0104-222 (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
f,
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.
(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.
Dater ,`! - Applicant F•
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'
BUILDING PERMIT- PERMIT# _. �... �.
DATE VALUATION LOT 01,0 2,2,2a TRACT
1�af �� 6YY:aiJaSHI J
JOB SITE
APN
ADDRESS
0AX TREE
_
OWNER
CONTRACTOR / DESIGNER / EN &NEER
PGA ails 9f RESMENTiZA% OO(UnON
Dia, W& PAMIC Md't:` A • CaKM.€MO
PC) WX 1 C,U
462 917N.W3 AVTK. H9.02
i.,A tdU3'UA CA 92233
SOLAWAB,EAi. A CA 92075
(858)x;;;,9 ti+ -1500 CIBLY 5823
USE OF PERMIT
WCAL Ot'PKX? INFORNIA.'T1014 .
K.K.MI. k\, TYJ
73.160 M'. CAH A RI LYS" PL.
X64 ` -U4, 54.236 &54- OAK TR RE y B U i Lm iN af4; ,,-fi;,E
9VOL1.1'NTAR#Y RTRUC"§'ii-R&L h�SODWRRICAT 10149 p
VAJAVwATION 2%00M L8
MANIND CObvr OF 01DINUfRUMON
SUM"Ry
CC:sNSTBLUC,T1OAi PER 101-000-418-000 $201"
V1:s0M MOTIOIN YEE — U..SID 101-0004AI-000
►, w C3'YsAl, r' .- �� `. 'u�°i1CIN iAt�T,I� P .AH CIMOK
$209.00 '
LPteTMU DVENOW
=W.00
APR 2 0 2001
PJITI�' ®f( C� QV�Ii �RAa
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
IINSPECTOR
" BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts f
Forms & Footings
Ducts {
Slab Grade
Return Air {
Steel
Combustion Air t
Roof Deck/_
Exhaust Fans {
O.K. to Wrap
Owl
F.A.U. i
Framing
�����
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
Final [
- SPAS J
BLOCKWALL APPROVA�S
!
Steel [
Set Backs
Electric Bond {
Footings
Main Drain {
Bond Beam
Approval to Cover
Equipment Location [
Underground Electric
Underground Plbg. Test I=
Final
Gas Piping ["
PLUMBING APPROVALS
Gas Test [
Electric Final {
Waste Lines
Heater Final j
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 j
_
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
14
` C. _ , C- 6
d.
'.78
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CERTIFICATION OF COMPLIANCE TO the bestof our knowledge, all of the reported.
work, unless.otherwise noted,
substantially complies with approved plans; specifications and applicable seetions of the building codes. This. report covers
helocations ofthe-work inspected :only and does not constrtute:englneenng;opinion or proiect control.
CERT.
R0. O9:59 3 / S ' ° aINSPECTIOR NAME IJS
q .e .
i DATE
INSPECTOR SIG
NATU,
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r
CERTIFICATION OF COMPL' IANCEAd the best of our knowledge, all of the reported work,..unless'otherwise noted,
substantially complies with'.approved plans; specrfications and applicable sections of the building codes. This report covers
—)heJocations of the work inspected onljrand does riot`constitute engineering opinion or project control.
CERT. N0.0, 5 9' .3 f3 ' Sd.:° INSPECTOR NAME kJ c "'S �' Q
• _: :' ° J'. ate' . ti,' i Yliri�e9fij/%. .. - ..'
DATE dig Sly tJ C: �c�'� II ' INSPECTOR SIGNATURE f,'.
Page of
AVE STEAVEN
Inspection. Services
PROJECT�C.�p► lg' fel A�� ( PROJECT #
`ADDRESS CLIENT -P ..6 �-Jes-i N o Pr
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BLDG. PERMIT # ARCHITECT(., A ;henup
ENGINEERJuJ�AJn,F [ �J CONTRACTOR S.^r!R Wc-, ,
INSPECTION TYPE
INSPECTION REPORT'
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CERTIFICATION OF COMPLIANCE To the best of our knowledge, all of the reportedfwork, unless otherwise noted, ��_,...
substantially complies with approved plans, specifications and'applicable sections of the,building.codes. This report covers 1. 1
�he.locations of the work inspected'only and`does,not constitute englneonng opirnon or project control
CERT. NO. P��S9.�-_J.y ``'INSPECTO t
te' R NAME _ t i
a� x A. A
DATE V7L INSI?ECTORSIGNATU
Page of Z
DAVE STEAVENS,:.
Inspection Services
PR0JEC14" 1.cJLPROJECT # o7csoL - O 3
ADDRESS .• A:5 . LI Ste' g:�('� CLIENT iS
i
DATE` ,2;
:BLDG. PERMIT.# ARCHITECT (;QLAA -Ae e*4 (T C c-rcF 2 �
j
ENGINEER J IJ �J o E .SJ L CONTRACTOR])'
ONTRACTOR 64. 12A o2 PAcir / c-
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INSPECTION TYPE
INSPECTION: REPORT
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CERTIFICATION.-OF COMPLIANCE To the best. of our Knowledge, all bf the reported work, unless otherwise noted,..
:�fhe'Jocation'
ustantially.complieswith approved plans; specrficatlons and applicable secfions:of'the_buildingcodes. This report covers
s of the work inspecfed`.only and does not constriute:engrneenng oprniori or projectontrol:
CERT:.NO. O��/.3 �Q�.—� INSPECTOR NAME �E fllltr►-�.5
DATE 075r INSPECTOR SIGNATUR��