0108-338 (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
7315 ,: - 03/:1/2(
Date ` f }. 2/6 1 Signature of Contractor, t
OWNER -BUILDER DECLARATION4� - f`
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.
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 MOBAWITY
(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, 1 shall f rthwith comply with; those prov,ions.
j Date: / Applicant,), � t /`A t1 , /� �? l��i -kI >/
Xrriiing: Failure 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 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 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.
SignatuCe (Owner/Agent) lr;a�.: k ilf,' r .+.., }'r ` Ll Date—V �• . %�
UILDING PERMIT PERMIT#
DATE7 % VALUATION LOT MOW= TRACT
{`J
I act9$8e
JOB SITE` <
APN
ADDRESS
OA.R0.�q11L.h �ryry
_ .
_ ^
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PID SOX 1060
4162MMYRNS AVE, 0022
,LA QURTM CA %22S3
SMANABEMM CIA 92075
838y192-1500 l'RI-6 Site
USE OF PERMIT
LOC/A6 OFFICE INFORMATION
Gi �.In R OaIS
75460 ST. Ca'W. ,0j PL
(j:y7 .6-4 54.613 4'94.604 LEAK HILL- k�I1;tIDI)NO;fy';t'YPE
Q;-V?7SoI.iNTA€r Y V1 RUC"9'UR AL MC/DIPICIATIC9NS
VALVA f'IUN 2060M00 00 i, s
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20gY.!SJ'GCe4 o
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.
CONSTRUCTION T_ELP 101-000-418-000 $29`;A
S'd'.I£.01;10 &s1(1`17d: N PEE - RESID; ', 101-000-24.1-000
?FsE _P
10 2001
CITY OF LA QUINTA
FINANCE DEPT.
STJD- rC9'dAAi. C-?NMRT.:C::TIOX AND PLAN CM -CM
$200.00
L&Q3 P:f E-Pli`. T-11.F..s
$0.00
"4't1'EAS. PERMIrIT Is .�5,� IDVE NOW
92€ 9.00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts E
Forms & Footings
Ducts f
Slab Grade
Return Air
Steel
Combustion Air i
Roof Deck
O.K. to Wrap
Framing
Insulation
_ _
D%' pZQO
�� _U2 �J/�(. �jbOl14A1
Exhaust Fans 4
F.A.U.
Compressor }
Vents [
Fireplace P.L.
Grills i
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
[
•
i
•
Final!._OWI-V i
BLOCKWALL APPROVALS
Final (
POOLS • SPAS
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 1
Electric Final [
Waste Lines
Heater Final {
Water Piping
Plumbing Final [
Plumbing Top Out
Equipment Enclosure f
Shower Pans
O.K. for Finish Plaster [
Sewer Lateral
Pool Cover [
Sewer Connection
Encapsulation
Gas Piping
{
Gas Test
[
Appliances
[
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:
4
ti
Page I- of a
DAVEfSTEAVE:-S
4.
hispedion Services
PROJECTGA vJtrS �' .P►�SC l°� PROJECT #__ ty0 2:-.'4P 3 I
ADDRESS.:Vq-X3`7`: &;2 (t31 e of CLIENT I` GA t,JES`T., koro
tCW l tL,4ej �. BL �(o S:
y �4 DATE
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BLDG. PERMIT #ARCHITECT GOL'M d4(Z.C.,
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ENGINEER ,fit" 'S4 �l0 :�� L. CONTRACTORS
j
INSPECTION 'TYPE
INSPECTION :REPORT
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DCERTIFICATION OF COMPLIANCE To the best of ourknowledge,°.alhof,the reported work,:,unless;otherwise noted,
substantially complies with approved plans, specifications and applicable sections1.:of the:buiiding codes: This report covers
the locations of the work inspected'only and does not constrtute engirieeririg opinion or project'coritrol.
• ��,< ;
CERT. NO. O�3SQ S� S' SO a' `INSPECTOR NAME p ' " F Ai>t,.aJS
nt
DATE. eZ 8 r_C /'3 1;100 Z INSPECTOR SIGNATURE' j�+.
,. .-. .. . - .y ._ ^ T 'Y.'.3 -m ... ir.�ii-�._.. "s'�•:.. •;-+N"1'ft'19.:<-L '�•,..?• �.,ipn`,n1:iy,i+sF,y�v,'3'1^i^a�'y,?S�•ii4'.
i.
-'-DAVE- STEAVENS"
Inspections Services
:'PROJECT L�+� �If5'T•t7NASE'
ADDRESS .-Sy =6'3 .. 25
-'OA{1H7LL hA,Jg
BLDG. -,PERMIT #
ENGINEER a4 i %I k I rj i e
INSPECTION TYPE
Page ( of
PROJECT #
CLIENT-:: 1C1 K. CST' V-ky- �
DATE 1lv t=t. ayo Z
ARCHITECT tjoL6 A• R 2(?j4 %�L.%u 2c:
CONTRACTOR t
{
INSPECTION REPORT
f
CERTIFICATION OF COMPLIANCE To the best,of our, knowledge, all of the repoitedwork,,unless.otherwise noted,.
substantially complies with'approvplied plans, specifications and apcable sections of.the. building, codes. This report covers
.uw the locations of the work inspected.only and does not constitute engmeenng oplrnon:or prompt -control.
CERT..NO. _�3�43 �i� - .� INSPECTOR NAME AJ t Sf R'✓ESS
$r4'i wa.. ±wit
h) `.
~ DATE a Le SEB uD Z INSPECTOR SIGNATUA
PROJECT t'G A uJ PROJECT #:
ADDRESS '� L��
CLI--ENT
DATE I . m A:IrZ oZc)p
BLDG. PERMIT # ARCHITECT 6.,O&RA! A aC4
ENGINEER ju 0 �J S A JO i �,. _" � L CONTRACTOR DSL M tQ fZ PAG) r'i C-
. INSPECTION TYPE
INSPECTION. REPORT
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CERTIFICATION OF COMPLIANCE To the best of our knowledge;'all of thereported work, unless otherwise noted,'` i
substantially complies wit. h,approved plans; specifications and applicable sections of:'the,building codes. This report covers
the locations of the work inspected'onlyand does not con' t�tute engineering opinion or project control.
CERT. NO. O 9 37 S C� INSPECTOR NAME�:Cv SGA.
,.•`DATE � �1� /( o?v� Z _: , :•. ,,..> "� > `ntClear
INSPECTOR SIGNATU