0108-334 (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
73315 2. 33
Date 't �', % f Signature, of Contractor
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, Buslness & 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.
CAI, fNDUR:kwIIfy 'H"t42I74A
(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 Latipr`
Code, I shall forthwith comply with. those,'provisions. ;{
Date: it �� Applicant _v %, ^ �• %%r ! .M c
f/ .
7WarnWi 6 Faildre to secure Workers' Compensation coverage' -is unlawful`and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to.
any permit issued as a result of this applicaton agrees to, & shall, indemnify_
& hold harmless the City of La Quinta, its officers, agents and employees.=
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature...(Ovvner/Agent) A' ! bate ?Z/:
/:
BUILDING PERMIT PERMT#
DATE VALUATION _ LOT 01.09-3',A TRACT
1/J
' :�►$A.DJII$3
JOB SITE
APN
ADDRESS
QAK XMJ.
OWNER
CONTRACTOR / DESIGNER / EN &NEER
PGA VVEITr IUMD11:i43 IN11.A; WOC IAXION
DEL MAP, P MVIC C}E3�►M. C✓OMt ACNIR
PV BOX 1060
463 5 13 AV, 0.902
LA QaAZt Mk CA 9225'3
80T AW3.A.RUC3 CA 9205
(658)792.1500 Cavi
USE OF PERMIT
L'OCAii OFF= i11FO.RAILAT1014
'155.160 ST. CI•%Asl LES PL ,
9� °d£�ti,�52Saf 54.941 &34.829 €i,A K KILL - BUIWINO 1, S PIE,
C �CJ'isiTARY STRUCTURAL LMd4nNF(e''AT11ONS
VALUATION 20,0 +0.00 1,S
ESTMA7 COS)7' OF C:ONSi" '.I'�t-FIO 1
�C93�s iD.:CK3
K;C3;V5'1'RUC:TJON FEE 101-000-41B-000 $207.00
3P'1'RONO MOTION 1W • iM ESID ; 101 -0300-2A I -t0Cd
D Q �
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
STJB-IrMAT., t^;0MT1R,1TCY109 AND RL.l W' 0 X.K
$209.00
LESS 1_"' 3 -7 -PAID FM
$0,00
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE 1
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 4
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 5�� ,/�
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 I
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:
i
Page. Of
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DtVVE'
Inspection Services
I
PROJECT ';�'
PROJECT #
A g6fIr
Ig elk CLIENTS
ADDRESS 6A
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PLA" 12": R L� I F_ a: a
AILL DATE
ARCHITECT.�BLDG'.--PERN ARC
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kNGINEERh u',) 0 SN'o,,t k;_ - M.) C; CONTRACTORI-C
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INSPECTIONREPORT
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our.:knowledge, 61116f. the. reported! work„unless otherwise noted',
substantially
ERTIFICATION OF. COMPLIANCE- To the. b t�of�
th”
complies, aPlAv6d-piihsil .if6qti6nsr and!'ippIi6abIe6ecti6ns of,the:b 'id' This report covers
i , .,..._ !qg codes.iions-of the %i6w f .he loca work inspected no :constitute.enainepTipg-�pp!nion of 6i'd6ntrol.
I ..f projp
INSPECTOR 'z�
CERT. NO. (0 9, �59 CIA
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DATE F Ic ., -!N§PEq!qRSIGNATOR
-77 7
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Page .1 of �--
- DAVE STEAVENS
Inspection-, Services
PROJECT C-� R ..ls) E S. - .I P, PROJECT #
ADDRESS
tt963.Q,�S CLIENT G"A t�J�ST �or4
DATE .- a O0, 2
BLDG.PERNUT°#
ARCHITECT (ho d+4 1RCNt''TE'G uRt� i
:'ENGINEER. iOrJ SAQutr=
'll.lLCONTRACTOR%)ELiL
,:INSPECTION TYPE
I
INSPECTION. REPORT I
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CERTIFICATION OF COMPLIANCE To the best of our knowledge, all ,of the. reported work;',Un. less otherwise noted;
substantially complies with approveii plans, specifications and applicable sections.of.the:tiuildirig codes. This report covers
'the locations of the work Inspected only aril does not constitute; engirieenrig opinion or, project control.'
CERT NO.
� _
"` DATE f E �, U-C� a-. INSPECTOR SIGNATOR "�.,
._ , .:3Y. ; !;b - ;'''`"�;,i'•„-;_n-:„ .>r:.;;•, jrt>'S`'- " <"Af.JSJL� ,T'�er.^e.+^'1 •s(:?icY •�rs`a :e,.: _ _ ••t.,:?4:�:nia ^^,S+A.sc4',=.
i
4: s. Page �- of i
=DA�VE�.. STEAVENS.` . -
"'Y Inspection Services
PROJECT #
T
PROJEC.�� J�:ST - t�N� \.3.
- - � - 41,o�b�a O3 �
ADDRESS ' A5 L 5 E J "CLIENT A_ c,J E �'T N o R ,
DATE rt$: o o Z
BLDG PERMIT # ,_ ARCHITECT C, oto R A2_cH r.T gc7"ucE'
.n
ENGINEW. AL SN6617r L. CONTRACTOR "Dt- M,P, Z F'fiCS•Y I L
INSPECTION TYPE I
:INSPECTION REPORT
CTRL 5 — a ' 3 ,•``1 S- _ 3Lo n,. ` -r6
} Y
L�Lo_LK(rJ'C�.
n
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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 inspectii :, ly and does}not constdute engineering opinion orproject'control.
CERT. NO. O S.Sg' 3 g- SU` INSPECTOR NAM Jt= ' J'r> A J S
DATE %' E Q INSPECTOR SIGNATUR