0301-357 (RER)H
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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
Profess�onals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
713)52 T-1. I -DO 311�111C?13
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). "
V') I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business &� Professionals
Code). I 6/
() I am exe�mpt,under Section B&P.0 : fo'r this re so
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Date 7 a %') ^"r Signature of Owne-... ,.
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.
(y) 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 fffATEI•I1h1:�1 Policy No. 04601ibNIT000941S
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(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 th t if/ should become
subject to the workers' compensation provisions oVectlo /3700 of the Labor
r,:Code,�l sh' II f44'rth�with comply with those provisio yY V
Date:.. �+l�s Applicant—
Warning:
pplicant
i
Warning: Fellure to secure Workers' Compe d ation coverage is unla4u and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the ,City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for. 180 days will subject permit to cancellation.
I certify that I have read.this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon .:
the above-mentioned property for inspection purposes.
Si nature (Owner/A en�-/Date? �F
BUILDING PERMIT PERMIT#
DATE LOT TRACT
P VALUATIONS,WAICKpYJOB
/
SITE
ADDRESS ' BLDG,, .1:A L;l 'CiR.f .s - M' WERVI SS 57/,U Y I
APN _ I f
OWNER
CONTRACTOR/DESIGNER/EN (NEER
P.O.'BOX 1060
353319OU1,11COA IAMIRWiAY.V E?. 250
LA Q'�f`XrA CA 92253
CARDIFFEVIVESMi CA 92007
(760)435-.1013 (I 'LAC 5SZ"5
USE OF PERMIT
F)LDO d9, :4• fi4I, S44$ 14 ;t4e�3;�„ S44W. �t I.LIN`Y,�1,1RY
STRUC:T6 7L WO-DIMATIOVS
VALUATION 00
us"XIM"M COST OF CC)XS- X0_1=,(QX
'201M.00
PERMIT Mil .SUR"
COWRTRUC T IOI+6 FER 101-000-418-000 ": $?P7140
,QTR Ncj MMON FFX - RESID 101-000-241-000
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CIFI C 0EP?•
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RECEIPT
DATE � /J
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BY-^" r -f
DATE F AL
D
E R INSP
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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 APPROVA S
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: ,_;�31<41
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Page j Of r
DAVE STEAVENS
Inspection Services .. f
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PROJECT PLA Q C sr. �- Lee. co' a S
ADDRESS 5-y—By#.
BLDG. PERMIT #
ENGINEER N,+,, o 5,a h 11' :c
INSPECTION TYPE
PROJECT # copao 3 - ct , `
CLIENT Pt A t,jc., -" HOA
DATE (o in y e;,00 3 i
ARCHITECT GD LSA A 8064�"
CONTRACTOR le - L MA r2 AC1F>C, t
INSPECTION REPORT
G e A I !. S I3 S--" 91 OC se A ou 4 Pc `'% AJ A 1g. r,J a - c> m p e E rC
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
�ubstantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
e locations'oflhe work inspected only and does not constitute engineering opinion or project control. ,`,.E
,ter
CFRT.NQ. SV3 J C INSPECTOR NAME 1~ r�fl�i .J/�./'�!/C'�
DATE (0 %) A `i �C%D INSPECTOR SIGNATOR rtzze.-
:4
� . DAVE STEAVENS
#rte Inspection Services
Page ! of
PROJECT '�C. A W E s'r - (C 6.4:- Q r)S PROJECT # d o O 3 -' O q
ADDRESS AV), 9_� a 9 CLIENT A
?-ddVAicss P-A,J/% A&&Jq DATE S InA.l 2y03
BLDG. PERMIT # ARCHITECT Go L 614
ENGINEERCONTRACTOR t- L M A rZ
INSPECTION TYPE
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
e locations of thg'Wbfk inspected only and does not constitute engineering opinion or project control.
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C;RT.NO. oX957-3I/ �' 5"o
DATE S-`"!4 Y 9003
INSPECTOR NAME ir/ ' .
INSPECTOR SIGNAT -R
I-tEf1L)r,AJ'S
Pr"..°ry) - F