0108-344 (BLDG)I hereby affirm under penalty of perjury : that ,I am licensed under provisions of
'- Chapter 9 (comme,ncingIwith. Sect63000) of Division 3 of the Business and
Professionals Code, and my License,;is,in full force and effect:'
License #- Lic. Glass Exp. Date
733M
Date' p'
Signature of.Cdnt cl' orrt•1t(.I _ (T
WMER•BUILDER DECLARATION
C-
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 proper ty,,or my employees. with wages as their sole
compensation, will Ido'thiwoek, and'the structure is not intended or offered for
sale (Sec: 7044, Business & Professionals Code).
(• ) I, 'as -owner of the property;'`a'm exclusively, contracting, with licensed
contracorto construct the project,.. Business & •
r ts . Professionals.
Cede)
:rO}I am'exempt'ynder Section ` B&P.C: for this reason
s.Date Signature; of•'"Owner
• y K WORKER'S COMPENSATION•DECLARATION
hereby>'affr'm under penalty of :perjury ones `of the following- declarations:
(Kl,) 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. 1.
( have and will maintain workers' compensation insurance, as required by
3` Ion 3700 of thW Labor: Code,' for the performance of the work for which this
i rmlt Is;;issued My workers' compensation Insurance carrier & policy no. are:
Lamer Policy No.
G il< �WDB iNi �Y' 1I3021741.A,
(This section need°not- be completed if thepermltvaluation is for $100.00 or less).
r=)I cehifytha`6n•the`perfommance of the work for which this permit is issued,
I-sh.,11 not employjany,: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 LaboE
Code I s_ hall forthwith comply wlth41ioser rove dons.
Date f- APPlicant"� 7� r t� t^�d e
yJ(»calf g:-Faltpre,to secure Workers''Compensation coveragWis unlaWul`Ad
shall subjectan:eyer to criminal penalties and civil fines.up•to $100,000, in
.,addition to the cosmplot 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' asa result of this applicaton agrees to, & shall, indemnify:
& hold harmless,the,;City of La Quinta, its officers, agents and employees.'
=I 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.
r
Signature (Owner/Agenv, ( L ! LI.Date
m ;•'; '• f7 :�„'( Vic. 1 .
BU. ILDING PERMIT
DATE v 7'VALUATION LOT O1(I�S �A TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
3�I, SMON?KfWFSIY Dk
Tir' I MAR I=ACiN`1C c lrAl> iAt.. Ct7b1"t'!tlilC,"i'(}.
T'0 TIOX 1060
462 ;31'1- VE:NI3 .AVZ 0302
LA aU N'1',A CA 92283
-
SUI AMA,BEA(. -1. CA. 5121!75
1;500 cHz 5ff�3
USE OF PERMIT
1 iL3c��:9:1,t>Ai t )i3S
so 60;rr. CtfAR.1,L'y PI,
X54 t3T`iA=:iiia: t•1)j-. 'i4.3D1 OAK. 8011 01Na ill. TYPE
9,tt�?irJ➢aZlNTAIW STMICTORAI, M()DIF➢CA.1'iONS
V/tl IM01011 20,11130, 0 tZ,
i"(FcYI'�7i
::di
<ih9�P:1CAATZD
F4:3t WT F.€i:'ls;. S[)IAIMI ARY
C(.) 4ST.I.UCT➢Cif1 ME 101.000.41l3 -NO i;i)Y,00
MZONC) MOTION IME • It.iE: O 101 -000-241 -(KO Om
SEP 10 2001
CITY QF LA (1UINTA
FINANCE DEPT:
:1tCTt-1'C) I1�3. C.`•c..ti.b7 .tRi1r,'~3 f�>hl' A.M.) PLAN (4,f ixx
$209.00
ISM :PRIG-k'.A7l YKIN
$0.00
TOTAL r. KHM1111 11-.01111; MJE POW
VAI 0 100
RECEIPT
DATE j`
BY
DATE FINALED
INSPECTO
INSPECTION RECORD
OPERATION I _ DATE I INSPECTOR OPERATION 1. DATE I INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms 8 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
Final POOLS - SPAS
BLOCKWALL APPROVAL 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 Plaster
Sewer Lateral Pool Cover
Sewer Connection Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas) .4
ELECTRICAL APPROVALS���
Temp. Power Pole (;;� (44, cpl; CS'
(1
Underground Conduit 11 3 a' _ J �•�
Rough Wiring 2 nn �f n
Low Voltage Wiring 3 'G� / y (� p`
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
f
Final
Utility Notice (Perm)
Page / of �-
DAVE:: STEAVENS
Inspection Services
_ s _T_..
f PROJECT (, A. W.ZsT- NrAse • t° 3 PROJECT,# d u o°2 -o 3
ADDRESS 54 V1, 31 . 3 I 10 1 CLIENT';)G rN t J ST "ko +A
PL A J 9 `'DATE .2 O'. /h•A it'cH
BLDG. PERMIT # 1 ARCHITECT GOL•d 0 >40e,r=N
;- ENGINEEtu a i.1 SAyy L > CONTRACTOR`:176 L Wl X12 ' PAu i C
INSPECTION TYPE t✓?v
INSPECTION•REPORT
(,tel C- L.o-'C A -r r u,j S' 6- Po -': `I:"
H0U E: PTH CCStC<GLe-1)" A:O 1.'C.Lp-�Aj Op 17E 5 ;
A P% -r n ,.l A S _ �. 2 "` G3o-_'"ice} 14 S
ik
7. n
V I?zAt (a,A- .- l;U x- 4401-f- i)CPTH t ,..O.,ALC., �GTVA /'a DSA
Sof - 3 2 S i"y A► -L N A L-\.- R L A iJ t .
