0201-087 (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
7331115Et 1. 1 f-1
/��13 �3
Date A 4 Signature of Contractor
OWNER -BUILDER DECLARATION
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
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:
Canter Policy No.
(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�shali 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 3,700 of the Labor
Code, I sha`l.tort ith comply withtho�p� provisions.
Date: APPlicant .. t .
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, indemnity
& hold harmless the City of La Quints, 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^ '•,r ? •� r / �`' �, Date
BUILDING PERMIT PERMIT#
DATEVALUATION LOT 0201-007 TRACT
M)
! =N"M)
JOB SITE
ADDRESSj� ^ ,
ISTO
APN
F71. ,) r
OWNER
CONTRACTOR / DESIGNER / EN &NEER
PGA VWK.` T UFMD.f'ti�`iAL AS;3C�. AMON
T F1, MM PA(-'Wl(,'%'-4ENliR&T�CO'tTfRACWPI
f' () E�C. X t k*O
253 3.500 RT COAa"711101INVAY S']fTi. 250
j.A Q1 T1 CA
CARDIFF BY'1'1 g SIA CA 07,007 .
USE OF PERMIT
Iv1. S' . IIANLO'US
BU11,1117NO 30 . `14.801.9444 .91.351, 54.37) - VOLUNTARY
S7'R tt"TUE`AJ,%SO.I)1FIC.AFICN1.0'
VALUATION $a,At}fl.(s0 I's
F517ML`1kV COST OF CSC NSIRIXTfION
201(100.(10
PERAU Fir,.E SUMMARY
CONSTRUCT1014 FEE 101 -OW -416.000 3�fr%GO
STRO)iCf MOTION FFF • AF.S11) 101-0(9)-241-000 I17.au
^ice
�
c3
FI' MIrtYI'At. (%))JS1RtTC7n0N AND PLM4 �70FCtt
TOTAL PMYr Fi+"X ? PUE NOW
$(Kfy)
RECEIPT
DATE
B
DATE NAL
INSPEqrp
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
FireplaceT.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS
- SPAS
BLOCKWALL APPROVA S
Steel
Set Backs
Electric Bond`.
Footings
Main Drain y
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
Sever 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)
i DAVE STEAVENS
inspection Services'
PROJECTS A `c:: - C-CCjXQQS'
ADDRESS f -13 9 T 1, $,14. ` &I
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BLDG. PERNUT #
ENGINEER tiJ Sri JP �C . t of 4 .
INSPECTION TYPE
Page of
PROJECT # A aoa - 0
CLIENT. P&14 W c S r t4y r'1
DATE
ARCHITECT 604 -dA t4 (L. t w
CONTRACTOR'.bl t tAA #1 R -Ac j G• c.
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially.,c omplies•with approved plans, specifications and applicable sections of the building codes. This report covers
he IecA#tions of..tFie work inspected only,and does not constitute engineering opinion or project control.
I ,fir�} .�" jam'" .
CERT. NO. Grp, S-2 3 �-g � ! INSPECTOR NAME V �7
{ DATE co ,INSPECTOR SIGNATURE
F
-"' DAVE STEAVENS
k
Page ( of I
Inspection Services
PROJECT ,?(-� A uJ E 5'r - t a: (.0 0b S PROJECT # .Z v o ;2 -yG'
ADDRESS -Sq -80i 3.8st A 4Zq, SO *7 CLIENT
R4A,. 0� .?a �� �� .2 DATE /8 -7141, Y Zoc�o Z
BLDG. PERNUT #
ENGINEER .-xl * J SAdort; /JC..
INSPECTION TYPE
ARCHITECT 6o t d#4 A c N
CONTRACTOR Let Onh#41? P`I u A ,c
INSPECTION REPORT
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7/S •'! — 0)AtAoJ0 AL`/ A/14fLiA)4' - CraEw.3L�"z� 1
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
, ;;Iocatiorls of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 3y D 1-43 INSPECTOR NAME �N\ J t:
ld
DATE J C! .iu t. 2 -VV INSPECTOR SIGNATURE JA.. a0 -A- '