0201-063 (BLDG).
:nl;hereby;affirmiundeiipenalty-.of'peJ4',ftt I atti'lldensed`under.provision§'of
Chapter 9 (commencing wRh Section 7000) of Clylslon 3`01 the Business and
C14
W;. Professionals Code, and my L"nse Is In full force grid effect,
p Ucerise 8 �. t1a Class Exp. Oat9
Z' Date ''f `Signature of Con
tactor _ "�
O. F ....
1s' OWNE"UILDER DECLARATION' s
W W r` I hereby Airm Wdi er penalty of perjury that I am-exemptftom the Contractor's
~
CL LOw•for the following reason':,,
2 O ` 1„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). `
)l I, as owneF of'the property, am exclusively ocntractirig with' licensed
. `contrtictors to 'consfnict the project (Sec. 70",., B_ usiness &*Professionals
(),1 ani`bxemptunder Section`..B&P.CMor this reason Q o
Ignaturel5of
W , WORKER'S COMPENSATION DECLARATION '
1 hereby ,affirm`unden penalty of `peijury one of., the following declarations:
T;IQ- I. have and willmaintain a certfflcate of consent to self -Insure for workers' .
j(. W .Aoompensation, as provided for'tiy. Section 3700:'of the Labor• Code, for the ,
O Qrmance of the.workfor which this permit is issued. { `
m:Q V I have and will maintain workers' compensation lnsdmnce,as required by
O -'Skdon 3700 of the Ichor Code, 6i the performance of the work for which this
4. �permk Is Issues. My workers` compensation insurance carrier & poGcq no. are:
Z Gamier s 3, ; ; Polley No. ,
0,4
yam` .(Thin section need'not be completed If the permit valuation is for $100.00 or less).
(); I certityMat 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 Iaws,of dalffomla,and agree that if 1 should become
eutiJect to the W-rkiraGcompensatfon p'roviBvilotis of action 370/0�of the Labor
Code;hil comply wfth th�se1
f:tlVarning: Fallure:to secure Wiif ers' Compensation coverage is.,unlawful and
gstiell $ubJect an em ployertor'cHMInai penalties and civil fines up to $100,000,:in
`addition to the cost of,iI mpansatlon; damages as provl&d for In Section 3706 ;
♦ �qof,the Labor Code, interestand,attomey's,feea '
IMPOR'T'ANT °AppllCatlon.Is hereby made to the Director of 8uilding and Safety
•fid Porta'perfn{tti Object�to�the�condlNonb and restrictions set forth on his'.
>* 1. Each person upon 'who as behalf this applicallon'Is made & each person at
whose request and for whose,penefit week is, performed under or pursuant to
; any permit lisued as a result of. this applicaton agrees to,;& shall, indemnify
& hold harmless.the:City of La Quintd, Its officers, agents and employees. .
2a An
y permit tIssued as a result of this appllcatioh becomes null and void If
ii work 'is not -commbnced within 160 days from date of Issuance of such
x` permit, or cessatlomof work h6r180 days will subj4t permit' to cancellation. '
€.'• ., } ,
Nn I certlfy that I have reed this application and state that ttie above Information Is
A; ' .correct. I agree�to dbmpiy withalltliy, and State,laws relating io the building`
;'.conbtruction; and hereby authorize representatives of this Clty to enter'. upon
`the
above-inentioned propertyPh
'pecNoti urposes' RSignature (Owner/Agent) K f �{ {
nae t
1 �.` �..
Ori
6W
Sr1
DATE L VAI tJAT�ON i • �� } r •LOT.` TRACT r;,
JOBSiTE r _ ;'{
ADDRESS' - +
AM
'.
OWNER ” }
CONTRACTOR /DESIGNER/ENGINEER
- X
DCF Me Pa C ODWAL CONW1;'IW
BOX X054
2533 BOMB COAS!'IUMMAY' 330
LK QUWrA .' C k 3
CAIZDIt ] iYMM�'HE RA CA//�.�y9*�20�07�
nn
USE OF PERMFT.
MOINO 13�&p:J^ M11111, YOL"T!1RY
a>iIi
> UG'!'ORkI M" On, ioRwii4NE
VALUATION34ODD,9d t�3
{ Mm"COST OF CU."grauC1101"
xftrUt70.ti0
112MWr
-
t to r�ai'»t 101.O0a4as.�o s�a�:oo .
.a�� C .� �• - •}•
is ', ,� ��yf.'
c
4
.
.
