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0104-238 (BLDG)LICENSED CONTRACTOR DECLARATION I her ffirm under penalty of perjury that I am licensed under provisions of Chats (commencing with Section 7000) of Division 3 of the Business and .Profes onals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date .._' a ;? 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 1 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. CALINDENNITY 1130623.74A (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: f ' Applicant J-1. 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' /'_ U/ ,1. BUILDING PERMIT PERMIT# DATE i VALUATION LOT 0104--ZV TRACT• JOB SITE APN ADDRESS 0�y Aryry�� TRW, OWNER CONTRACTOR/DESIGNER/EN 1NEER XJGAIA*-V RPMENT1,01 A030=170H DE, iv. AR PAMC C &EMEM, CCMIR AMON LA 01 ITI-A CA. 92253 80:...�,�i',�n.BEAM-T CA 92U75 (858,)792.1500 Mwj 58 43 LOCAL OFMCIT TKPORMA` Wi H USE OF PERMIT I+19:IMC'.. TANEXA'fi3 7��f6f) "P. C•ILPi%3�.1 P;�, . 89.637,90-643,90-640 & RO-653 CkAX TRIM - 8U1LVfN0 r y TYPE VJfiLtJ. TIQ114 is MMAIIs.+IJ•:s4.s'9f4.7A' CFYA.SO.L.RiJNe8J1.O-W .KrY76Q�1,lV ��:f 101-00041161.000 $207.00 COW T ': ; IOC' AWD Phi' 0.9W. Z $209.00 I MW ITZPAIDIFUMM $0.00 APA 2 0 20011A11 � FEES )YU. CITY OF LA OUINTA FINANCE DEPT c a . RECEIPT DATEt jp BY DATE FINALEDINSPECTOR I j F t.,rr Z • ,' 1 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 _ _ _� F.A.U. Framing'r �j� Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Party Wall Firewall Condensate Lines 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 Underground Plbg. Test Gas Piping 1al 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 r Low Voltage Wiring ; Fixtures Service Panels rn erior Receptacles - I a •oke Detectors emp. Use of Power Final Utility Notice (Perm) G.',`� Page of DAVE S'TEAVENS Inspection'Services PROJECT ��,Q �.)e' T- f A ADDRESS SO -(.:r 4q3, Gyq , Gas S • oA►C�ct+� a��� 3y i� ��aa BLDG. PERMIT # ENGINEER�v, a ►J L INSPECTION TYPE PROJECT # Ivo!- 0,3 CLIENT t, A wt ST H o A DATE �} (� (.;2-0tol ARCHITECT 6,0c& -A 4d:c4i7a.1 yr- CONTRACTOR C.L. M A IZ �Ac/ F r C. INSPECTION REPORT S 1 . (�%4 -�Gc49 .(n -S5 (nAK rani . 'I=�e#34 I �. PL/1 A i_L L,A lx) t ,o �! 11. J� t� �.M' til Vi t l_ t 0 C= A 0 h S i Z Alt ? 10 �S 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. e9 S5 1? 1/9 - �INSPECTOR NAME � ` J 'V 5f -EA q(Frig C1ear11 ) DAT E0 ( 00 INSPECTOR SIGNATURES u. _ /� t.►w .Yyr ',;,, p.:+�'r"l'"v'' �'�riFr ;�+'�+il�p�ji''C� Jt•L7!}ivy..%O f •� l+�a•-• Page of DAVE STEAVENS Inspection Services ,001, \ . PROJECT; K. ,}, We -11- � �,c 1 R PROJECT # acro i - O 3 ADDRESS A S t_t S"Te-3 CLIENT ��N DATE 30 ASV o;yo 1 BLDG. PERMIT # ENGINEER�o INSPECTION TYPE 9,0 ARCHITECT.C__-, 0t A A IeQj4 17ec..Tu2-E CONTRACTOR C L M412 PACIFIC-* INSPECTION REPORT 06��kLe LA T_ 0 4,L,_L ; -� tIj ,A S G IZ C � � _ ,C' ► C� t4 TE 0 &'.) 