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0104-240 (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 Date t { ' ' / ` Signature of Contractor—'�' • r'` a I' 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. CAL YNDFI NIT ,(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 nbt.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: .�' i 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 a4 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. r / Signature (Owner/Agent) "` �` '''++ r� Date i i BUILDING PERMIT PERMIT# DATE VALUATION LOT 09.(W2A0 TRACT ��uuqq JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER 1?GAMW:i�.'r�,IM ':>:"fAL A.158 iCIA` 1011 D:iU..W.la'. PAM, CGEWUAL C't')MMACTOE PO :I. X 1060 462 ,EVENS A!f'Y- 03,02 ' LA\QI me'. CA 922:53 :01;ANABEMM f"0_ A 92075 (a5s)r/92-1500 (Iwo 5825 WeAL OMCE'tW'.MRNATION USE OF PERMIT ASCIF LANE V10 ?S•160 ST. CHARL819 .PI. 00-601p,30BR -70-0 OAK Er.A.gKn�1`.'�'RT1,+:rx.E - Lg3'*ZTry1aM040' 4, TYPE €f►40�3j r-I69y',��',y3�,kp D YiilLGi/�l.rpC11i6.r1( O'A'!S.'LhLJS: ���d 6t8i,iJ CIO.Vi..'I,t R4�1-.i i1.i.��0a ��Q ' VALUATION 20,06D.00 LS '?'.!!MAUM C09T (YAT COMMUCTIO.tY t£9. 1YMMU PER RUMM fiRY (1;.CONS T'1P1iG I'IC'111 M., 101.000.418-000 $207.00 S 1`3i.OM MOTION FEE. P.R.SIE) 101-11DA10-241.000 (� St -IrO T1, COXZ-11,I(TIO'KAND 1P1;J,44rd` (W—MIC �D $209.00 u APk i, 21, CITY OF LA OUINTA FINANCE DEPT RECEI OCk�, DATE FlNALED INSPECTOR INSPECTION RECORD 'r OPERATION DATE INSPECTOR . OPERATION DATE TINSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck O. K. to Wrap f Exhaust Fans F.A.U. Framing _ %l d� 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 AW -1-121! Final _or 1 9_ � /�� a� �6Ji% 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 G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Page of %. DAVE ST' EAVENS Inspection Services PROJECT�e_A���s: •t��-1A5� tR ADDRESS�D•lo�\.1��'�,'103."1�c. aAK i�r•� ea'A 362 it,Aa q BLDG. PERMIT # ENGINEERC7�A t1a (G .Zti1C . INSPECTION TYPE PROJECT # a2ov t 03 CLIENT .?(..4 WE ---47 HoA DATE /l 5oEPj �00 ! ARCHTI'ECT 4�0 c..BA 142CN i?'E-(..7r4 ZC CONTRACTOC. 1r1 A� e I Fi INSPECTION REPORT L v a � ta.1A�t_..s 'S � r � Z ►.1 A 1 c_t .� C .. -%w� D STi2,A� r� (tel C, - C'�c�rn�Lt~T c ' t LS-A\'L�0,CZ A-ZI ikun C- r.IA1u.JC-. — Cx.)mnL-,e-- :r � CERTIFICATION OF COMPLIANCE: To the best, of our knowledge, all of the reported work, unless otherwise noted, , 1. 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. QSSS �' 7 8 ' �© INSPECTOR NAME l )i�.