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0108-340 (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 14.11 hp Date JA!'A' / $ignatureof,69 fiQto.r��`?,u 1.. - OWNER -BUILDER DECLARATION i• -Citi r'C.E. 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 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 f ection 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 Polic No. CAL I14EMNIT l' 113%2174.A. (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 complytwith those provisions. ; �; Date:C / Applicant., WaminTg` Fail'u"re to secureWorkers' 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 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 pursuan0o 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. Signature (Owner/Agent):., �./ +�` s:` ` 7 i r.;_L_ Date""..(2,, ` BUILDING PERMIT PERMT# DATEVALUATION LOT 01(1.340 TRACT @ JOB SITE v "`" --- APN ADDRESS OAK =11 OWNER CONTRACTOR / DESIGNER / EN (NEER . ,'Ujk W. '1 MOBTrIAL ASSCY KIYO I DW M.!`R PACMC: C3.�EaC COX °t.1%iWPOR P19 DOX 30150 462 USM AVE. 9302 LA Qt.51-"A, CA 92253 SO NA BRACH (,A, 92075 (858)792.-1500 MIN 5PA2 3 LOCAL OPFICE INFORMATION TION USE OF PERMIT M18CHUL NEGUS 73.1+60 3i'. S:iMLn, PkI Mf51 .,34510, -54-11-7 & %105 z X HILL - 13UILOINC.i 6, TYPP, VALUATION I's FUMATED COUr ORCOMMUMMOAK gC9Qtt8�K3 CONSTRUCTION ME 101-000-4118-000 $207.00 STRO'td0 MOS`1014 MWE - i1ESID. 1€11 -MI -241-0600 $B.t30 y D Q � SEP 10 2001 CITY OF LA QUINTA FINANCE DEPT. UUkS-_J i}SAL C':�'T`.i�t1CLON A "D £YC JW O�iEIiC�� �2f1�i.6?6) •P.AM ES g �py7��y�p p� �v�Lq�.i DUE A 4P.6A.Y.0 .f.. r Y.�!fA%.�. d' .P ES D E NO IW Qo.yy$�n0.y000 6U&09.00 RECEIPT DATE 7 BY DATE FINALED INSPECTOR 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 O.K. toWrap _ Exhaust Fans �/ Z �� F.A.U. Framing A" Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Qy Drywall - Int. Lath Final Final /mfr"j� POOLS -SPAS BLOC KWALL APPROVALS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Pibg. 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) nlolz 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) s •. ..r. ,.—..sy*:6rf ii."�`','YU'2.5:].71': e E5`'y Hx s �+m`dC t ...�:�Y.'•? iP:+i.�. i•.}-rF,3.:..: �sU„5'"�i.�._. � ,i` . + .i er'•.�.....•_'-^_T—�^ _ Page . 1 of 1 DAVE :STEAVENS Inspection Services PROJECTPGA �J.S� T'W.o-YS� l(� ADDRESS''S`! S�y I, t r 1 pkv1 VA LL SCA" V k GLAD 7 BLDG. PERMIT # ENGINEER I G J.a L INSPECTION TYPE PROJECT #, a a o '3 CLIENT /44A DATE, ' -o.at?_ foo 2. ARCHITECT Go -L3 A,_ VAC► -I . CONTRACTOR F 4, F C INSPECTION REPORT CQrv\ LE T E 35.5 - I��rh�C.�TL . CERTIFICATION OF COMPLIANCE To the bestof our knowledge, all of the reported work sunless otherwise noted, r•-1 substantially complies with approved plans, specifications. and applicable sections of'the building codes: TFiis'report covers the locations of the work inspecte�J oni"hd does; not constitute engineering opinion or protect control: CERT. NO. Q ,. INSPECTOR NAME DATE `T w1Al2 U.O Z• INSPECTOR SIGNATURE i Page �_ of . DAVE-STEAVENS Inspection Services PROJECT � iA � E 5 i i�1NA5e (6 PROJECT # .2'p6 A - O 3 ADDRESS S q. = 5 �{ 1}��9 S/ ?