0201-088 (BLDG)LIULNSLU CUN I HAG I UH UtGLAHAI IUN
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 # Uc. Class Exp. Date
733132 B { 341/'03
Date _4?_1 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
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
on 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 iTi'AT9 NU141j Policy No. 04601LIN I1'000941S
(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 shell fort)twith comply with those pfovisions.
Date: _Q 1.4D Applicant tom+ 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.
_ I}
Signature (Owner/Agent) 'j / Date
BUILDING PERMIT
DATE I / VALUATION LOT
PERMIT a
0 -vi -ow TRACT
JOB SITE !- APN
ADDRESS � T� V -7YS I
-
OWNER
PGAti'>rI?.Yi RES[I) 1'TIALA9SWIATION
Pt's TILOS 1060
LA Q0191 -A CA
USE OF PERMIT
MV1C; f:Z.J:.A)�W10X; £+
CONTRACTOR/
DF -L IVAR PACMC 0EIM A L C01,M4,AC7
2:53? 40ILVDi C.'.C. AST 1-1101-TWAY SEE 250
CA111711:'Y BY'.1'14Y_ ,1HA CA 92007
(-16 ))5(,,9500 CZTX Sit i
BUILDING 31 •34.719,'Sh-'l41, .54.763, 54.735 a 'VOLUN T-ARY
STRUCTURAL Tse O tIN`WATIONS
VAI,01, f1(yN
20,009.00113
PFRi+ rrFkT S''t7'N""E1'Y
(10HU RUC"TSON P719 - 101-000-418-000 ffi t►"J.01►
STR0140 MOTION OLT.- it.►LS10 101-000-241-000 5%.iW
S3[th- i'c:+�'Ai. Ct'j1+]:1'I"k't1i�fi]:t77N' .ANr� i''I.t�1;�i?.I i�;►'�F:.
�rc�� rgrc�lrx ir��� ��►. �� ��,�
RECEIPT I DATE J I BY ; '- ^ I DATE
2 o,t'31'1fJ.m)
fj;2l til. ii(1
92119M
DAVE STEAVENS
Inspection Services
PROJECT
ADDRESS,'
BLDG. PERMIT #
ENGINEER'.':
INSPECTION TYPE
PROJECT #
CLIENT;;
DATE r r'
Page of
ARCHITECT G`
CONTRACTOR K
INSPECTION REPORT
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.
INSPECTOR NAME
(Print Clearly) _
DATE INSPECTOR SIGNATURE
y
61
.JI
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.
INSPECTOR NAME
(Print Clearly) _
DATE INSPECTOR SIGNATURE
DAVE STEAVENS
Inspection Services
PROJECT we t r Lic "JP
ADDRESS - S_ % 311 `+ !,; '1 q
BLDG. PERMIT #
ENGINEER
INSPECTION TYPE
PROJECT #
Page of I
CLIENT 5T a-t U �N
DATE ~` ._i 0 L.'1
ARCHITECT A A (?C �-
CONTRACTOR UL. M ,'Z��.�%c
INSPECTION REPORT
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.
DATE
INSPECTOR NAME
INSPECTOR SIGNATURE .
{Plljlt Clearly}
Page _ of
DAVE STEAVENS
Inspection Services
{
PROJECTPROJECT #
ADDRESSrJ- 7t�L+'743.?g1. I
of
irizet Tome go&.03 t
BLDG. PERMIT #
ENGINEER�uPJJ SAtJvI4C 1.%Jc.
INSPECTION TYPE
CLIENT P614 W w. �$ F" *•` AIVA
DATE d-1 JT 4 L-1 �� Z
ARCHITECT L1., o c ,d ,A r4 je szH
CONTRACTOR) -C "141?- AA c 1 r ►4 -
INSPECTION REPORT
Mall- 7- PtOcKwte.. A -34S
s aim ar lsc.M-J
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted.
0 substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
il�c Zns of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. S .3 �- �d INSPECTOR NAME ✓"S
DATEA2 J'u �. `/ c; <JO Z
INSPECTOR SIGNATUR� ++ �..�
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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
733752 B
11 t�
"/x d, ', 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). 1 .
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
tr.
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
Se ion 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 iS'.(`.ATS AMD Policy No. 04601'iiHI 0000443
(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 withrthose provisions.
Date: /�+ / �:' �- Applicant - Jl'�I /,
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) t ' +� -�( IV 14f Date
r'
BUILDING PERMIT PERMIT#
DATE t'r / VALUATION LOT 0201-M TRACT
1/
JOB SITE`
ADDRESS /
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PGA'M—Mr RIUA }% ld"A A L. ,AiOS0C":c TION
DEL Z.E.1++R P ACTFI ' G:�.�'.%1�'.�M.. C01M,Ai IYOR
po k- X 1060
2533?�++30FU �� COAGS'[ IPIK V kIT-, 250
LA QUIMA, CA
L.k��'� �,s.��a+ �� l ��'�� i�Yl`vi'S CA 9A101tV
(-160)564-9500 CBMS. .1;V23
USE OF PERMIT
13i111r1 €2dC# 31 .. +f�7i9,� 2•"iti,t, .+� iR , i.=tt4S VQLU'N'fW,Y
YALaw,+.A.THYN 20,000,00 Is
PYAMT PI t'` 9113MMit►d Y
CON12TRUCT3011 ME, 101-000-418-000 VIV100
biC}XG MO'TION'.C�,%• RES1 D 10110% 0441-000 �ia'.Ltti
",
I i
JAN 31 �C�DZ �XJ,
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IMM-TOTA.i., GOAtMUCi`]:ON AM
$209.41Q
:.5i :R?'�` -PAAw 2�1.��'�'$0-00
:s
t
RECEIPT
DATEf
BY {' .•
DATE FI ED
INSPEC OR
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 7
BLOCKWALL APPROVAL6
Final
POOLS -SPAS
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
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)
COMMENTS: