0201-086 (BLDG)�:r.'_.—y a-. w .r.. ..X.: i w. ... r _/. .. ♦ .ij ,{' r Y w
LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 .W Professionals Code, and my License is in full force and effect.
O 5 M License # Lic. Class Exp. Date
(� Lo
LU
tr
7331d. .G7 39 w'�17V.7
oZ it� Date >!. Signature of Contractor-
0
ontractor O
J U co OWNER -BUILDER DECLARATION
WLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) License Law for the following reason:
Z ( ) 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).
M () I am exempt under Section , B&P.C. for this reason
LO
N Date Signature of Owner
ON
01
CL z WORKER'S COMPENSATION DECLARATION
o cc I hereby affirm under penalty of perjury one of the following declarations:
FZO () 1 have and will maintain a certificate of consent to self -insure for workers'
X W 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. ,
C3 Q U ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
d ,4% Z permit is issued. My workers' compensation insurance carrier & policy no. are:.
Cartier Policy No.
aD 5.4`�.c�'%I3 f�titlf 0#i4Slt�?lfflgp{?^eS9
J
(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 forthQth comply with those provision`s. 4 �
Date: I rI-7', i'11 ?„Applicant i'>!
Warning: Failure to secure Workers' Compensation coveragei§'-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 CitylL4nd State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection p/urposes.
i { r
Signature (Owner/Agent) ) :r r,!�i! I �% Dater
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
W.fi3f A'd' V f i•.17i1
JOB SITE —
ADDRESS
APN
..�.a.
OWNER
CONTRACTOR / DESIGNER / ENGINEER
IBCA •WWI+K!F. . F A; ASSOCi•. 09
DM, )AAI . PAC t, C QENWL iZ. CONTRACTOR
P0'1 MIK 1060
2533 0,10MI ryOAZ"I'L•IMMAY S'7Z 250
L& 4eiW1.4'TA CA
CAR. 1FF BYT1V, ,S'XA Cf� 92007
USE OF PERMIT
411110RU.� INE,I-l' s
BtJll,L,f' O 'U•t' L111114T 11Y S'TRkIC;'I'URAT,,.
mGmi�d� !1'i Dt3'1J21
d'ALOA'TION
ISF 17mm!' "D CoS"I. or Con"Tr iaucrton
20,owoo
CON'STRUCTKYN YK9 101. 001418-000 $207.00
STRONCI M0`1'TON P`FY,= iPYZI0 101-C${N3441 OD
JAN 3:1 2002•
��ee�OW-AMi 7,
,t
StM40TAL aw°t.? ``lRI'S4'MOX AND KWO�WCK
€b�i39..S1ii
TOAD. "1 IMYETH MITE i+7OW
RECEIPT
DATE
BY
DATE FOAL
INSP 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 Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final D
BLOCKWALL APPROVA S
l 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: /
I
DAVE STEAVENS
Inspection Services
PROJECT taLvjesT- i- t
ADDRESS.r Y- 9 0, 9 Y1
t.4) (' 2
BLDG. PERMIT #
ENGINEER .-J Sri Jv +c t a c -
INSPECTION TYPE
Page of
PROJECT # Z d c. Z - y `f
CLIENT L J e S7- -q u / ,
DATE / i •xu L Y a cry gL
ARCHITECT 6rd (-d1l A
CONTRACTOR 1t: 4- W "f 1Z
INSPECTION REPORT
• i..'t L's o c te + t3 . y4 - C a•M J i- a` it ►
��,.i Att_S -'
�p+.may'-1 �` •� -
Lr. 'Tt7� f ddt.r+,J'�. S
4)-1 5'CW44J5 rA
(r ♦� T (�
/ 7 • / !` •� w1`
�� W • ! t • t7� A - 5
t'11S 7. 44,04W+,J& 5#IE'A.2 - LowtJLt1
tr-t C)Z-7+ VV Sp y•`� �. 4(,I rwLST-v,Jc- L i -4e, .2e
cn'N*%-% - t 3j5 '� B4VCW A J 4 fG1/ P%A+C, qt._ — �O.r..)Le.•rY-
�;,-� .., e.� 4l + 4�4 �[ , l $,S • 7 - 1i� +se.�C Pot+2t " lt}M";-� 44,rTd a r1 .J d
.r
`; A• t✓ '• Gr 15 7 • S R#I pi q r �. �.! L Ft �J t3 t•' +, % tai? ;- ; c ,L t 1,
y ti n �..• i 5 • �. a it i �^.F - Vii" t t !'� G ' A1,4 r t & .J t. c i 4
.. r w4 V : i • 'i ria. »T..� ' 5#4f r1 e, tat 41- L A L` I i. -I A + t_ � � 1 '^ (.cM 'Lt -F C
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, alt of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
ge locations of the work inspected only and does not constitute engineering opinion or project control.
CERT.No. 016SY'3419• 5V INSPECTOR NAME-�AJ C TL 0I aChas
DATE / 7 �7• Nt 1..`i �, sJp Z. � 7Ln (' o
INSPECTOR SIGNATUF ' (tLt �c «�..J
,• ,