L, (2zA(t S..,.;-AtoLc l?'`�P�rt>.1,��J,�o, :..yL>S- 11L11) ? 14
i 7
Rtaa.2 Ccexr<41ti- a LuC_S f'S L rJ�TN . J'i
to i�'' ',;.: �,"� :�_ ..i.� `• z i „
�arD���S l-�Uc_cs 11—D De?Iti Llirq-3/3 OAW 141 LL-
E
/,�
R�>72 C TcR avo5 s ,s-„� t :T►� °i� v,A
(►J 1�zA2 00,1 7z -.4• 1 l_cC - b-�o L� ` (=2 rt �;� A . I?'0 (.? L �.L) T
Sy-30� D�►! H�L.L. �LA� 3�.
Lty ZEart S��T..+- ! ��,c -!Wvcc -.12• Dz I�� vo ; / ,'Lt �T� (+} 0,A
Lv�THrl� rAsd/�OQ`J~/5�r,iJG?ti/ /F3,OiA
CERTIFICATION OF COMPLIANCE To the best.of our knowledge, all.of the•reported work, unless otherwise noted,
-�;'substantiall with a
y complies ppI`oved plans, specifications and appbcatile�sections ofahe building codes. This report covers •
) the locations of the work inspected':only and does not constitute engmeering opinion or:project control:
,.
CERT. NO. D�S 7 3 - 'd' INSPECTOR NAME �� 1 �I1 T�y�`C� �►l�S
.. u , a
DATE C 0 iYl A �ZLr•/ o�'y 0 2 INSPECTOR SIGNATURE ,
.. .. .l,e �n•.w..�y.y :.etifaJ�i 'Pfs.- �a3t:.:��..,r o'a�'.'e4k-F-;i%c�:i+y... .�..-.siq.jc3:-.r :.. _. x...ti xi. ,.,
Z
-Page �- of
DAVE STE -1NS
Inspection Services
PROJECT �/, f3 "S.r 5-r- ? A� kyt, ..PROJECT #
ADDRESS ..A S'. t- L s CLIENT 14o. A l
DATE o1y w+ A2*"LH a o0 2.
BLDG. PERMIT # ARCHITECT A°'ec-H
• ENGINEER*Iu of j SA'Z'rJ<— CONTRACTOR J)65: AMC. PA��`>:�G
INSPECTION TYPE
-'INSPECTION REPORT.
20 6AOZL-II (L :.840 ..kf7LAJ q
i `f L �2 A M 0C:; . I� LO G.� i C� Z r1 S u: L A� � t o O -74) _ '-s
l
�CYfktc_5 t_2-3-14 LS -q 0 CLa- k"?C,_,eoM'`Jc. Tt
M.
y Y3 3 44 1 . 10 3.4 Z DflK'NILL �� �G. cv J��A�J fa
J ,
LoLi
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 engineenng:opinion or project control.
CERT. NO. •C�S 9'3�'.`;Sa �, 'INSPECTOR NAME J.`.
- .: x =L Pri' lea •.
r
DATE �L% /N1 A /L L r/ C 0-0:2- INSPECTOR SIGNATI�A ' .
.;?.•; �.a:SK:: .r. r .d: s S,n,: Ea=r'4'^;.cl'A•u.��ti J't. A.t..T . E�-a:.fr n 523`vf'w:y;:gY.c�..wx':.,?oU= '�'a,rre _ 3.-'..'-^.^ ?^_.n•....'_ .._
Page of Z
DAVE- STEAVENS
Inspection Services'
PROJECT+�6- '_Zt - t� 5� t3 PROJECT #. off.y elid•- O 3
-ADDRESS'.CLIENT`7?G A" %' ST - 64 o
DATE
-BLDG.. PERMIT # ,42 COY. T. -
�-ENGINEERy i Tajc CONTRACTOR'
10,4ct=iL
INSPECTION. TYPE
INSPECTION REPORT.'.
SY 3' i 21 3. 30 ( oAH rLL ..
�4- ` i 1J int:. r✓�j ��Z A, ins 4 ":1 C� 14 oa Z) u941 dc: t;:T ti%S C�.t� N -r O 13 co
A rJ TS _71I (, W TCA) C
;4 Tr c S - 5 Nt AZ: -A.JA I L 1 AJC., :'RC.o C � .,d, 4 r L � �! r, - `D r+, PLC T `t
5 y- Lf 3 3, 441 c . k q:: 3 `'t lie""' t L.L:. 3 Lb C. :-1�k-
CERTIFICATION OF COMPLIANCE ;To the best of out knowledge,,,all of the reported work, unless otherwise noted,
substantially complies with approved plans,'specifications and�applicalile 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. OI> 9 _ T B ` SO `:INSPECTOR NAME i�'�G • t t�1 U C k� S ;
.::• .: - �i:.. ' ,.-....:. - _ . ,.tip.•. - �.. ..
\ ✓w -a
DATE MAIRC�/ 4610Z.INSPECTOR.SIGNATUR a