0108-345 (BLDG)I he 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 p Lic. Class Exp. Date
7:4 t i
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)...`
O 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 forwhich 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:
Gamer i '; Policy No.
t:.i:13r.11f1.1i1MiV11'P . td,fl%.'.1�I7r1/a
(This section need;not be completed if the permit valuation Is, toe $100.00 or less): .'
(.) certify that in ,the performance;of the work for which this permitjs issued,'
I shall not employ any•person.in any manner so as to be6o'me'subject to the
workers' compeAsation laws of Callforoia,•and agree that if'.1 should become
th
subject to e:,workers' compensation provisions of'Section 3700. of the Labor
Code f shall Forthwith comply with those proylslons: `, . - ; J.;, -
P;,
Applicant
�rWarntng:,Fallure to secure Workers' Compensation coverage`Is unlawful and
shall.subject an employer to criminal penalties and'civil fines up to $100,000, in
addition:to.the cost'of'comp.ensation, 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. l 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 prpperty for ins9ection purposes;
_Sigrtaturt3 (QuJn"e�7Aen�)'' j If;: f r j Date
BUILDING PERMIT n
DATE l / VALUATION LOT (j,[tfi•• 3 ♦=i TRACT .
JOB SITE
APN
ADDRESS
' AWNER
CONTRACTOR/ DESIGNER EN (NE'ER
`GP. .... . .
'q;'TO
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:i°�j };:t;;�};)960)960r��.:3"fTs�.l�n'r•
}
•9 I*t /',_
: S.;l:i•:, t"Sf.ti
2 '�
5 "n,�. i';:y. a, '! j
F v' ,.i ut, i. /
{11,`371 ` "..1_`00 ('7�Oi
USE OF PERMIT
�. ,I�, ...ti Yi .. `l�1 �. G.4• I
�i'Y1:. it tj',f�, 1: 1 �')' I�'�:
;ftig, :-t�,;;LS d: �a-25-t01*.K kl.tt.,t.,•. {S 1. It...;d f Ir,'i'l"I<Z
itlt'" �tlr:!f.tr111i;G�lt Z}t.i.)��."fl,tr;:ll..?.°Ca►'�ft''!�:A;i'tiya`;�:;
• �X_.+��.i.,1.:1./:':{C���4 ':3!i,iit(l,tlli;.i,�S
• ; 1:,4.f%int�r� a �::i� c.�.1,4 z; a �.:� r:�r'¢Ey:z f:'�d4:r��.'z•t:c»�r
2� t,ta�il):fir; .
j:`1:;Ldl�11'f.'-.ii'�:.'1t: �I:{t?•:t?�vA�i:C*:"x'
(:'afp,l+{':i3�iit.''%}(:,}}.t+'t�;i� IaY'I„A•,�)�>.:,;..t taf.)(j', $:{i;',tt;i
_1 CONK; M11, Taf?ta FEE Pii*r31.1_ 101 52.90
SEP; 10-:2001
CITY OF,.LA WINTA
_
FINANCE DEPT:`
st{fs•'I'C+•'I'.f>,l..I::J6vtl*rrR.I:lC'.'.t'iE).l•43 rNID VIAr.•d (':I:IEc
.{.,FI PRF -PATE) RIU-10
$0,010
"ra)”, {v
RECEIPT
DAT
BY
DATE FINALEO
INSPEC
..y .y:
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
i
Final
Final aZ
POOLS -SPAS
BLOCKWALL APPROVALS
-
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electra
Underground Pibg. Test
Final
Gas Pip!ng I
PLUMBING APPROVALS
Gas Test
elects., Final
Waste Lines
:Seater Final— j
Water Piping
Piumb!no Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Poo: Cove- - —~
Sewer Connection
Errzoyuietaon I
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
�► 3 -
C�
r v
�j 0�
1_ � _ db
II
!i/l�ry �✓
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
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)
61
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• � 7 :r .� r.": vI•M r^: ,, �.y?ye w.am�•7Ti;.e. .! �cs:�fr- ; v.Gwr -ame 4..:v�r.��'.t:'+.=IDS�i .. s:
t
Page of .�..
DAVU STEAVENS.
inspection Services . a
PROJECT .# c2 c?O
CLIENT't76-
/{-
i
DATE` > f M A�er-9 ,2yo. L
ARCHITECTwr`BA
CONTRACTOR J G. M M i2 C �r C
INSPECTION. REPORT
vcc�L.-ItfL)c Q.CA -ria.Js fPso..1
A AJ CCeA
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AR
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o ►--f W r
Izz,paems,."-r z -1 LvGS- 64oL S•o .12 I)d prw( data —tl-01) N Sze DiA .
LcU fii-I' FtyLa �.�: �PT+.� I:, DtA. tZ075.-:1.5.L�,tvC�TK Z tA:
BSD - 2tvcy- NO 5 -/ .D�P7�-1'" 1•'DtA ��IDS- I?�rZEalGTN ��Qr Z'iA
B.e1) -03 -� r:y�S - 44LCS / .. D c�TH'. 1. ,,1�A 17o AS - 0, L�:vGT.N
r
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i°tH' (:[�+�5�� F.;iJG?ia S�g`'prfi
CERTIFICATION OF COMPLIANCE To the best of ourknowledge, 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. 10p, Si 3 -q 9. - S-6
,. INSPECTOR NAM;'A\).E
DATE /i919QL N aDD:Z INSPECTOR SIGNATURE