0108-336 (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
Date �' % Signature of Contracto[�% ri. �`' i ;f.. f r iM/ .
-„,,,..,.,.,,,,...,.....rte-• �' ) . t'�� ,} � e �'
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 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.
(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 comply with those provisions.
i
Date: APPlicant)
"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/Agent)._ /ivy �� ( ' Date
BUILDING PERMIT PERMITk • ,
DATE VALUATION LOT W.M•336 TRACT
/
JOB SITE ' V Zq,.._..
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
PGAVIET15t. DM41W* , iWOCUTIO 3•
Dra-1 W.Z rIMTCr GEVERAL CQiMP, i 14TOR
P0J3QX 1060
462 UMVE S AVR '11302
LA QUJV A CA 922'5.1
801.ANA MACH CA
USE OF PERMIT
LOCAL 0FI OR:INPOR1?4 ATION
�4l; E LL” iC�t
7050 S'T', CHARLES P)..
1A-4-7 :% 3f-74;3, N-.'i,ST &.M-709 OAK NILI..' BUTLI?)NO � TYPE
10C VCiU3"IN Aki Y 3'i RUCTUI1rA,T�A,0D)F1" m
�
J
VALUATION 20.000.00 LX
aT.HRUYa`91W 0067 M t:OI3WINUCITON
201(XV100
mama §,n,summA ' i
CONSTRUCTION FFS 101-00041R-000 920100
1*"Ti.ONO P•1TO:'ION ",T, =9t D . 110 -1 -000 -2411 -WO $3.00
.p
. 4
Lr-�1
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SUB41af AL (_'01J',73.RUCTI0.9 AND PLANT CEMCK
$121M.00
UMS FRE -PAM MW
S0.00
TMAL PEM49 :FUS DUE .NOW
r
%00
RECEIPT
DATE / BY
DATE FINALED
INSPECTOR
H. T
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. to Wrap _ 1
Framing
Exhaust Fans
F.A.U.
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%S�d7LyaJj
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
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: /oz
U ��A*&0P d�11A
%
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)
_ -,` 4:,yy7•, .. tS5. `"P ,f .sig- F . $ i�� 7 it r 7 bit' f ♦`. ir.^ 'i ..''1 .�'. -'�
.. .,..,3f : y I Y `�`, ' �] S 4 •`.f S. VJ: Pu. � , p�C,.�', t'�. � . 4irim.^ -iR' Y ... .r1 ':J..,i• a. r Pt. rM,n s
Page _ of
DAVE.; STEAVENS
,
Inspections Services
PROJECT (t � L'Si 3�..1r!!M { `I; PROJECT
..
ADDRESS 'A S* �►' Sr �D . , CLIENT S . , t.J t S 7
LD t�3;. DATE l
�i-=• ��g- � aoo2
}, .• BLDG. PERMIT; # ARCHITECT : COOL Q314 {-4G'� Tecr u 2;�
S. `
r. .
ENGINEER,,a� : 5 A Joc e Z L CONTRACTOR �l. �►'� A 2. �L� �� L
INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE To the best of our'knowledge,3all of theyreported works unless otherwise noted,
substantially complies„with approved plans, speciflcations`and .applicable sections of, he building codes: This report covers
the locations of the work inspected only and does. notconstituteengineering :opinion or project control
CERT. NO.
-0.13 � 3 INSPECTOR NAME. r . • r .K
..♦ i : :4 . ,' - y� � �w �� 3 x mt CIeaAY) j' �.- � r .. . .
DATE I F L- vz' x,Oa Z INSPECTOR SIGNATOR `
Page _ of
AVE - STEAVE
DNS
r Inspection- Services
-PROJECT .t;, A W € sTIA. SC' .` PROJECT # a: oo: 2 d.3
'.}
ADDRESS' "7 `�5J . . 3 7 � 1,1 ' O
%'�^� oq CLIENT. A u] Es
DATE: F6.6a, oc Z
BLDG. PERMIT # ARCHITECT 6a.c:`8A A f'C# rgLTu2L
ENGINEER D u` a S rg "y O I P._L> i r.1 t CONTRACTOR pf
INSPECTIONX —E
INSPECTIONS REPORT
D
4 Im-A I-AP.
70 4.. L s �J�' Ti�S`u.�A'i1.0►� ".`oM
ID
CERTIFICATION OF COMPLIANCE To - ie best of our.knowledge, alFof the teported wo�k,.unless otherwise noted,
substantially complies witWapprove- plans, specifications and,applicable sections of'the.building,codes This report covers
K the locations of the'work inspected only and does not constitute engrneenng oplrnon.or.projecLconfrol:
a
CERT. NO. -T7 3 6. ' O - INSPECTOR NAME. 1:,'
l ' ' ._ •`� �.,: .. .. �/ k...�C tet; � r�:•. ��� :... ��a. ^
DATE 3 � .w2
IN SIGNATURE-<`
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DAVE fST€EAjVVT T
I
Page i of
Inspec:.tion ;Services"
PROJECT�WE 1: - I�NA5S 'l!3 PROJECT #
.. s
ADDRESS. may- 7Y S CLIENT. GAEs Ho N
4A"K N m:'' 3 -DATE
BLDG: PERMIT* ARCHITECT 'Ga'U A[CNiTF"cr�.�'.tt..
ENGINEER, :SAt1O�� /,JL CONTRACTOR"�t.L' /►9A4 �A'C�F►G
.INSPECTION TYPE
INSPECTION REPORT
a q. .�
SDS SGR�.u7S A�J� �ND fale/o2 aJu:T<S
�� T E cy: "O u'?' {�� T c- r► 5.:. o AJ Ty i AJ To r4 i'
-� CERTIFICATION OF COMPLIANCE To the best of ourknowledge, all of the reported work;.unless otherwise noted,
substantially complies with approved plans, specifications grid applicable sections of.the building codes. This: report covers
-the locations of.the work mspected'only and does: not constitute; engireenng opinion projecYcoritrol....
_.
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CERT. NO. INSPECTOR NAME,. 19.tJ S:f�A(CT.tJS _ .
DATE �7 /"L�d 1206 Z
-. INSPECTOR.SIGNATU ,
,..._._..r. of
Page
AV.E::STE YENS
Inspection Services
PROJECT #,':?Do.? D
CLIENTT M4 A .
DATE
ARCHITECT7utr
CONTRACTOR Vii. /YIA�AcI r i _
jNSPECTI0YREPORT
rD t L Q.W y M r? s o .Ji (2 t
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• f?Ck t L I U- L o s N- Ca. �Gt?Tti=i 4 1 j"� �ZJ 1 �1 rrE� �T H /g -L I A.
�CERTIFICATION.OF COMPLIANCE To the best;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 project`control.
CERT. NO
INSPECTOR NAME
DATE / INSPECTOR SIGNATU (may