0104-216 (BLDG)LICENSED CONTRACTOR DECLARATION
Inhere Irm under penalty.of perjury that I am licensed under provisions of
ChapWcommencing with. Section 7000) of Division 3 of the Business and
Profess'T pals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
pV f Cs
COM 7/2(
Date / f ' 1 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.
C.AL II;LlDMA22J'.i^' ld.r£� Ll -fit,
(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 4„
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 restriction:: 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 �g—'��1� TRACT •
JOB SITE
ADDRESS
OAK l, .' 7.2
APN
- -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
x'13 BC X1060
462 UMMS AVY.. 0302
Ut, QUIN-'A CA. 92253
SO`LAWA B.TW1.1 CA 92075
(858)192.1500 C'BZi'f 5823
USE OF PERMIT
LSClab'., (MeFLCE it KIIRIt ATION
75-160 ST. CHARL-ES PL -
54� M496, 34.634 l& :34e672 OAK TP - BUIL,DINC F, etlPE
I I 'il'OL Ai^!'. 21.4'' STRLXTURAL Mf DDICA'I`fONS l
VALUATION ix
COIRI 'RUCTION Lary 101.000.418- 00 $207.00
SMONO A4,d:3TION FER . MID 101-000-241.000 $7.00
A5 3-1 I' ., C('. , R•MMC ),q As D K-1817 C".a IK
$209.00
L&93 PRE _Plolkw FIERS
00
APR 2 0 2001
Wf OF LA ®9DMA
FaNg DEPT
ReMrPT—S BY;
DATE FINALED
INSPECTOR
1'! t,I,S � •'4
INSPECTION RECORD
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
Framing
Insulation
_
I
F.A.U.
Compressor
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
POOLS -SPAS
BLOCKWALL
APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
[Lal
Underground Plbg. Test
in
Gas Piping
.0 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.
411 -oke Detectors
mp. Use of Power
Final
Utility Notice (Perm)
j- - r
DAVE STEAVENS
Page oZ of 4P -
Inspection Services
PROJECTI +` HA5C 1P% PROJECT # cP a-0 (� 0 3
ADDRESS p 5 C.r 5TeD CLIENT t�-�A L•.1c S .. HOA
BLDG. PERMIT #
ENGINEEI��I u '1's spw o ft - f'3
INSPECTION TYPE
DATE "7 SLAB kJ C eP v -o
ARCHITECT Gc>L.8A jill RCi4 1 rC cTu k
CONTRACTOR le L rn A eZ c.
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially 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 project.control.
CERT.NO. n%<934R-5 V INSPECTORNAME� ^J
(P"id •Etearly)
DATE INSPECTOR SIGNATURE-
k' 14
` Page of
DAVE STEAVENS
Inspection Services
No
PROJECT P,445c; 14 PROJECT # 02 001 3
ADDRESS 45 L -1-57-E-0
-'�L-bC.# \\
BLDG. PERMIT #
tf
ENGINEER cx 63 A X101C-
INSPECTION TYPE
CLIENT P&)i 6cJ c 5T f1011
DATE -4w-VE- ayo t
ARCHITECT (S o t-dr4 AZ cH t rE cru2L�'
CONTRACTOR JJ MA J A c i FI C,
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
�&ubstantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
I,the locations of the work inspected only and does not constitute engineering opinion or project control.
A ,L C
CERT. NO. C7 !35� 3 7q - S -V INSPECTOR NAME e 611E d tCQ S
Print Clearly)
DATE l,2 J"(.c�� C��%y l INSPECTOR SIGNATURE t''►— ..�.�. n .J—�
DAVESTEAVENS
Inspection Services
PROJECT
A t��s 0 A se I
ADDRESS �5 t_ t s ► Ll
t. BLDG. PERMIT #
ENGINEERI.,. a,,\ SA d a t t rJ .
INSPECTION TYPE
Page of '
PROJECT # o2uD (— U 3
CLIENTZ;)hA t.lr�-
DATE {
ARCHITECT(�:)oL.2 R AV-cj4 accri, Qc
CONTRACTOR)�El_ /AAQ _ ?flC-r rt C_
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 applicable sections of the building codes. This report covers
the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO.y�S J 3 f3 -S,(:) �Q INSPECTOR NAME c `WJE I-AkS
Iggr
DATE I J y Ud E pw O / INSPECTOR SIGNATU
Page 1 of 1.
DAVE STEAVENS
Inspection Services
ti
PROJECT ujt ST _ NtkMZ 0:4, PROJECT #
ADDRESS -A S c- t S'c Z� CLIENT _�&-A WEST- 1yo►4
.BLDG. PERMIT #
DATE 3/ M A 0-o I
ARCHITECT AP_C_H 1-1 e<--/ tv/Lz-
ENGINEER'Dt• Q tJ 5Ay o I E 1,0 <_ CONTRACTOR 1 C L M A 2 )Z;9 c Fr o
INSPECTION TYPE
INSPECTION REPORY
100.(.4`[. U
A A I L I J (, C Q M p L. t. C C LL,,
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially 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 project control.
CERT. NO. Q INSPECTOR NAMElVd-
int Cleary)
DATE �_�� C90 C INSPECTOR SIGNATU
- DAVE STEAVENS
Inspection Services
t,.J
.PROJECT
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ADDRESS AS -Lj STe-j)
BLDG: PERMIT #
ENGINEER ,� ul✓A/ S M ✓o 1E / Al C. .
INSPECTION TYPE E PO -e- y
Page-
PROJECT
age
PROJECT #' a or->/ O 3.
CLIENT 7w A .
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DATE #1 A `F
ARCHITECT A P2CA tT CTt�Zt;
CONTRACTOR IF-L.rr Mz�.
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.applicable.sections of• the building codes. This report covers
he locations of the work inspected only and does not. constitute engineering opinion -.or project -control:.-• . ;
CERT. NO. O �3S"93 �g -SCS ; . , INSPECTOR NAME `/i4✓(�
- as A a IP. �__
DATE INSPECTOR SIGNATOR