0201-080 (BLDG)M
I'9
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
13315 B (f 3/31 /03
Date �!� �! �" 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
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:.
Carrier STATE FUNT) 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 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 with those provisions '
Date: �"/� / lr,sa? �- Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverageris 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. j
Signature (Owner/Agent) ��'f!f ?-� t'� ��-� Date
v'
BUILDING PERMIT PERMIT#
DATE % f VALUATION LOT 0201.480 TRACT
�/� �n � .B�WpOl1VaWV
JOB SITE _
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PGA 'JJFZ"t'.MT:ii?t?Mn. 1 L ASS01 100
DEL MAR PACMI: OPMRAL.G`OITT'1"tAWAM
PO Ba' 1060
x'333 301M COA1 TIRG.EIGNAY UIR 250
7.,A Qi1.11>P. A CA
CARDWo' BY "1`O SHA CA 920M
OBLI). 5823
USE OF PERMIT
2uiimia - z • ss,3 7, 53a`�?:S+', ss -331, 55.363 a Z/O1.t!?d'Ye" R.1"
VALUATION 31000M 1,015
G�tl'ir' C'�'C:.:C,.k�'Y7,p;3C^"•'C�:i
7i.�,0HEAta
yy�yl.Y.a'n '(�v y �n,� y:.�n.W.�:I.i1�13:�
.i 34.1.ti.,[�l�,. T d`. , 'd�+.�1�idY.laii.['C.7.
001481'FtUMION FEE 101 -000418-000, $207.00
-2,41.000
S7 :�Clt i .ii+lZfiBUPd M.8, _ .RE ,iia 101 -OW -2,41-000
z.
4
V i-1*.KXKA_ : Ci,?@3`s'�'i�2.�'C„;�I:ORR:i.7 NAM CEMICK,
U119.00
0100
�T'./aI.' . W FEE1;1 Y—NOW
s2W.00
4
RECEIPT
DATE
Bir
DAT I L D
INSPEC
I1 ,
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
I Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wail Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL AP ROVA S
POOLS -SPAS _
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS: /G
�/N�/� i`%�/"(� 0*
• "° Page of
DAVE STEAVENS
Inspection Services
PROJECT PROJECT # a7wO 44
ADDRESSSS- 363 3 S/, 3=%.31 1 CLIENT �C�6
- %'e'C57'.'4�+�`� f i % DATE
BLDG. PERMIT #
ENGINEER Dv-oj SAJoi c l o t -
INSPECTION TYPE
ARCHITECT Cy—Z,4 AdW
CONTRACTOR b61. A-4,% Ar, c.
INSPECTION REPORT
1;iE~Pt111 .2A. A '-4 yA, _ S'. 1 TS • 7 • IS4Lar&e. Ar 7e-, Z. f'rl::r•�
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially c6t'nplies7with approved plans, specifications and applicable sections of the building codes. This report covers
locatifteWfhe work inspected only and does not constitute engineering opinion or project control. .
CERT. NO. Y' .J INSPECTOR NAME
DATE c C�3 G►�DU Z..M
INSPECTOR SIGNATUR
a
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t'
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially c6t'nplies7with approved plans, specifications and applicable sections of the building codes. This report covers
locatifteWfhe work inspected only and does not constitute engineering opinion or project control. .
CERT. NO. Y' .J INSPECTOR NAME
DATE c C�3 G►�DU Z..M
INSPECTOR SIGNATUR
a
DAVE STEAVENS
Inspection Services
PROJECT �0
ADDRESS .a 5�2�. *3 33q
4 3;#1 j
...s11 sem. A 1i
BLDG. PERMIT #
ENGINEER b"wj SNdam WC.
INSPECTION TYPE
Page I of I
PROJECT # cloo -2 - 09
CLIENT `P&A +u Ci A*T' HOA
DATE dl J'tx L 67002.
ARCH1TECT.6XJM heat i
CONTRACTOR �11 L. A'A .Z.
INSPECTION REPORT
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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
Ibcationid of the work inspected only and does not constitute engineering opinion or project control.
CERT NO. Q • V INSPECTOR NAME , J t;. �tP401LOS
DATE ? ! -f.A AIC e�W 2 INSPECTOR SIGNATURE
�''
DAVE STEAVENS
Inspection Services
PROJECT �0
ADDRESS .a 5�2�. *3 33q
4 3;#1 j
...s11 sem. A 1i
BLDG. PERMIT #
ENGINEER b"wj SNdam WC.
INSPECTION TYPE
Page I of I
PROJECT # cloo -2 - 09
CLIENT `P&A +u Ci A*T' HOA
DATE dl J'tx L 67002.
ARCH1TECT.6XJM heat i
CONTRACTOR �11 L. A'A .Z.
INSPECTION REPORT
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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
Ibcationid of the work inspected only and does not constitute engineering opinion or project control.
CERT NO. Q • V INSPECTOR NAME , J t;. �tP401LOS
DATE ? ! -f.A AIC e�W 2 INSPECTOR SIGNATURE