0108-335 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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
tl F9 0�1y�
Date / Signature of Contractor
r1
OWNER -BUILDER -DECLARATION 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.
( ) I have and will maintain workers' compensation insurance, as required by
lection 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 041) 1� M 1I3062174A.
(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:
Date:' Applica'1 " , i,,w W i' °1 ✓ ' �' r; ,;i i,✓
Wning: P–dilUrd to secure tX/o`ri<ers 05rnpensation coverage is'un
Warning: lawful an
shall subject an employer to criminal penalties and civil fines up to $100,000, i D
addition to the cost of compensation, damages as provided for in Section 370
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
for a permit subject to the conditions and restrictions set forth on hi
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),f d f Date
PERMIT#
BUILDING PERMIT
Q.�3.�.,.', r
DATE , / f VALUATION LOT TRACT
1
r . .
, .. _
I .r�aaaa�a ;
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER ,
PQ',A% Wr,1 ').` J_4V TyB1'lT1AL ASSO IAA'rK N
T:9a3 KA PAC.VC 0 MRRAL k -,'O V1"iZAM) 0 k
PO BOX l GSW
462 MRN13 AVE, ffXYZ
U-� Q TXS] TA C,k 9225.3
801AWARFAC11 CA,, 92075 ,
(858)792.1500 MTft- 5823 ,
USE OF PERMIT
.190.t;LLA '•iUEI
75460 ST. CI~ M -.LW PL
. 4.903, .793, 54.781 & 34-769 t:JI,.4K HILL. - RUILOINQ 7, `I'Y'F.9
40` we OLI31wTARY STRUCTURAL I130I:%sMATIONS fd
.1 •
VALUATION eft 00. Do
11:071MA '. D C09r OF COIN M.UC"9.'Te" V
�.'t}�&I�'itilf�'Dc>At .t��s. 3 �fl �T30�43 €��Ci02� �2E1'�,OS►
'
Sr6 Rg.rNO MOTION FRE - .MESS ; 101 00(1 -?.4 j -000
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SUB -M. rX,('!0I(YiRTTf'M01q'fiAQ)PT" CM.CK
i�,20'1.t3s
'i
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
O.K. to Wrap ���9��r,2. �`dia�+ "
Exhaust Fans
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 �� 1 �(� 4.0—M l
Drywall - Int. Lath
Final �/2-50-M /GL6j
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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:
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)
DAVE STEAVENS
Inspection, Services
PROJECT(,,P l h PROJECT #
ADDRESS A -i, c. -i sre'0
BLDG. PERMIT #
ENGINEERax�,, 5A JO t e Za C.
INSPECTION TYPE
Page 1-. of c1
07 CX> 2 -01)
CLIENT P&A W E5 -r P 0 A
DATE iCC6 d v O 2-
ARCHITECTC41-84 A aaN t Tt CTu Ae
CONTRACTOR)>EL M Aa jPA CG -e-, (-
INSPECTION REPORT
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r-; CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless. otherwise noted,
i substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
0
the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. g ��9 ��� INSPECTOR NAME _1) A J Z ✓ ! e A
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(Print Clear
DATE , FL"� 0�0� 2- INSPECTOR SIGNATURE iJ�
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ns
Iectiori Services
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ADDRESS 7�9. 7Q�;:'7?3 �OS CLIENT., �� (,�J EST /'SDA
`;BLDG. PERMIT # ARCHITECT GOLRA:. Ak?,,Hiter7-1.0)e i
ENGINEER ,�r 1 fj't) CONTRACTOR J L IVAA PA'G i. G► G
rt INSPECTION TYPE 1
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INSPECTION !REPORT
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CERTIFICATION OF COMPLIANCE To the besf of our knowledge, all of the reported work; unless otherwise'noted,
substantially complies with'approved plans; specifications and applicable sections of.the building codes. Thisreport covers
the locations of the work inspected only and does notconstltute.enbineenng opirnon'or project control:
'CERT. NO. _D >�59.3' 8 ..'�• v t INSPECTOR NAMEx ' ( r* s` ; e
DATE 13 rt l3' Z4r;2, INSPECTORSIGNATl1R
r •''v,•.r . a a'S i . Up; •"`,..�.,+.. ,tvSs�Y� t!+ ��.rt 4,•n': --.� . t.hM4q.�,•�%{'[. rr.wrs�y; `?'< ir.,..,-y '++"pp .. '".'�.^ _. ;rt ,..�Y';r�y�(::-``i
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Inspectio1UServices
PROJECT'#
CLIENTt_'�
A.