%> SLi' JEv�) (Print Clearly) DATE . I I S 1� Iy Q I INSPECTOR SIGNATURE 1 �Y.. �• 1r. w.' � . S.r. ..r.• + .. �A��'th'.�"w4"75��['?b`'r."'j'��t`f1.'ti'r'•'�...:... Page _ of DAVE' STEAVENS F lilspectfon". Services PROJECT4)(,-A `V.) Si P444SC i A ADDRESSQD-G9/;G9 7, 7d5.709 BLDG. PERMIT # ENGINEER I u JO SA Jo I F_ �►� . INSPECTION TYPE PROJECT #. d 4-0 1- 0 3 CLIENT ?KZA tA),r gT k 0 A DATE -% Sc T Zc;,o / ARCHITECT (go L8A 4464/-1-tCTui2E" CONTRACTOR'et- A R 2 f AciF'� c INSPECTION. REPORT 14 L L L o -Q GJ A t ZA Y n t rJ N A •2 6 tJ is 2 t `i_ ii -%,:, LLLAT o r f S'C A2- LA.) S A � � rel �JGNvf2. Il )� -s � G NT e IJ ALL 1 i i c 5 _ ��2fRm �n1 G, SLvCKItiJG, A =36 r5. L 7! `�S G '%JS AhQor"\PLCTZ-- le1 14 / 5 ` 9 - -1. L -n c K i R/ C. A aJ 0 3S g — \_o A.% LcTc 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 r `•he locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. P,o S9 4; - S'c7 INSPECTOR NAM E (Print Clea y DATE o2 INSPECTOR SIGNATURE Q, �s �r 1.• X1»54. ;�..+,`;.'�«:c:-...r-br-« 'wF..tM.,�[�•:i�('s>^`t.�ir {r w:%.�E.�,;iY:�i:r'�..-3.3.",�.�('`ih„"�..�/���„'�rryt'y„N">.+,.+r.. r'� -lfh- v-Isti^.r'.^-.i`a'�--ii�'�:. .. �-. .,,._— t DAVE STEAVENS Inspection Services PROJECT PROJECT # ADDRESS Sd � �; 6 9 74 "T 0 1, *10 9 d#K't'acC 3L q tLR+J BLDG. PERMIT # ENGINEER.�_\t,,.-, o S&Jvi l✓ Ta L INSPECTION TYPE Page / of ( ii a SC)ot-o3 CLIENT': &N tZ e%. k t4oA DATE S 5E p7, .2 v a ARCHITECT C. O L:Z. -PA mRQ_. wreco%.a CONTRACTORIEL- MAX c... INSPECTION REPORT z s'%'a � N -t . o 011 -A,-� z. z ��y `�9 4.5 ►?�Aso�, I btA . f4bS I'l f.EW u- /i?. D iA. h.. - I'l (1 $ n 2 tv�Sr t_tt ” 1 LWC - (4dL�S - (� *btPTN 1V'0 �,, 0IA. JR -0 b -o. L'C0('-r-4 xib 11h l2z.A,m Qx-irr Utg - I LuL- �AOO� - k; -OE-N'TH 1DtA . 4A - I'l LEQC.'f H Val ., 3 "(�W,�c>; e.�rM- 2 LuLS - 4ai-C 5 -111-. bL� W /4 a (N . X00 3 - Ili t_CQ'C r.4 uA . �O-'7D3 014KTREt ?LA�J t �, RZAP, a-1XVC?_ _ o) Lo CS -t. �A0LC5- (la'DP_trt N 3/ytt�'� . ODS-II,�C�E�1ta(�-1 S�� IIIA. 2r, -Aa CPks-C 4.., U , l Luc '- A�o�_Z- 1�:' c tH (''.D�a. 'Z��- ('1 t. ►:tc�Z�-1 /f� 1� A. }���'�.- �..>`yG..g--" l-•�yL�S- l�t d�r:t�'t�-1 t�� tA. �,2oDS - ('1" c.�Jc.Trl ,r��'��A . 90-109 rx\KTeCC. t�A0 3 12�a�t LOE-s � (-( (Y - I LvL- HoLjC - 11 �� � 3X4 J�tA. MoD- I �c.�aGTM X16 ��iA aLoc-s-'rlat_eS- Q. 1. Icy-rTo Cb*. ?.ods- f'l Lr." e_'i'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. This report covers �he locations of the work inspected only and does not constitute engineering opinion or project control. 'CERT. NO. Q� �Y ' SO INSPECTOR NAME J A f� )�LJ9 liCW S (Print Cry_' DATE � S I P -% 1-0 0 INSPECTOR SIGNATURE Qi►.E.R