0104-225 (MISC)LICENSED CONTRACTOR DECLARATION
I hey Irm under penalty'of perjury.that 1.am'licensed.under.provisions-of
.a�",;�`� ' `t Chapw(commencing with Section 7000) of Division 3 of the Business and
t fV LS Professionals Code, and my License is in full force and effect.
C ch License # Lic. Class Exp. Date
1133115Z B
Date Signature of Contractor
OWNER -BUILDER DECLARATION
03?31 r 2C
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.
(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 li should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, l 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 $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a. permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person -at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance )f such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
P-�RMIT#
'
�-BUILDING-PERMIT'-�---- --= .�
DATE • VALUATION LOT 0104--22S TRACT-�
Znlk r,430100
JOB SITE
APN
ADDRESS
OAK TI&.. .
_ ..
OWNER
CONTRACTOR / DESIGNER / EN (NEER
FIC3•A4. W, Mn. I RF=Z1 -0AL M.190CMNt, N
DEL M"..PACV 1,, i3.f:rNk,IZAT, MArr%Z e COPOR.
2K' BOX, X 1060
462'ULA NNS AVF. 0.30
LA.Qi3xl°ITA CA 92253
101A13. BIAC I CA 92075
(838)152.1500 C"Bludl 5623
�� It ♦+e �qt�� 6i3 C tr A tr�25
1A3C-„A1, V Cg I?�i'<?Yf,i6 � ION
USE OF PERMIT
15.165 Sff. t7'tfAR.ILR,1$ PL
54448, 54.140 & 54.132 OAK '9`3;.EZ - BUILt;MO t:5, TYPE
VAt..LDATION 2iP,0E:tdM LS
EUXIL t3A71ED LOST OF C:f3,N8`.E.RUC"noW
2t�,t if.fBCF
CONSTRUCTION TION H119 301-000-416-000 V07100
STRONa O'nUIN FEE . R&SID 101-000•-241-000 a.ao
Q q" 03`4 T, t .; 3 a' YpC ti !t'1gJ .!U+3Ti 3: A<id C £1 +:
2fl9.043
D IMS 'PRE -PAM FEDW
Sam
;PR 2 0 2001 .: rF—kWr JKUS ]DUE N W
09
F LA OUINTA
ANCE DEPT
RECEIPT
DATE ,
i
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
BUILDING
DATE INSPECTOR
APPROVALS
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap/_
Framing
_�_�
� moi!
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 �-I,
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
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
Exterior Receptacles
G. F.I.
oke Detectors
1,.p.
Use of Power
Final
Utility Notice (Perm)
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x Page of i
DAVE ' STEAVENS
Inspection -'Ser
PROJECT #. _ e -V yzIp — 0.3
CLIENT_ �• E. b -i o,A
DATE t .Z
ARCHITECT• e,.ou3R Arc..; crGc.rue-r
CONTRACTORCI)i� L r n A 2 Pro U ri e_
INSPECTION REPORT
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CERTIFICATION OF COMPLIMdE To the best,of our knowledge, all.of the repotted work; unless otherwise`noted;
�su6stantially complies with:approved plans, specifications and' applicable sectioni �of thebuilding codes: This report covers
,,__)he locations of.the work inspected :only,and does not constitute -engineering 'opinion or; project'control.
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CERTIFICATION OF COMPLIMdE To the best,of our knowledge, all.of the repotted work; unless otherwise`noted;
�su6stantially complies with:approved plans, specifications and' applicable sectioni �of thebuilding codes: This report covers
,,__)he locations of.the work inspected :only,and does not constitute -engineering 'opinion or; project'control.
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Page of
DAVE STEAVENS
Inspection : Services .
• PROJEPROJECT # a? .va 1. - o 3
..ADDRESS S 1-f STS CLIENT -?C -i . &J•_S w.4
DATE /O i..7k r_ 'Y
BLDG. PERMIT #ARCHITECT O t✓6 A RkW 1 iCLMUACi
.ENGINEER,110 0 SA Jot e- =Ajc. CONTRACTOR
INSPECTION TYPE, ,�•
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE Tathe best of our kriowledge,-all of the.reported work, unless otherwise noted,
substantially complies with approvedplans, specifications and applicable sections of the building codes. This report covers -
.___the locations of the -work inspected only and does'not constttute'engineering opinion:orprofeci control:
CERT. NO. Q1? ?%34G—.S6! ,
INSPECTOR NAME �JE •' • •'S�.AJe2s ,. .
DATE / ✓Gc C• y QZ v`DI INSPECTOR SfGNATUG+� :
L Page { of �...
DANE ':STEAVENS
Inspection =Services
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PROJECT (4, Il E c i RH A S e I A PROJECT `# c7
ADDRESS A!> ��5'TLrc�'''. CLIENT ��!}.•.r,J�s-r r-loe4
QI C� DATE cZ 4, z, E
BLDG. PERMIT # ARCHITECTot::BA ,ASC TEcTu 2t.
ENGINEER ,yqy o, E ,,)
c CONTRACTOR
INSPECTIONTYPE
INSPECTION REPORT
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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 applrca4le Sections &. the buhding codes. -This report covers
the locations of'the work inspected only and does not co statute engineering opinion .or project'control.
8.` SCJ INSPECT�J3CERTVO.S9►�J 5
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DATE 019 •l LAOE INSP.EGTORw- . _SIGNATUR x. s