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0201-079 (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 73152 8 '; j Std l/c A 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&RC. 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 pe ormance of the work for which this permit is issued. 1) 1 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 Policy No. STATK FIA41.) 94611111'MT01109+�119 (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 3700yfi the Labor Code, I shad fopthwith comply with thole prgv)sions. / Date: /_,! / !' ,1 _ Applicant— Warning: pplicant 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 - ity to enter upon the above-mentioned property for inspection purpose/s`. A' $ignature (Owner/Agent) {' A% l� r J ^ f •/Date /)J/r�•- BUILDING PERMIT PERMIT# DATE i VALUATION LOT 0201-079 TRACT JDB SITE ADDRESS 5-5- l APN 1�aaEsrOnti?: OWNER CONTRACTOR / DESIGNER / EN INEER PO A W RST ROIDENI AL A890C=0X DEL MAR PACIRC (UNFIZAL COWTRACTO PO BOX. 1060 2533 SOMM CWTHIGHWAY AY VIX 259 LA Ql'MMA CA CARD" BY THE SEA CA 92W7 (`if►b)Sd,4�450n C:k L # 5£323 USE OF PERMIT MISCIMLAN MIS RUII.l IWO 72 - 53.405y 35.417, 3!1-429,35441 • VOLUNTARY STRUCTURAL MODIFICATIONS VALUATION 20.00fl.00 I.,S MI IAM COST OF fI0.6;1STRUC110H 200)0.00 JPETOMT FEE 9MilViARY COHSTRUCTiON i 101-M-418.000 f�0'a,ryo .,TR, -MQ MOTION FEE -'i ESID 101-000-2,41-000 r X1.00 f l 3030, -TOTAL COkdSit(IMOR AND PLAN, LFSJ >' A11 R7 3 $0, ill) TOM PMUT FENS DUF POW S209AX) RECEIPT DATBY DATE F LED INSP O INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE 7 INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Fomes & Footings Ducts Stab Grade Return Air Steel Combustion Air Roof Deck Exhaust Fans OX to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath Final Final BLOCKWALL APPROVALS POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans O.K. for Finish Plaster Sewer Lateral Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Appliances Final Final/ Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wring Low Voltage Wiring Fixtures Main Service Sub Panels ' Exterior Receptacles G. F.I. Smoke Detectors ' Temp. Use of Power Final 41tility Notice (Perm) COMMENTS: o/"/,W/,f DAVE STEAVENS Inspection Services OW PROJECT LIC 4agxW) ADDRESS r -dr -441 q-lqr L46 V40,5 r#kCJT0JC J9.0(.-fda PZAJ BLDG. PERMIT # ENGINEERUA&A INSPECTION TYPE Page of PROJECT # Ud ol - 0 CLIEN DATE &116 Le J ov �, ARCHITECT.404-4* CONTRACTOR ,ICC OV -0 f -1C.14=14. INSPECTION REPORT -1 1.2#.4. 4A. 51/5•'7 - .I V u f, )A -rA it-!$ (,115- 7 — Si�eA;Z A)A stedl,, Aaj) P/Y A - ,i)' C -T tN it,-), Ppic-rgg Aid at-acl Ay A1,4 -L i de, - V CERTIFICATION OF COMPLIANCE: To the best of our knowiedge, all of the reported work, unless otherwise noted,,. substantially complies with:approved plans, specifications and applicable sections of the building codes. This re rtcoVWJ,V,,J, iocatioQ&'work Ww'inspected-only and does not constitute engineering opinion or project cor' itrol > CERT. NO, INSPECTOR NAME `77 DATE INSPECTOR SIGWJR;:;;:� .e DAVE STEAVENS Inspection Services PROJECT 06A 0iL4i I - L.EytaPS ADDRESS4 041 ? Vo BLDG. PERMIT # ENGINEER 1 u., -0 'SA,Jrrr� �•�� . INSPECTION TYPE 1 Ott%�S — Q ArZt%A^ Page t of I PROJECT # Z2cW 2 -• v q CLIENT �A Q C -.,,T- tA0 A DATE c;4 Z%& J Ie o? v0 2 ARCHITECT 6vc-dA A4c.N CONTRACTORIL-,L, *"A,2 ?Ar -#47-44. INSPECTION REPORT T 7 LKt!/Ai6 . 5J "7 Is. ' ,QCoe #,J G 0,4-1,v y. A -3:!r �..c�,ndac7a- :.T-N L g 05 - 7 - til x Kr aio 14' 3 1cu A—, ,?c. e"T C:� �"• 334 sal, s/s."v3. 1.57_0AJt &La_PLA0 -� P6. Y € try te- `k .; • 1-'SIALSI OA t L10.12 - C'OMO _IE?'E P4 "I JA"Lr.i t.. ('wm4Lt+" Y -t: If CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially complies wift approved plans, specifications and applicable sections of the building codes. This report covers s loca"I%W, the work inspected only and does not constitute engineering opinion or project control. BERT. NO. 0$tR 15 Y3 5�© INSPECTOR NAME '.Z)1N JC 5%& 6 ✓LtJ5 �n-t; Crwr1» DATE l4 _T u ^1 tt ;3 UO 2.. INSPECTOR SIGNATURE"�"'- ..... �