DATE
ARCHITECT..t o }'3A' ZeN
CONT R 'eTOR A2 cl r L
O R
A TI - r
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CERTIFICATION`OF COMPLIANCE To the best of ourknowl6dge,•all-6f.the reported work,. unless otherwise noted,.
substantially complies with approved plans; specifications and applicable sections ofahe buildmg;codes. This report covers
_'-
the locations of the work inspected`only and does not constitute_engineenng opinion or project control.
-CERT. NO.
5�137g`I�CiINSPECT(
INSPEC70R NAME.
DATE oZ 'FEof V 0 Z INSPECTOR SIGNATU - y
4 Sy{:.i � ,fit' • •' ..
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,,� Page _ of
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Inspecti d Services
;•'P.ROJECT�( PROJECT #,.c
ADDRESSIs I,rlyb- 4365 CLIENT
OA4(N �� ` ��DGa' ?r.:► `� DATE
BLDG :PERMIT # v ARCMTECTc, d:A ARC44 atc��E
ENGINEER,v_ Q SFa.)ntit '=Q L CONTRACTOR S L. mA,2. ALS
..INSPECTION TYPE
INSPECTION REPORT
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DCERTIFICAMON'OF COMPLIANCE To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with:approved plans, specifications and applica6le.sections of the building, codes. This report covers
the locations of the work inspected omy and does not coristltute'.englneen opnlon or project control.. .
CERT. NO. Q SS �I 3. y Q 1 D INSPECTOR NAME A� A do � C
Y
DATE nMR
INSPECTOR
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Page 1 of 'L
DAVESTEAVENS
Inspection+ Services
'PROJECT ?� i vJE:S t N 5 E 1 t3 PROJECT
ADDRESS'` -"7(0`9 78/ 7 F3. l�'O CLIENT:6 f� `h/4.s i
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INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF.COMPLIANCE To the besYof our knowledge; all of the reported work, unless otherwise noted;
CERTIFICATION
complies with'approved "tans; specifications and a"plicable sections of the building codes. This report covers
,� ..
-'the locations of the work inspected only and does not constitute`engmeenng opinion or protect control:.
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.^..ERT. NO.�iS: / �j'" Q INSPECTOR NAME ` J.
DATE / INSPECTOR SIGNATURE`
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} K Y Inspection Services
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PROJECT QG Pr �J G S t - PH 1 AS'E' ` (A PROJECT # 07 60.Z!.- 0.3
:,.ADDRESS S LSI S TE CLIENT
DATE rlE$ o�oOZ
BLDG. PERMIT # 'ARCHITECT (S- cx:&A iE c U tLE
,ENGINEERaj&,3" 5 �orE ,%.Qc- CONTRACTOR, t�,gc�r�L
INSPECTION TYPE :
INSPECTION REPORT I!I
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CERTIFICATION OF COMPLIANCE To the best of our knowledge, all�of the"reported work, unless otherwise noted,
ubstanUally. complies with approved plans;: specifications and`applicatile sections ofthe:building codes: This report covers
the locations of the work ins ected onl and does"not constltute-en Ineeri o Irnon:or" ro ect control: "
P Y 9 . 9 �. P P .1
-CERT. NO. OgS 9 3�p� - -(� G
C S • .• JNSPECTOR NAME. '• -: �'�� E
DATE ..r r INSPECTOR'SIGNATUR r x