0108-339 (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
� '4J/�
Date `? i Ile:+ fL l Signature of Contracto� r��:` .,f % f
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 Co, le).
( ) 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
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.
CAL N=174A
(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 Ulbor
Code,I shall forthwith comply with those provisions:
Date:,!
F Applicant,tft,
Wam1`ng-Faifore-to-secure-Workers' Compensation coverage is unjawfy an"d'
shall subject an employer to criminal penalties and civil fines up to $100;000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person! at
whose request and for whose benefit work is performed under or pursuantto
any permit issued as a result of this applicaton agrees to, & shall, inder6jfy
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void°if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
j' Signature (Owner/Agent),`t°' d• .✓ �'- ' Date !
BUILDING PERMIT PERMIT# a" ;
r
DATE / VALUATION LOT 0.1M' -339 TRACT
JOBrSITE
APN
ADDRESS
0AXAMH 14
OWNER
CONTRACTOR / DESIGNER / EN (NEER
RGIA W99r UZW, RUAJ3 fi SSOC.IA.x ON
DEL MAX PA(: OC e.ffiM.E:AL CON :$T•',AMUR
FC! BOX 1060
462 MMENS AVFn 0302
X.le.QUPTYA CA 92.253
SOLAN A BEACH CA 92W:5
(850,792-1500 00 CALft 5823
t.,kK ARI, O"ICE fWFORly ATI0)1
USE OF PERMIT
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a.577,54-565
vo"�T°R"d RL�C'CrRAF 3IIIC.A",i dE�f"
V,Rl.Ur.` TIONS 20AID0.91-0 Lo
EffnK .M COS' ' OF C OMAIMMON
2010M QED '
PERNEITYWE MIAMARY
Ci' 10 RUC D10W ME )01-000-418-000 $207.00
.S 1'I; ONO L• OTION 11 Ir.E • R)UsD 10 I C#PA-2A I -000
SEP 10 2001
CITYFINTA
ANCE DEPT.
LESS PRE -PAID I S
$0,00'. .
TUM S .[t«.�.1,.4P.2.6.)., S ll.'S..L9'.ti.�l. . NOW
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
S,1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS I
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
I
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 k
Set Backs
Electric Bond
Footings
Main Drain
{
Bond Beam
Approval to Cover
[
Equipment Location
Underground Electric
[
Underground Plbg. Test
[
Final
Gas Piping
I
PLUMBING APPROVALS
Gas Test
Electric Final
1
{
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
t
Appliances
R
Final
[
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)
COMMENTS:
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Inspection `Services
.".PRQJECT �(O` 0%
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BLDG. PERMIT#
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CERTIFICATION OF*COMPLIANCE
*s 'To th-e-betit of our - -kn6wlie�dbe,'ali,of-ffie re - ported W 1 6 rk,-,unlesotherwise oth
,`
rwise noted,
substantially complies with plans;.-s'ppcif!cafions.ar
i&ap li6able'sectioris'o,f the; buil, ing. codes'. This report covers
.--'the locations of the work. inspected only'an'd,4pes: hot6onstitute, engineering opinion;or project control.
CERT NO. 09T / 3 V 8 - TOt6 .5
INSPEC R.-
INSPECTOR .` SIGNATURE' Wt -j..3 -^4 2C pj ;Zoo 21
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w Page of
DAVE STEAVENS
Inspection Services
PROJECTLE�� BSc -fit NASA g PROJECT # ° C..6o.2 —.0 3
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,ADDRESSF5-7;`1(;5.2- CLIENT &,fl uJEST 140l4
OAwP (t_r: PLD&'`�12'- 0 DATE'
BLDG. PERMIT # .ARCHITECT
ENGINEE
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INSPECTION TYPE
INSPECTION, REPORT ._
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CERTIFICATION OF COMPLIANCE To -the best ;of ouc knowledge, all of the reported wo&k;iunless otherwise noted,
substantially complies with.approved plans, specificationsand'app'
licable-sections;of the building codes. This report covers
the locations of the work inspected"only "and does not=.n.stitute engineering' opmion:onproject control '
CERT. NO. O8S93 �h SCV INSPECTOR NAME J t� Sy-�'_ f4 J t,Oy S ;
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DATE - e� �i M �• 'Z. C W a VO' _ INSPECTOR SIGNATUR� e�
PROJECT T�¢1 tJES r1►RS�; .C3
ADDRESS S8'S. 57 7.
4 -
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BLDG. PERMIT #
ENGINEER �uc a� SA. J
INSPECTION TYPE
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PROJECT z� c a: - C> 3
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DATE 241,P0 Z
ARCHITECT 60L 6 R Pt 2"C34 ,
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CONTRACTOR r: 4" "tA a Fie
Dt4llCERTIFICATION OF COMPLIANCE To the best of our knowledge, all of.the reported work,"unless;otherwise noted,
ebstantially complies with approved plans; specifications andapplicable sections of the`building'code`s'.this report covers
locations of the work inspected '1` and does not constitute: engineering;opinion or•project control.
t WJE A cJ:c;'.rJ S
CERT. NO. 8 5 3 y.ZS - , O INSPECT, NAMlE
DATE 2 M /4 Q G ►-i 240 Z' INSPECTOR SIGNATURJ
.:PROJECT PH I&, f r3
ADDRESS .15,11 SS9. 5_9I _1'33
,qj It
?BLDG. PERMIT #
ENGINEER),
INSPECTION TYPE
PROJECT #: 406 z
CLIENT P fl % J 5 ..b_koN
.,DATE , U:;
ARCHITECT,, -GQ(- 43A AP-cH
CONTRACTOR D6 M A A. PA Cj Fi
INSPECTION-, REPORT
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CERTIFICATION OF COMPLIANCE To the beef of our. kh6wIe:'86e,-aW66here 'portedwork; unless otherwise noted,
ubstantially. complies with- i1pprov, e-d-pillansjspecificationi and Applicable sections.of the building codes. This report covers
the locations of the work inspect'6,d"6iVy..acid ,does ,not ,cbn*siii4ie_," pVgippefifig opinion or project control.
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A,J:
CERT. NO. 0
-'.INSPECTOR :NAME
ar,7
()ATE I Z M S Q Lel 2 U0'L- INSPECTOR SIGNATUR&:��_d