0104-228 (BLDG)LICENSED CONTRACTOR DECLARATION
I.1hereby 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
B0.01/m
/m
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:
Carver 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..,
Date: ' Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) ''s''` `''�'L Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT},-` ($ TRACT
�3Si.43f3
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:I'O DOX 't 60
462 MIEVERS AVE, 0;402
LA QUM"U CA 92251
SOI.A13'AUDh.CH Ch 9207S
5823
USE OF PERMIT
UO—CAT, 01MCE IN Oi;i MA'D ION
734611 TY. CHARIXS PL
Us 33 80.352, 90.363 80.30 OAK TWE * HU TYPE
9 VOUN A,RY S"I RUCTItI$a1L MODIFICATIONS
VAWATION 3tt,DI; ItO Ls
E57MVIATED COST 0I)' MNf3MMON
20,OWM
CONS'I'I UC''I ION FBI?, 101.000-41 &000 $20 100
STRONG MOTION ISI, . R30D 101.000-241-M $2.00
AUWAALCKDA
UM101TAND PLAN MW".
$12109-00
ISMS PRF -PAD I `"Lt,`9
$0.00
APR 2 0 2001 ,1DI.a�f 14 'S DW' HOW
CITY OF LA OUINTA
FINANCE DEPT
09.00
RECEIPT
DATE
-, 1 �
BY.
DATE FINALED
INSPECTOR
i
S,3
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
O.K. to Wrap
Framing
_
; _
Exhaust Fans
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Party Wall Firewall
Exterior Lath
S/�1��
Condensate Lines
Drywall - Int. Lath
_177
_
Y Y41,
Final
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
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
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
IN
DAVE STEAVENS
Inspection Services
PROJECT .,d Q r-5; -
ADDRESS .34S c_ /STS
BLDG. PERMIT #
ENGINEER k J a SR JQ�-
INSPECTION TYPE
Page X of ;L
PROJECT # o" 00 I —t� OZ
CLIENT P6 A WE z; HOA
DATE 5 I L y aLco /
ARCHITECT Ca L,6 to 4,?CN /'TE C_Tv +fit.;
CONTRACTOR NL MAR 9RAci Fi C,
INSPECTION REPORT
I-Aw L L)
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S7i2APA1J(� -
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
We locations of the work inspected onlyand does -not constitute:engineering opinion or project control.
CERT. NO. t� S 3 Vg SC7 INSPE„C_TOR NAME ` J►tiJ� �ra ��'�S
DATE C25”
'Tk L -,'I c;y'O INSPECTOR SIGNATURE J�
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v.:..^.++L,e,:--�•-.�-..+acr.,..,�,.,;,;tyv^++fn..i-` �';+.-i%_zw�tN J`." - r`.".ratf..."'r'Y�"'yrYY'a+.M;r^^"y*s.•'1.r',.sr�,f••, -:1'L�...-..w.,..- _-•-•�_ .
DAVE STEAVENS
Page t of (
Inspection Services
PROJECT�6* --P 4N " - 1 #, PROJECT #
ADDRESS Ac, L- t s—► e7
BLDG. PERMIT #
ENGINEERNAt3►J SAJo (F-- QC .
INSPECTION TYPE
CLIENT -;:)C-t\ U -)ES? 11-10A
DATE ='14 Su L-,/ ac—vi
ARCHITECT (7oc„BA 7r'14GN % ► GGTu �i.
CONTRACTOR%d [, M :LAC i r �G
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. nQFN 3 46 - so INSPECTOR NAME %;. -J � � St�� V)tPJ.S
s / (Print Clearl
` ,DATE e;t0 INSPECTOR SIGNATURE°-`-
-. .. - o
DAVE STEAVENS
Inspection Services
Page I of
PROJECTS PROJECT #
ADDRESS CLIENTJ�GA L.,)e 5 ,,A,N
-- DATEa
BLDG. PERMIT # . ARCHITECT (.. z>L_3A
ENGINEER _t*),, IL L=SD lc„ E /JC_ CONTRACTORJZLma 2
INSPECTION TYPE `/
INSPECTION REPORT
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- - j UR •
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.�� �lf j� INSPECTOR NAME
(Pry
DATE�CG INSPECTOR SIGNATUR -+ V
DAVE STEAVENS
Inspection -Services
PROJEC44��A JA.JeS—(. P/44SE414'
ADDRESS As 4.is-ren
BLDG. PERMIT
ENGINEER�L4 JAI .S9411o,,c :!-VC-
INSPECTION TYPE
Page 3 of 3
PROJECT # Oc7o/ - e>3
,.CLIENT'1-4o,+
to
DATE �Q
ARCHITECT GOz_aA A& w fnc 4: rg,
CONTRACTOR J)el- IntV2 tic r
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 doesnotconstitute engineering opinion or project control.
PERT RO.OG15-7-34�9-5_0INSPECTO R NAME i >NJ G7 9,62 t/eWS
DATE INSPECTOR SIGSLAT