' {'- - •r� f�f,: t�+rf'T ,lY��.+wi'w{r•.iar _
'- �, 'fir, / }�••
,
74 1//��('jj'' �F` Ctft• fl
_ ,Vi'i�47r1
• ' '*'isnAx. �i'it�rC� +l4Nb �� �ri�r�'^tt ., - r
� . ���.oQ ,
a, , i jE 'AIS► 9:,
' , $000
���{
'•7�`tYt'AIs Y'�' 1!s'` .351'�FOiiN. •
° , . r
,,
+`..
00
RECEIPT o
DAr
BYor
D FINALE
I PE OR
Ori
6W
Sr1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE —TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Sacks
UnderWmnd Mxft
Form & Foo&Vs
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Dec*
ExImust Fan
OX to Wrap
FAU.
Framing
Colnwessor
insuiation
Vents
Fireplace P.L.
cWth
Fhplacs T.O.
Fans A Cmftls, 17
Party Wall Insulation
Condensate Lines
Part
y Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWACL APPROVALS
steel
Set Backs
Electric Bond
Foofinp
Main Drain
Bond Beam
Approval to Cover
Equipnent Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Unes
Heater Final
WOW Piping
Plumbing Final
Plumbing Top Out
Equipment Encimure
Shower Pam
O.K for Finish Plaster
Sewer Lateral
Pool COW
Sewer Connection
Encapsulation
Gas Pip -.ng
Gas Test
Appliances
Final
COMMENTS:
*1101
Final
Ublfty Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
UndeWouM Conduit
Rough Wring
Low Voltage Wring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.t.
Smoke Detectors
Temp. Use of Power
Final
U" Notice (Perm)
11
Page"'' of,
;E S, 7
Services
40-
-IPR61" L -,PROJECT #-*7"040.Vf?
w .c
CLI
EN
ADDRESS W-S�,J 1-4 4 Y'�'7�'
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,,DATE21 git� 4e
MLuiaft R'Wr*
AlkrMW,CT
,ENG E -CONTRACTOR _6
10M E
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..Td the best
CERTIFICATION O��COMPLIANCE. bUr-knoMed rwi 6d'
our -knowledge, all of irted w6rk,'unlen'othe so not
r�
ulgomeQ�, .app _ ro, tions:and a0plicaW6, g CCjdr Tfi.,,
I "wbstphtia iW�plansrsp-ecifl6i 5- es. is, report coveriO,
pfth�,
'does.n- --'tiWt4 engitiberihg opihio project co
0 to it 0) sp,�iaid dhly ancl.' ot cons n or proj
ntroL,
Z
CERT
INSPECTOR NAME
INSPECTOR SIG
.7 tt„!-~ �'�_.."_�*..�'k... �.s?S - ri s !'„•tir�,. -y .. �"r'" t -'.. - �. ,r `.' _ . .•^••� ` •y'� rri � _`'4 t��:l .;
. . .moo•. , . f _ ,, � ....._ . �.. � :; � t
# F - Page of
,DAVE STEAVENS
` Inspection :Services
PROJECT �Zal "i' w LZG-,ejos PROJECT # (.70 • e Q _ "`�- `
-,, ADDRESS "t CLIENT
'DATE �[ iytA • 'i,c.�, ' '
r ►r ;BLDG: PERMIT'# J = ' ARCHUECT, _62,vL AA E4`r,
ENGINE CONTRACTORIEL• "Ak .
'INSPECTION -TYPE
J INSPECTION-REPORTSC '.
J
CMCJZ Wt -3
V A S Arm . j� ► / % �
fM
L.. A r L { !?Z5, 7 - r�54,41 c � s► e;�J 4. �# ` 3 ' e. '7,6_;% � �c►� .fit � srt"': .
. T..1 /ff /Q
.. .ice • , . [ q
' ►.►�t� em't,JLiCALf�r A -.'S"
CERTIFICATION,OF.;COMPLIANCE::To the best of our knowledge, all'of the reported Hiorki'uniess otlierwise'noted,
Q_pproved plans, specifications and`applicable sections of the building codes. This report covers'
p r _ locations �#f tfins acted only and does'not constitute engineering.opinion or project control:
14,
a ~ `CERT NO . '."t.$ "�3"�t�
_ INSPECTOR NAME tJC. r: CSS • u•'
- DATE.: 17:` t:/�%I "j� wZ 67t .�• ' W _�_INSPECTORSIGNATOR i d0AA041
.. r
} Ili I'. • y . . r - _ _i. . •�-Wirt+►' ) ♦ . • 'y. y��,