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'only and does not constitute engineering -opinion or.project control: CERT. NO. ©G7 J 9 VIE -T0 INSPECTOR NAME')A J 0 c) / �CA-tJ CA)I'D • (Print Clearly) DATE © # u INSPECTOR SIGNATUR .""`t..^..•-Nr..v....y.w'1.'�`."'•);�''*�'<.1..f��Ms.lei.�ii�a-r..'ir�,��^^�"F-su.�."+sJµ k_i�rA�P''R-..F'�ix-�.r1IY.,:•�1�ti.iSY.Y�.I.-r....t1r.�'rt..f+w.....i"L:F-.-r�+t...�,�r....r�h-..-�....`: -'`: DAVE STEAVENS Page 1 of -'2— Inspection Services PROJECT7(,f, v)ES-'f - 11-"R, %1F�, PROJECT # a C-;ro (- O 3 .ADDRESS 90 - (1311:1.3 (=S Qt _(125'5 BLDG. PERMIT # ENGINEER 11►a y) A . -r -t-,c- INSPECTION TYPE E;)vk`4 CLIENT* nk kJ)P--ST t>-k6k DATE �l :At,, 1-,, --7-dn 1. ARCHITECT (,4DL--,A -AIZCyA 1'Tt.cXcxg CONTRACTOR-'*1-sC-L n N AZ AGL;z ( c - INSPECTION REPORT a- 39 6AllYZer- �� ,1�►� 3 t ����3- Zwc�- (�o�.��- 11� �T��'�-1 If��r�. I�O�S- ("l�tx',►..��,'Tr1 �%t�11 il�fl. L.( Ii- 1 toC.4\.) ..+r- 11 ZV11A I" L)iA A. QO6- 1-17'LF-vac�t, 4 r?- �L-UC- l --to' - l t�caT, 4 l 64A• �o�S- {1 �� ��q C, 1" 90LZ'S- IT UiYTH ,a 3,14 DitA • tZvs�S.- JI! _ L.ftJG,7rA $/s DtA , K�A2 (xJLft-g .%a1 UL 1KP'Zr1 �`%AJ �C,7A�EAST L1 - ILot- �-iut.�'Iat')�Ntl r +i D(A. ot7 I 1ttLZNG.T,4 s�rZiA �e2 0r'nc _a - � Ley. - !-to SEs - 11 1 ATS. i J� A. RvbS- (� LXOC �l �$ NA a. - a �o� 5 - �o��s - 12 t �T t -I (� RDbS - (-T L E>J (,T#4 -71610 J t A 0As4-MLC:r; !3 4)LA tJ �'�'..� - �.. w c.5 - !� o �� S - l 1 `� �c'.P-c H : l `� .n � A . 20 D S - I -1 � _�� c. � �! , lg +� ► � . ��� E�-t- - I t.a c - It Nu c.r - r r ('T► -f �, ( o 1 tIr Ro D� 1 c1� t �.� c. ; ►.{ �lg„ n ► ra . ALL AaoJ6 LnC_ATIoti')_S c t._e.AK) e-,►_ 'k)r-laZI S APPL.1!'>}lT17)A (i,.]4L = C -ba � 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 Johe locations of the work inspected only and does not constitute engineering opinion or project control. • CERT. NO. C�Sq IJ INSPECTOR NAME c' Jf� �%�� tJ�'•�► (Print Clearly) 'DATE 1119 -{'l ulI '. a4yo I INSPECTOR SIGNATURE ...... f>M�� .... .-...� :r� .�•., ... � .!.'�,F.n.. v...- r�. ♦ '1: o ,r; w -v .::a,� '•:�,y} •'i`y.. •.rT•fcr"�f� :.:ird-Y3�1.1.:rb :1 �.d .. _ .. _.- . � Page of Z DAVE ST.EAVENS Inspection Services PROJECT:�[,A L.,) Z;!Sl•TSE - I A PROJECT # 3 ADDRESS 6 -Ss CLIENT BLDG. PERMIT # ENGINEER,�u_o_�3 INSPECTION TYPE • DATE. -,)Q Au -C. ao t ARCHITECT 60v3A 'A11CH t i Ee-Tjze CONTRACTOR%�L fy ALz ; Nc% F, c INSPECTION REPORT La kck . 2-5: 1-31 nAKTZ e- C 7�, `Q c., ' 3 3 1 " LO v`1 �.zP"LI-'s -- SAALfla- IZ :6 KWA L i o e- C , E (a\ 3 AQct-lain - Lim; ae3N 4 I5 - � - � L �C►� ��� '�t� .a�a�Lt,.► Ca- eon• pct i c .4 ANib--:�HeAt2 �• OO = �o3rj x..43 .b`+9.C�� 5 OAK'T2s:>:. -3�C�� 3�F �+ cwt la • ALA- .14 �,-r-T% cs - oQi �4 - Cam'PLeri i3 -7_(Q 3 . (.19 DS- 1. 2, 3.1`i '�5-�- .�IOC.FC Aa1 �L�I �,�A«�►�t� - �mJC.E'r'E A t.L 4 �zTi C -S - _TA t LI S (.p 1R L.Dcj( Pt �J D 6j F1 E 41, N t I' V3 C- - QMiLeTI- CER TIFICATION 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.Oe5gJ T A '4!S 6 INSPECTOR NAME DATE �G G QQ / INSPECTOR SIGN, F