0201-085 (BLDG)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
I-- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License. is in full force and effect.
O =) M License # Lic. Class Exp. Date
r -C3 U.) n
1 r
r` 7 k 5? s 1 /" 363 110?3
oZ r,- Date �� �``�� Signature of Contractor
COOS
J U coo OWNER -BUILDER DECLARATION
WW Irl -I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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
t 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
p cu
d Q WORKER'S COMPENSATION DECLARATION
It (r I hereby affirm under penalty of perjury one of the following declarations:
Ln FZ 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W LIL compensation, as provided for by Section 3700 of .the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q L) (') 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 L Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cartier Policy No.
aoo �i'£.fts"f1s' FUND G��QYt1li1`€Qttr��i9
g (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
3 Code, I shall forthwith comply with those provisions. / rZ.
Date: /M /f i� Applicant �,l V V �/.
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 3766'
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 agree'`s 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.
{ , ! / t.. / 1. / /fy
Signature (Owner/Agent) r E � Date" ` ''�� `�"• +
BUILDING PERMIT PERMIT#
DATE VALUATION LOT l3Pj1,--�}e°f TRACT
.5CA,
JOB SITE '
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PGA WEIST PX1.Sf)rD_4 f7a 1 P ` ; CITi I01
DR11 i AIA P CR -le GWIR '� Iii.. CON11.i2.,ACIX)p
po-WIM) 160
2533 OULTIM W-AnK fC3HWA3'_•R 250
LA t%);;)f%t"M CA�'iA1�I3
1:t��f f k�; �i+:�4 C& 9200.7
C160)564-9300 j44 58211
USE OF PERMIT
!3i)d;.11ITACf t n` £•98'IA4.4�t.�,1�..005, 543 027 `V'C1LUIN7'AIZY'
S'f°f�d tC`!`tiFaAI,, MODIFICATIONS
a't4}NS
NAWATIOIN 2.0;000,001 LS
ESTMIAITED COM, OF COBS MON
PF.Ahlrf VV A1l*dWaARY
:.CO MTRUMION FE k E11 •ili9t) f 8�At10 .3 2ff4
°Itt1C.trl'3c;t<i F,
r
.�
3 d`
^al _ Jars i 2002
SIM',TO SAL C9�a�3��'T`R.ti lr) AWL) °7- AN C�ii:C'f�
$209.00
�jw" MZ :R]E-PAIDi 1.0
VW0
.A V*A83-TJ .,L •1'.cA.L1.?Al.E. �.f .7s' G!'3 ,�,r+`1/:L'a dY4Y
t 1
I�i1.lf�.�i?iT
RECEIPT
DATEBY
DATE FI LED
INSPE R
INSPECTION RECORD
OPERATION
DATE
INSPECTOR OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final z
BLOCKWALL APPROVA S
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test.'.4
Final
Gas Piping • �.
PLUMBING APPROVALS
Gas Test
Electric Final .
Waste.Lines
_ Heateffinal
Water.Piping
',., Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
t`' 0. K. for Finish Plaster
Sewer Lateral
t� • "` . ool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors <
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
��j�
/
DAVE STEAVENS
Inspection Services
PROJECT tLA uJg�T - LC CE$d5
1
ADDRESS -'W';*
7a JC 'FL -4)L0 Zy zoo Z
if -OL at�
BLDG. PERMIT #
i
ENGINEER ,'oj SA,J� � � � aJ G.
INSPECTION TYPE
Page of
PROJECT # a d c. 2 - y `f
CLIENT L -J a ST 14,014
DATE /7-7414Y ;2 v c. Z.
ARCHITECT 60 c. Jtl 04C.4
CONTRACTOR I ' L. rt' 04 4 r
INSPECTION REPORT
PCZ ACLS �p�� �--rte L -?OST W&, 563 ScWtwS tiro
L �_ i� t t.. • ' t i ,3 : is �i {�c :r3. `f �S. ' •�� `j' 641- P4 cT'�
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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
C�'
locations of the work inspected only and does not constitute engineedng opinion or project control.
CERT. NO. INSPECTOR NAME A J E J IC fit: �lS
DATE / *7 , -&4 L`/ jt. u0 'r, ~� I��
INSPECTOR SIGNATUFtEZK
Page of
--= DAVE STEAVENS
Inspection Services
a - N f
PROJECT R.6 u e � 1 in &'GC x/11: PROJECT # •7c.•v L - o 9
ADDRESS rT •a V7 vv 5,0:5q f CLIENT P6,A 6d e Si' 140A
oa-+er
�g 5 ro JL d` A,, .16 'P4i+IJ S" DATE / (a .T" (- Y Z cx-'t
BLDG. PERMIT #
ENGINEER1,aJ SrJoog. t4c-
INSPECTION TYPE
ARCHITECT (, 0LL""d.4 AAA 4AI
CONTRACTOR �''L A ief d AGS,*
INSPECTION REPORT
C. 7,4 S • l , 3 �s • �t `- C d L' �'� Ita . A • 3 y 6cr,.. t L r �
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.' A t �. S 1 S • 1 .ems �S • 7 A 1' b�/� S i 014 3 Ld & l kA LC. .
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially oom lies with approved plans,"specifications and applicable sections of the building codes. This report covers
ope,
Ic i Mork inspected only and does not constitute.engineedng opinion or project control.
CERT. No. iC).k9153 Y SfJ INSPECTOR NAME f► . C Jr'7�¢ /t �/E �.1 �,
r DATE 16 V2eC Y ?do`
Z INSPECTOR SIGNATURE!