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
73157. B t IkI/ ' {J 071l0..
Date / �" Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perl'ury 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:
( ) 1 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.
r) 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:
Cattier Policy No.
NATE >•IA4D 04601IMIT0009115
(This section need not be completed it 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 91 the Labor
Code, I shall fopthwith comply with those provjsions. ; I
Date: / Z' 1 1.: Applicant '! ii / r /
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 thispity to enter upon
the above-mentioned property for inspection purposes.
,J
Signature (Owner/Agent) i t ! ' f i / j f Date � /) -
BUILDING PERMIT PERMIT#
DATE { VALUATION LOT 0201-079 TRACT
JOB SITE
ADDRESS 7— V J41
APN
YME��N r
M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PG A WERr R&SME 1IAi . JiABSOC''DMON
DFL MAR PACIRC Cl.ENF"T, C'014T 2ACTO
p(D DO:X 1060
1533 SOUTH Crtt+`TT 111011WAY ,"MR, 250
I.A QUlWI'.A CA
CAhMF N%'' THE SLA CA 9200-7
(760)56/1.9500 C"BL4 5$23
USE OF PERMIT
1�1ISt'°1�.L1•..AN�9U'"al
I3t. ILA)IN0 22. 53.4115, 55417,55.4n, 55441 . VOLUNTARY
STRUCTURAL MODIFICATIONS
V AI,Ukt. MYN 2%000.00 I
X611MXfED COST OF COJIVBdA3UtMON
20IM0.00
YERA93T FEE lCT.31Yf1AARY
CO S;TRUCT1ON FEE 101-1000.4.16.000 $207.00
t
STRONG MOTIGN iEK .'RBSIf? 101.000-241-000
1
gUTi-TOTAL C01+1M.i1C'MON AM P Atd C''q(b'.ex
AID F1.13
TOM, P=Mn. FEES DC>F NOW
S 09AX)
RECEIPT
DAT
BY t
DATE F LED��
INSP O
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 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
Finai
utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
I G.F.I.
Smoke Detectors
Temp. Use of Power
i
Final
'lity Notice (Perm)
COMMENTS:
UQ�
,- - DAVE STEAVENS
Inspection Services
PROJECT #\ vJ e S t '" (,, t~ C.> P—wZ
ADDRESS 5"--_W41. 4.7`4'r, t-1. 40
BLDG. PERMIT #
ENGINEER ,,) ,�`AJ&it.:
INSPECTION TYPE
Page of
PROJECT # U
CLIENT 140A —_—_
DATE( ^,4J
ARCHITECT 60
1
CONTRACTOR �) E( WO1`Y1
INSPECTION REPORT
uJ A t..1.... �-rN r' i'
73.)ti'T N, tlr'x- I S, J Pl�r•7kc)Z AJC ,)Le) A -Y AJA rE ✓rJ � L "y''��•
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
l�jhe locationsof.fhe work inspected only and does not constitute engineering opinion or project control.
CERT. NO. l:OPR-� 7 4�G+ ` INSPECTOR NAME.
(Printf Clearly)�
DATE INSPECTORSIGNATUREP"t��,Q.-- c-
i'
17 - • A
Page of
, DAVE STEAVENS
Inspection Services
PROJECT PROJECT # c�c�
ADDRESS 5 S -Y Y f n .t,. w r w u a CLIENT �G A i.tij d - t-kL-)A
�►=`S7JJZ .71 r &A-i b DATE
BLDG. PERMIT # ARCHITECT God- ■l Xa Q-)
ENGINEER. ` i.x r J-h.a 5 A CONTRACTOR,, L— *" rk;
INSPECTION TYPE
INSPECTION REPORT
r
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
I the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. INSPECTOR NAME _
(Print Clearly)
DATE INSPECTOR SIGNATURE