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
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!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 '
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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
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
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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
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