{ .Sd S CLIENT �q _L,�E S7- Moja n AI zW �_t_ '4�_Pa0 (j SL r- 7 DATE: Iit DG.. PERMIT # -; ARCHITECT, GDL Ci A A Rcr•E . t ENGINEER I LLj O `- S A Jo r c' r &),C.. CONTRACTOR y-1" Co►� S T. INSPECTION TYPE gf'O X' t INSPECTION REPORT 0!�-Qt•L4•_,I &\/_ L-,O4A-rtOti1S Ero,n-I S PS, 1 ir- rF F X p• 6: � /404 E.5iE'AT04 r,_WL7_C, ' 0"'ZI iZ 1SWEQ 0> C L-r.a A n F E•:3K_(S, AfRLi c r(o13 Qlb tj5rA: A-rt7ERZ S C_ 0 5(9 YT 0A1eNHL Pj_AIJ. �4 LSCS- Po E-, - l 1%,A c�iJS— I 1 t_E�C..T - r S`LIy " o` LyGS' '/`IOL�S_ 5 �.% �EPT►-{.3/ti'�"ISA, i2yDS— � jrLE�JGTi-{ Tl- a t�1q 5y 19 Del K N t. C.L. til A r.J ; LvcS • Nocz3= e";? ..4)F.PTH 1.�A , 'pop S /7 �aGTK �S D �A H _� �, �7 � A I is A f5 -7 . ;--rnAW Hl cL Pc�4Ajinn .1 0 Lk - G-1 Pr- �4 1 1.7` r j1r v'l � -;Pru /y A u U. (S ,? LV c5 tt'i OV€S - 1'2 1% E 1 .tri (-'b rF1 �Ro.Ds l'.'7` L e tJG�rJvf (P,b r A Ot,,,TVA LAIC_- o�.E�—`�:2 i�£PT►-1 10 vl2oOgg- I-T LCluGTK S 1�rA A LATH Loc- 140C 4 " %d2 JM.P'fr1 44 :Cl% { 1A0t, •.'i 5 L�.►JGTI� � p r* CERTIFICATION OF COMPLIANCE To the best -of our knowledge, all oft.he reported work; unless otherWise,noted, substantially complies with approved plans;•specifications and:applicable sections 6f_th6b6ilding`codes.-This report covers. the locations of the work inspected only and does not constitute engineering opinion or project control ., CERT. NO. INSPECTOR NAME DATE �Ef3 �ODa2 INSPECTOR SIGNATURE .. ... .+.: ,, . .,'. � L.... � ..yl.. -.w - •..•... ifi•.�St ..r �.i�atY'1,W(�'S'4'i.Y+'wr'w:wq,.�. cti ..'q�:�w: .nsaa tJ' x .b•,#,y„ jam' ",; Page : L of Z. DAVE STEAVENS�— -('.: Inspection Services �'r t )H At t PROJECT# 0'Z —0 -3 Tcr� CLIENT: AG%t GJ -QST f40t - DATE. la 6�?"r4RG hE oZyo ARCHITECT..'G04-64, 62C_4_ CONTRACTOR .F INSPECTION. REPORT i l,� X5'7, y N S� oe4c,ll-► i t.l�LA l _2 i 164. 5 - 9 _ 3 LO c: A c? Z T� ' beTAIL:. 3 s.. r+Tq. Co A C_' La i c - �v's: -- to a L t H'liLl�Ay' Il Lz,6it..i. r yk �. ( I �i - !_ O G -` r t Lq p 0A,tL�,l',1 C— LEicr - CERTIFICATION OF COMPLIANCE To`the bestt.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 peoject control. CERT. NO. S9 `7 g -.$ U ;:INSPECTOR NAME ;n. ' E . 5 1 /i ii CAIS DATE (0 Ih/�iQC%1� o?UU Z- INSPECTOR SIGNATOR ._a sr ......v y.wrT..r.{^ — —_r. � .-��P�.. c...c..�R•`fd�r�gy'f�•].'ym. .- _ _ ' .. Page of 1, DAVE STEAVENS Inspection- Services PROJECT 6 A U- iE,5r e7wA�E t PROJECT # a vo z. -0 3 ADDRESS 5 9 CLIENT A Lt%t s r AA0A �:..;. DATES . I m A (Z acro .1, BLDG. PERMIT #. ARCHITECT• �a069 2C4 ENGINEER Ju rJ S AJO+� 17,J C_ CONTRACTOR Ibie_. m 42 PAct r L INSPECTION TYPE : • ,, ' INSPECTION REPORT Sy _.S4•t ?s r.2 y. S1 7 s'o�" C�i�ttiY H (Lt-- 0 13c.Zv "T j Low w� 5-F2p.n.,�c 4A►2.zWA0Z_C =KJ LA_k-A i L o,) C-0—DL.1t, C `5i 'r-sZEW's A a. 9- llt7-5 - T6arCAJC-6 ' S•-r;Cts 31, (oA 5 . Co l 3 �U`'t' ©r4�'Ir-t l L.C.. ry LA J L S 1'2- 3 ! 9 S a Lcv. c.t�• .ft t�L y fJ a4 t t_ ►.� C, �.o •� O c: f r - W.w Loc,VC i4 L7 : S W cR I�c_CT'r _171, . 5_4 (0 R 11, (:o S's, ('11, Lby R(LCAS ►Nig akEb.' rv+Z 'LA—D-4 C)e ' : CERTIFICATION"OF COMPLIANCE: To the best of our knowledge; all of,the reported work, unless' otherwise noted,, �t 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 p�oject'control. CERT. NO.. � S 5 q : ` �'. J V ,INSPECTOR NAME ' .'-:'. st e q �e'*� " —(PrinClear, DATE �. /�?�.�yy Z INSPECTOR SIGNATURE G % .