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0401-353 (SEISMIC REPORT) 79713 Arnold Palmer LICENSED CONTRACTOR DECLARATION 1 PERMIT# I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT 353 F-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and, DATE VALUATION LOT - TRACT N w Professionals Code,and my License is in full force and effect. - tcom License# Lic.Class Exp.Date JOB SITE O d 7331 S1 B 1411 03n 1/v ADDRESS 79-713,70.5 A.R.1101M PATAVEIM APN i C, 4- OWNER CONTRACTOR/DESIGNER/ENGINEER o ZO r,- Date Signature of Contractor =r V H C:) OWNER-BUILDER DECLARATION PGA WFISTRE' ` IM1.1.'AS.80CIAT[OI.J DEL MAR PACIRC01=': 'f".tiALCt7NTR1>CMIS,I W U `I ° PAI BOX 1060 2533 0011 HH COAMP HIC7EMAY MS 250 W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's C&RJ)P B r"1kM 3EA: CA 920TI Q_ 1 A Q'13IN'!'A 902253 '" (0 License Law for the following reason: Z_ ( ) I, as owner of the property, or my employees with wages as their sole (760)535.1010 Ml 5823 compensation,will do the work,and the structure is not intended or offered for sale(Sec.7044,Business&Professionals Code). USE OF PERMIT ( ) I, as owner of the property, am exclusively contracting with licensed GMMAILELM JAN 0 contractors to construct the project (Sec. 7044, Business & Professionals Code). VOLUNTARY SEISMIC;RET OPIT Cl) () I am exempt under Section` B&P.C.for this reason LID N Date Signature of Owner ON 07 a Q WORKER'S COMPENSATION DECLARATION oZ I hereby affirm under penalty of perjury one of the following declarations: e Q oC VALUATION 000.00 1.3 r F. O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' X W LL compensation, as provided for by Section 3700 of the Labor Code, for the O Q performance of the work for which this permit is issued. C0 Q U ( ) I have and will maintain workers'compensation insurance,as required by QU Q Section 3700 of the Labor Code, for the performance of the work for which this d rn H permit is issued. My workers' compensation insurance carrier & policy no. are: It Z Carrier STATE FUND Policy No. 0+11501UN'jT00094t5 ES"Ii'.d'Ri IAIT D COST OF Ia`OMMUCIT0.11 6X0.00 °rD O PERMIT Ii'7r V MM",V J (This.section need not be completed if the permit valuation is for$100.00 or less). GONE TRUC ION K.F. 101-L 00.418#000 U A ( ) I certify that in the performance of the work for which this permit is issued, STRONG MOTION ISE.RN D 101-000-241-000 $.b0 1 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 provesions, 1 Date: ( , f t Applicants-.-^-✓/ Yc` / •- --T —r D a Warning: Failure to secure Workers' Compensation coverage is unlawfultand shall subject an employer to criminal penalties and civil fines up to$100,000,in JAN 2 9 2004 addition to the cost of compensation,damages as provided for in Section 3706 of the Labor Code,interest and attorney's fees. ' CITY OF LA QUtNTA IMPORTANT Application is hereby made to the Director of Building and Safety FINANCE DEPT. 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 TUB-TOT AL CO. t.0;L.,` ON AND PI-W MEEK $81.60 whose request and for whose benefit work is performed under or pursuant 4o LFSS PRIF-PAM FETS $0.00 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 "INIALY.'ERMU I1'3'—N N DU NOW $81.60 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 - IIIIIIII VIII III VIII IIII 45 • 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 t IE the above-mentioned property for inspection'purposes. RECEIPT DATE BY DATE FINALED INSPECTOR Signature (Owner/Agent) XXDate ' a'- ` 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 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 Final Final POOLS - SPAS. BLOCKWALL APPROVALS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground PI .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. I Smoke Detectors Temp.Use of Power Final Utility Notice(Perm) . it Page ( of IIIIIIIIIIIIIIIIIIIIIIIII 46 DAVE STEAVENS - IE Inspection Services PROJECT ��A u) ST- f4D A PROJECT # o200 q-4 !5- ADDRESS I<- 711 S . ?U 5r CLIENT P(-�A 5-r 140A AzOnt-IN Pokunocr_!L DATE to INA Y 0 BLDG. PERMIT # O U ' 3 ARCHITECT (' o4_6A /q eZCL.f ENGINEER',.k)" SAJO,,- _—_r,Je CONTRACTOR PAC-r F1 � 13 C 0 G INSPECTION TYPE INSPECTION REPORT ,,�«.�• a a l •3 • 8La L -sys, •3y !fir. TA r V 9 S 3 Lo C{.<l SFJ i1 ! . c�)i ( h C►A t%__'5 -7,15. 3 4 -34 " -( 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. OZ7 l ?' �G� INSPECTORNAME (P: (Clearly) DATE (ia /,//� 7 �y� INSPECTOR SIGNATURE, IIIIIII I III III VIII IIII 47 Page 1 of IE DAVE STEAVENS Inspection Services r PROJECT N A u,)65-r NDA PROJECT # o?ov 'Ll-K) 1�' ADDRESS -r q- I 13 . 7o5- CLIENT P67 A /, .)r ST filo to 74;z DLA DATE 4, 04 Y e>lyU 4 BLDG. PERMIT # O`f Q! ' 3 ARCHITECT G!o� (-6A 2CW ENGINEER,,,,)k� SA Jo � SJt CONTRACTOR t'Ac-(Fi c. /3 L 06 INSPECTION TYPE INSPECTION REPORT u ' F►A t L.� t4 -_ ; - (7yM Lit..t rz ��>P. t��- a�a�•ls•.3 - BG.ocKi,tJG � -�ysA3N � - �'o�►n�� - �! TIA �•5 Kn,�1 A S - - S'Lo ck i ac e- 1514GAR jwi-, ��-t �t�� 5 - 3 � L P T ��. L - 7v � �'o.•h ���-�-� 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. 0 5 rq& fig- J 49 INSPECTOR NAME "�)A 06- ',t=1 ,q'/ e�,� 'Y4 (Pri t Clearly) DATE (ia /i/� w / INSPECTOR SIGNATURE I F - Page 1 of t DAVE STEAVENS , Inspection Services: PROJECT PGA L0e51- —C(-A55/C 5 PROJECT # r;7 va t+ — S ADDRESS�4--It 3, ?D S CLIENT ( A W S^iy !`} A tR l•I L' )#�l rn z DATE M' 60 O 4' BLDG. PERMIT p 1 ARCHITECT eSQ L?�dk .A-K-C H ENGINEER -jJ d Sk VO r C 170c- CONTRACTOR +)tgcL t t c, INSPECTION TYPE INSPECTION REPORT 1 / 5 - 3 - -RLoC-V Au T3 r?t.-t p► ��S - �, a.Ar I s- - t3 Loci r t e:=4 4 t L--s 1,J A L_! A-"+) a L I.-)C. - � -S p. t L_S • �tE . !'m A-3 -70"P D t= (Li sk t.t__ PA r-i 6-2 A 0 C) `f)L y A Jit -Atl )S•'3- -6c--d>CW PL � rTA t t..S - I� 15` 3 " 5^r (Z�-� ►� �[`rt �,1�.�L., r - 11�,nn�,,�..�'' (_.;t.0 k - 01®nN 3 L.e'= 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. r� � T�- �D INSPECTORNAME'��L�� �C�VS n (P int Clearl DATE I A A 4 2-00 INSPECTOR SIGNATURE �t! t