0108-337 (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
/�. i; 1 s 12(
:
Date �.l;Il Signatu-re_of-.6o tractolr=�'�'
OWNER -BUILDER DECLARATION 4'
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 thestructure 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.
Se/„• I have and will maintain workers' compensation insurance, as required by
c)fion 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.
COAL, INDE YT Y 1+13QQ1%,#
(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, l,shall forthwith comply with those provisions.
Date`!, /10 46i / Applicants
Warning: 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.
Signature (Owner�Agentj 4 ' t�Y �, ' ' Date
BUILDING PERMIT' PERMIT#
DATE r; VALUATION LOT 0108 TRACTS •� i. . r.' ti
JSITE
APN '
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
MAW::.t°;?' REWDEWIPL ASSOCAA 71RX4
DEL MAR. PAW K! 0, Ri:IMAL COMMACM.9
PQ BOX
462 913MB AVZ 302
.LA.QUWA. CA, 92253
SOLWA:E RAI CA 9205
(859)?92••1500 a o $823
I.04`AL taFF10F, IAflK,iIMA.TION f .
USE OF PERMIT
W..)MI LA 4)US
'75-160 3'I`. C}IJtE •L3 P1,
Clob3�, 54413 & 14.661 OAK .HILL - BUIL.17YNO , TY -PK
STRUCTURAL MODIIr7,C4ATIONS
VALUATION 7%000.00 lk
F9 S AT` COIF OF CONUMLfCMON
20,€ .W
.0 SYRLW.a.Y.1t%7 X9.S9. lyL7h'1�d4'SM.V6Y.V. A
� ti
CCA1`T-0RUCTI OAt RZ 101.000-418 000 =00
°M'-kl,'JWCi MOTIO 4 Mv • 6;:EMD-w- 101-000-241-0,00 6�•UO
D
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
i
:1T� 13 •'�(J` Az. C01r3 ° �LiC1JOR AND k LAK C°FIEZC
V101 D.00 .
1X32 PF E -PA Ph.
$0.00
T01'. , g°FAMr>1' FEES DUE 14OW
l
RECEIPT
DATE, ,
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
Exhaust Fans
_
O.K. to Wrap �� py— ��p(Q Q
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%iil,GrG2oy►.�
BLOCKWALL APPROVALS
Final
Steel
POOLS - SPAS
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
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:
/
' F .
DA=VE STEAVENS
Inspection: Services
Page �_ of _I .
PROJECT #r
CLIENT�(��yJE �T erlQ(�
DATE, c2—I IEc 9-
ARCHITECTGvv3 •A A 2 e W ,
CONTRACTOR eLt rA A 2 'P,gc i ri C.
. 4
INSPECTION. REP}ORT
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CERTIFICATION OF COMPLIANCE fTo tfie best of our:knowledge; all of the.reported work,`unless otherwise noted,
substantially. complies with approved plans, specifications and applicable sections of tlae builoing. codes. This report covers
the locations of the work inspected •only and does -not constdute engineermg,opinion or project control.= •.
CERT. N0.095'93 `78 "S a'. t,. ,'k' :INSPECTORNAMEa , S't AJ£►� S:
1 Pr early)," • '
NATURE'j
DATE cP- �- F E B a 002- INSPECTOR:SIG
v
r ..
Page _ t of
DAVE STEAVEENS
Inspection Services .
PROJECT
-PROJECT # J uo'1 -.6 3 .
"ADDRESS. 5
73 .ESL ( CLIENT R
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BLDG: PERMIT#
ARCHITECT.: Goy $/� fl?C.N a-T'vc
ENGINEER:txF►J IJ 5 A Jd I
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E L� c. CONTRACTORE
INSPECTION TYPE E A )+-{
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INSPECTION REPORT
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CERTIFICATION OF "COMPLIA1.NCE To the best of our knowledge, all,of the; repo-rted work,unless otherwise noted,
substantially complies wltKapproved plans, specifications ano"appiicable sections ofythe building codes. This report covers
•.-/the locations of the work inspected:only and does not constltute;engineenng opinlon or project control.
-
CERT. NO. S INSPECTOR NAME N
1 � � t;. °. 1 r� " ,; ;� � '�". � •, �� ` � :- r' s�°� �'„�,'< ;� ( ) ,: -
oZUO Z r,. INSPECTO
DATE R SIGNATURE
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