0104-226 (BLDG)" LICENSED CONTRACTOR DECLARATION -'
+.'if herelogffirm under penalty of perjury that I am licensed under provisions of
C-;1ap (commencing with Section.7000) of Division 3 of the Business and
Profes als Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
7'5152 � ZDg�+1r2i
Date Signature of Contractor
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.
(Y) - I 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.
t.Wf. RMSWITY '13062174A
(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: ' ` 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.
I 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) Date
- BUILDING PERMIT PERMIT#.
DATE e VALUATION LOT 01KA-226 TRACT O'
JOB SITE
ADDRESS /..2 Z/
APN
- r
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
FIQ BOX 1060
462 ffE. *341 AVE #'2 %
LA QUMA C'J*1 f�253
C;TI C -A 92075
SOURA Mr�,,�rt�ry
y
X 3823
USE OF PERMIT
i,CtM (iFMCK INFORMATION
$+ i t" a JLC e
75.35i} 21'. CIM12S PL-
'S4Miil,Siai08fir-54•!NrLwTREY,- t'UILOC> O' <i,,ryn.
'o-1-M"N't'ARY S'CRtlC'1 URAi, WOD1k1<,%TEONS d�
VALIfA710N 240.010.00 LS
h` a AAA.AW,Padlri. M l!0w�i J6, Wr CON67A. UCIVE101'.7
bH7F�3tif•
G' HSTRUCTIONFEE 101.000-418-000 12Ti'140
STRONG MOTION lT1a1 • PX. SID 101-000-.2+11.000
va4nZ,YCi`.TC9'.�'4.�$,D:a�T�t�1`Tt^`1~i'�.d.``�.
DQ p LESS
�`2ffD5�.Ct�3
$0, Ula
1 P +�MFIV.f10 DUE NQ,')W
APR 2 0 2001
$2W.00
CITY OF LA OUINTA
ABY
DATE FINALED INSPECTOR
X3,1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
JINSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Backs
Underground Ducts [
s & Footings
Ducts [
Slab Grade
Return Air I
Steel
Combustion Air {
Roof Deck
Exhaust Fans
O.K. Wrap
_
/f�/
F.A.U. I
Framing
_
Compressor i
Insulation
�
Vents I
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls j
Party Wall Insulation
Condensate Lines {
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
pLi!501— SIR
[
Final
8/D,( �- _
Final (
POOLS - SPAS
BLOCKWALL
APPROVAILS
Steel [
Set Backs
Electric Bond [
Footings
Main Drain
Bond Beans
Approval to Cover [
Equipment Location {
Underground Electric {
Underground Plbg. Test [
al
Gas Piping I
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
I
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.
Detectors
W;_0
pke
. Use of Power
Final
Utility Notice (Perm)
A4 i
.7/ C, (r)PZd'f&) (L- odint-L iii A Xo7' bg.�Je5
LS lam, i9 20
A%
54 r_,4a 0A, I L ,j
P a
CERTIFICATION OF COMPLIANCE:To-the best ofour 'knowledge; all of the iepdrted-work, unless otherwise noted,
—,substantially complies With' appi6N;edo.lansi:'spe.'cificatio'*n"s'-"and'. applicable sections of thi building codes. -This report covers
__ihe locations of the work insp4ctkQ"nd.does. .not constitute engineerin"g opinion or project control".
:INSPECTOR NAME CERT. NO.
dos
'DATE 13 -VQ('y INSPECTOR"S"IGNATU
:ra ��r�a'"��.r?r F. �i l-',•' sY � � 1 y��+ �(��r y� C.,, �,,�,rsi!;'s(��''?�ti�y.�c<�a��--`tT+w��i• a•S'�"T�i'�.'w'"�+�''*.nr+i..*';�...3t�t.-:r<..;�'.w-
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Page 4 /
DAVE,, STEA.VENS
Inspection Services
J ..
PROJEC�N W'E_:S"t' / SE PROJECT # 6. /. - 03
'ADDRESS' •91 S STS CLIENTY?.G,FI
'DATE /O rk c; Y 61 -0-0 /
BLDG. PERMIT # ARCHITECT C— -AA k r~ +
ENGINEER-►�.cJ —R i oI 'e =- Ak. CONTRACTOR eG M Ciel C-
INSPECTIONTYPE `
T1VC�F.f''TT(11\T• 12F.P(li2T
dr1 C') c, .:F'�;:: ,..amt` e..�GL ii •�.. 3t2:� Sb-1�\ ''�'e;» C'.�:.,�:� „J � � ,
' w y Lqc_%. a..Z�C-tk Oct.
our �: 7 - "i1� tiii , "�?�i� - � 1`': L-tI r
to 'S ?c:2 lZ e -m
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•' o� A��� .W.f�S � GDvhUc..�:'C'
ALL.- A-r`r.t4S OAtt-ioL, C:-onA L C'
SBU-) HO Z
ANA
CERTIFICATION.OF COMPLIANCE: To the best of our knowledge,.-all-of•the.reported work, unless otherwise noted,
,•substantially complies with approved. _plans, specfications and applicable sections of the building codes. This report covers
the locations of the -work inspected only_and'does not'coristitute•engineering opinion.or project control.
CERT. NO. O� 9�C..�`:. INSPECTOR NAME
r ry9 (Pr' t�tearly)Y
LATE /� ��'� 4r C� v�I ' INSPECTOR SIGNATl1�F�E-�=
Page _L of
DAVE STEAVENS
Inspection. Services
PROJECTA�A .:ihN s— - I A PROJECT #
ADDRESS . -'CLIENT Q5% f-i0 r4
�2> DATE-. 3
BLDG..-PERMIT # .ARCHITECT r%pc,A A �r2Cw r T s GLT u r2
ENGINEER %,,j skc') r 9 ? L C' CONTRACT041CL /218
i
INSPECTION TYPE F—N* y '
. j
INSPECTION REPORT
51
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LCi! c� lr � �8
CERTIFICATION OF COMPLIANCE: To the best. ofour knowledge, all of tha reported work; unless otherwise noted;
-substantially complies with approved plans. specifications and applicable sections of the.building codes. This report covers
__)he locations of the work inspected only and does not constitute engineering opinion or projecf control.
CERT. NO. cez� 92 1d—Sc� :', :.INSPECTOR NAME � � .':... r�r1✓+ .j .
.0 S
_1 DATE 3 �� �Y� �' INSPECTOR SIGNATURE ` .