0108-344 (BLDG)I hereby affirm under penalty of perjury that I am licensed under provisions of
C?�apter 9 (commencing with Section 7000) of Division 3 of the Business and
fV W Professionals Code, and my License is in full force and effect.
CALM 'License # :-' Lic. Class Exp. Date
^dam:
t` W r, 7 3151 0 PI1f2.(.
:d Z ^ Date'L Signature of ConactorlE���!
I A -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
ULicense Law for thefollowing reason:
Z (.) I, •as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the stricture is not intended or offered for
sale (Sec. 7044,`Business & Professionals Code).
( ). I, as: owner of the property, am, exclusively contracting with licensed
contractors -ta construct the,project (Sec. 7044, Business & Professionals
Code)
s„ O I am exempt:under Section B&PC. for this reason
O'
Date ` Signature. of Owner•
O
a Q WORKER'S.COMPENSATION DECLARATION
o � I. hereby affirmiunderpenalty of.perjury-one of the following declarations:
Lo Q- I have and,,will maintain a certificate of consent to self -insure for workers'
X.W-O 6&npehsation;. as provided -for by Section 3700.of the Labor Code, for the
m0,. J. Q performance: of the work for which this permit is issued.
<'U? ,, ( have and will maintain workers' compensation insurance, as required by
O U Q S Ion 3700 of, the Labor, Code;: for the performance of the work for which this
a ;H mmit is issued.. My'workers' compensation insurance carrier &.policy no. are:
a; Z Carrier • : Policy No.
n`O h ;`
;g (This sectionr need,notbe completed rf the"permit valuation'is for $100.00 -or less).
O 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,
}3' subjecfao the workers compensation ptovisions of Section 3700 of the LaboF
3^'4 Code I'shall fo hwitcomply wlth4h
h o ovI ions.
Date` A00licant��
-�+----mss—
f /ir 'r' .t. jj A
t ''cftftxr'Wt0 secure Workers' Compensation coverage`Is`unlaqufUl aid
shall subject an emptoyerto criminal penalties and civil fines up to $100,000, in
;addition ,to the cost of compensation damages as,providedfor in Section 3706
Labor Code; interest,and attorney's -fees
.. 4
s v4 IMPORTANT Applicatlor,ls hereby„made to the Director of Building and Safety,
'i'. or 'a permit subject to -the conditions and restrictions set, forth on his
f
-;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.
a �+ ' ,any permit Issued as a result of this dpplicaton agrees to, & shall, indemnify:
&:hold harmless the'Clty of La Quinta, its officers,'agents and employees. '
µ 2'•.Any.permit issued as a result of this application becomes null and void if
x � X! 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.
(certify that'I have read this application end.state that the above information is
«:• ;:: 'dcorrect. 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
1 ` }�
Signature (OwnerlAght; f i , p �t i'ttA,Date
BUILDING PERMIT
DATE C. VALUATION . LOT 0109-344 TRACT
7/
JOB SITE .
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
fit il.11.'l# FZr REMYNT +AAL EISSC'►s; An()!d
D°r;L. M".. PACIFIC GENERAL COWRArMIR
F0,1 tQX 1060
462 MVEM AVL- 0302
IA C, UI2d2 . -A. CA 9225:3
SOLA:t7A,:i EA,(.tf. CA VV I5
("8Y19z 1100 CHI.JI 5823
USE OF PERMIT
f ��:f�l. C'i1�1CP`: P;!J I�C�SCPdI,e%`i'llifl'
'7'P-160 ST. CHARIM PL
�:3?rSt�'7,`9,4-. df S S4•:if:i �'t4•.3t1t C)AK: P3I1.1.• 3�t!lf.,.[�l?Vt? tt,'1'1'P�
Ar VoP.(1N•rA�€;� $')'I3LfC;'t1.ftP.l, P�z�r�rtrlt�,�Y'ta�f�n .
VALUATION A(iM0 I k”
_
SX'iIV£AI ?� CC�ti1 t 3 ' CONN17 lf*'I7:+DN(k10(3
PERMIT VVE NLTUM A-'RY
U1-00041 84?00 i:707,t I
WRONO 1b1433ION irXr • R.RSW 101-000-241400 tzoo
SEP 1 0 2001
CITY:OF LA QUINTA
FINANCE DEPT
"TB— fOTAL C`OblM_,i.ir.Tl:10K AM MAN 011
$204.00
1X03 PRE( -PAID FVXV
$0.00
TOTAL P1:'.R Mi'1'MEN iUU!!:AM
RECEIPT
DATE �/
BY
DATE FINALED
INSPECTO
/ / ' `� r
3, ;i
C.
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVAL
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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
COMMENTS:
4
it ��� 3 a' _ J
n
3 4L 7 p`
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)
-DAVE.STEAVENS
Inspection
PROJECT IV, R we c. -r NACs� 1 1--s
x
ADDRESS S -q
6AW H (L-LZLO(,.: I t PL ACJ
BLDG. PERMIT N
ENGINEERlu tj
INSPECTION TYPE c; -y-
Page I -of
PROJECT` #: d v 62 - 0 3
CLIENT ;)G)N
DATE .20 /h A 9 C--1,4 Dov Z
ARCHITECT (Sod, 6 #4
CONTRACTOR -Del, M A& PACIc C -
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CERTIFICATION OF COMPLIANCE
M.PILIANCE. t&thb best -+6f our 11 knowledge, all of I . th6. r606 rted-v . ork-,'unle'ss .46therwise noted'
,substantially complies witFi approvedp'l.ans-,spe iication'sLand`applicable648iiohi,&the buldihg codes. This repqrtcovers
the locations of the work inspecte. d'o5hIV and 'd6as-not 6o'nisift6te.enginepring.opinion or projedt," control.
CERTNO. DSS)--INSPECTOR,NAME .*.'.
v
INSPECTOR SIGNATURE -;-MV
INSPECTION , REPORT'
6:)L
t -n i i t I
C� 1- 0 C A -r
r uo;j':-a 67 f 0 v- -1 E
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S -
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"-313
-
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SN -301 0
7'
L P. C- 7 A
Lij LEAN 0, &J 167,
c11 -0C s
CERTIFICATION OF COMPLIANCE
M.PILIANCE. t&thb best -+6f our 11 knowledge, all of I . th6. r606 rted-v . ork-,'unle'ss .46therwise noted'
,substantially complies witFi approvedp'l.ans-,spe iication'sLand`applicable648iiohi,&the buldihg codes. This repqrtcovers
the locations of the work inspecte. d'o5hIV and 'd6as-not 6o'nisift6te.enginepring.opinion or projedt," control.
CERTNO. DSS)--INSPECTOR,NAME .*.'.
v
INSPECTOR SIGNATURE -;-MV