0104-224 (BLDG)LICENSED CONTRACTOR DECLARATION'
I dere Irm under penalty of perjury that'l am licensed under provisions of
' ChapMcommencing with Section 7000) of Division 3 of the Business and
Profes3'IQFi"als Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
d 31sa B 01V3il2t
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.
(),) 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.
CAL AINDMI TY ?dW9�2k'�id�
(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.
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) Date
PERM�T#.
... BUILDING }
-PERMIT:
DATE �., VALUATION LOT 0104-2,24 TRACT • '
JOB SITE
APN
ADDRESS
0.
OWNER
CONTRACTOR / DESIGNER / EN INEER
PGA. WEM s' Z%'`ME3+3IIAL ALSISOC.IM109
DEL MAR PACIFIC, GAINERAL C914`i 2ACPUb
1.10 BOX i 00
462 9MVER iO NVE. 0302
L& QtMITA CA 92253
vX0L WA.BRAM, CA 92t9''PS
(858p -1500 03114 5823
USE OF PERMIT
LOCAL
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014RD
APR 2 0 2001
CITY OF LA OUINTA
FIN CE DEPT
R { }
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
I 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
/,/9 L/
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
I Party Wall Firewall
Exterior Lath
Drywall - Int. La}h
�Luv �r
_ _
Final
Final
B
9�� OR
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Plbg. Test
CinUnderground
al
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
i Exterior Receptacles
G.F.I.
0oke Detectors
1-mp. Use of Power
Final
Utility Notice (Perm)
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Page E of
DAVE STEAVENS
Inspection. Services'
' PROJECTS
PROJECT*
o? C70 -
ADDRESs Ae LI S i cf) CLIENT `.�A lal CT A,lUfl
DATE
BLDG.rtPERMIT # ARCHITECT c.T'vQG .
ENGINEER CONTRACTO4-1,�EL'wtAA, A4 .
INSPECTION TYPE .
•INSPECTION. REPORT
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CERTIFiCATION.OF COMPLIANCE To the best of our. knowledge, all of the reported work, unless otherwise noted,
rsubstantially complies witFi: approved plans,.specifications•and applicable sections of.the buildirig codes. This report covers .
,the locations.of the work'inspected:only and does not constitute engineering opinion or project control.
. CERT. NO. 0 3ie. OR NA
INSPECTOR NAM
,DATE
-(� `1�Lrl _ 1NSP r z r y v
' - . EC70R SIG
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s: Page of
• DAVE STEAVENS .. .
Inspection: Services'
PROJEC'� . l,l�S`'I" .--\)IAASZ 'PROJECT # -I — O
ADDRESS' A S L1 S ► CLIENT �t U)
DATE I,3..�:GcL`i Po /
BLDG.. PERMIT # ARCHITECTC�wf\ �&o i Zi �e. ?1fa
ENGINEERaAO.) Just CONTRACTO10iL 0W. C_
,INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the, best of otd: nowledge; all of the reported.work, unless otherwise noted,
--,substantially'complies with approved plans;: specifications'and applicable sections of the building codes. This report covers
Jihe locations of the work inspected onlyand.does not constitute engineering opinion or project control.
•CERT NO. 3 _ JE INSPECTOR NAME \'' V '� �'J•
BATE INSPECTOR SIGNATU l