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0104-153 (BLDG)LICENSED CONTRACTOR DECLARATION 1 here ffirm under penalty of perjury that I am licensed under provisions of �. Chap (commencing with Section 7000) of DivisioA 3 of the Business and Professmnals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 0.31:31/2C 6 e !��f� L 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. ,e) .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. GAIN1?�11�14:R> RITC NV62174 A (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: d +`, t Applicant— Warning:' pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties a4civil 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. jr /Signature (Owner/Agent) ,.Rr f'� . !!: a ,a% Date -4A,;/ BUILDING PERMIT PERMIT# DATE VALUATION LOT 01(W1153 TRACT • JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / EN (NEER P011A WEV1.1;IMWIA , A.51 ii'sCIRUCrIT €. EL Mil. t PAC"ik"xa," COMMA, S.''t.9Ai'M.ACIX) PO BOX Iwo 4R IUMV NS ANTI, 002 LA 'UMI. -A CA 92233 ".30, 41A BICI !.0 H CA, 92(ris (85$7791'-1500 r C 5823 LOCAL OfflyfC1►1HV0R.K4A.TK)N USE OF PERMIT :3 1ti4i .%JAZ C�" 73.169 ST. C-MRLES PY, 5.020, 34.09Y, 54.095 & 54 -OW OAX : PXF, Ri111,d71NCf/TY11F YQ VALUATION Do 1.4 e " ESTMATM COV OSP° c O191RUCT10M 20MID.00 VXPI W11 -vim subOAARY CO1'313'1~RUCTfON FEE 101 -000-41 "00 $200 S x'rt0)dt,i MOTION I" a RESTD 101-000- 7,41-000 $2.00 s LESS PF -t -PAID PM $0,00 APR 2 0 2001 1 1 �` VIM DUE a%Ow CITY OF lA DUINTA FINANCE DEPT RECEIPT DATE ✓ BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING IF APPROVALS MECHANICAL APPROVALS Backs Underground Ducts ms &Footings Ducts Slab Grade - Return Air Steel • Combustion Air Roof Deck O.K. to Wrap s/� / Exhaust Fans F.A.U. 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 ->e=- Final a���� Final _ POOLS -SPAS BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final _ 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 F.l. r0m. oke Detectors p. Use of Power Final Utility Notice (Perm) DAVE STEAVENS �:C:�', .. • •iPiii%•...fsac.`•a may_'. a Page % of Inspection Services . PROJECT�CC"AyJ'�-.� r PROJECT #" vo I - 0 ADDRESS >q S L iST Z CLIENT PC,-Av.�cS T KoA DATE I m A y 01 BLDG. PERMIT # ENGINEER+ 0 d S ooZ I E �•,J�, INSPECTION TYPE >c Pyx Y ARCHITECT GO L 3 A A P_C4 i Tt c i`u,2r CONTRACTORIt L MAX INSPECTION REPORT" %3 C' Lgcx -to►J-:�Er�crc�( S�w.�SouJ ET r , Exr� (-g3, Nuc.cS -1z-#'N CSIrzLj.-/ZZ. _22-uSNE'Q A06 CJ_et,,J of -�2 S ��t'�Ictrrcowl Au t;kJ I, LOc Mss 3z't.' -L ., � wc.- Wo, e,s- 1'1�%�T� t"D�a , ►?off - ILo" LEaC,7T.4 -ills Z P" DEy'M � bsA RODs' Lo—(-IO�E- \�• i1El�Tti\ 'i DSA -Rob i(. `Ew14—I"� .b A. 991. 01gK E %Ls. .1 C Q RCAe-Cl-nfi- 1,JAC.L..LOCS- MOLES \at-�E.?TH.3�4"��I�.:. S/r 1�y�S - 1(a L,0Jc.i tJ0At'-k W ALi— -1 Lo LS. -'rrj t� S 3D L 4E,,1.,TN iA ©AW T%2 E c TLA --.1 " .-• 1�: jReaiz POLE :3vZ c e a (�z N 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.:Thisreport covers ` ,he locations of the work in only.and does not constitute engineering• opinion or project control, 1ERT. fyO.QO 7 3 c f S' S 0 INSPECTOR NAME Jt✓� DATE — ( M Pl \4 0 I INSPECTOR SIGNAL—� Page of . DAVE STEAVENS 4 Inspection Services PROJECT �e� �,, S`r~ _ ► ';i.. PROJECT # 4L cJo 1 ADDRESS q.� 5 ; �, ' ! CLIENT;j(a(; WeJ S -r 4oN BLDG. PERMIT # ENGINEERu INSPECTION TYPE +4 rn c A etas S'4 -9'7y QAK-rZe DATE _I M k y ARCHITECT (, oc._3A 4 Rua j -m C1_LL 2C CONTRACTOR QC'i! M Af��j� INSPECTION REPORT IS -9 A "Ss NAit-torCoM t ( . - � �T'A \ ��,_� �LoG� � A 1 to J t,.. Cv'rv\ � t►�:Tc '° ���t�\� _ Q � 5-�, 3e.oc:.►e\Je., a -35 � e'Y'i-LI• �N L A� + 3iac�.! � . -(� �� S4—•q8(r� o�>L-r�ztc r P'Loucrn]C. A -3S N LP` 4 ( St4:*'2 %-3Lrxs! tJ�\�„ac.- Lf T - 4 ' 1W r Q 11A .. \ l_ —?%I ..O- LA I j. . _ k r re '11. r 19:7 IL IIT -q RLOWW(a � A -15', 1�ETP� � t_ � I S -c1 ` � LoGr� w1 A � �. � ..a [ - C.o w• `� L.t"'t-c. . _.i =K�iiL lLS:O�1 T.4r�►�Z�i! LOT -14 _SH 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 f e locations of the work inspected only and does not constitute engineering opinion or project control. CERT. Nb.q ��Q.� — �' Q INSPECTOR NAME.. k j�F_ c - Prin Clea[ly DATE _ L M A 14 !”) ( INSPECTOR SIGNATURE,. �