3 Dra#r i ?4. Ad 14)
BLDG. PERMIT #
ENGINEER1CA-a,A . SAJc),iE
INSPECTION TYPE CPdX
CLIENT ;�<.A LJ Z S -f- rte O i+
DATE � ( t"AQ c PW ,Z o0 2-
ARCHITECT4i2C4
CONTRACTOR J '- t- MAR f,4c r 9'( c
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. S 5' -t 3 -Y 9 - J V INSPECTOR NAME A :Sft A J 4e#J S
(Pri (early)
1 DATE I /%► ti 14e N aZoo Z INSPECTOR SIGNATURE to -k--4-