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0201-059 (RER)
1 hereby affirm undAr penalty of peduryahat l am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and. Professionals Code, and my License 1s irt.full force and effect. Lkense 8 ! k`glass Exp: Date Date Signatureof Contractor' OWNER -BUILDER DECLARATION I hereby affirm under penalty of•pedury 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 W 66hstruct the project.,(Sec., 7044, Business & Professionals Code)'`71 e :f= O I'am exempt under Section B&P C. for this reason Signature of Owner WORKER'S COMPENSATION DECLARATION' "�f .°,hereby affirm under -penalty of perjury one of the following declarations: I have andwill maintain a certificate of consent to self-Insure•for workers' :.compensation, as provided for by Section 3700 of the Labor Code, for the 3,mance Of the work for which this permit Is Issued. M have and will. maintain workers' Compensation . Insurance, as required by µ 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: Center f Policy No. (This section need not be completed If they permit valuation is for $100.00 or less). O ; I certify that In the performance of the work for which this permit is Issued, l shall not employ any person In any manner so as to become subject to the . - workers' Compeneatlon laws of Califomiar and agree that If I should become subject to the'workers'�°compensation prOvislons of Section 370the Labor Code, I s all fo hwith comply with a' PmAslons. Date: ,Applicant _ �. Werning: Failure to secureWorkers' Compensation coverage is unlawful and ?; „shall subject an employer to criminal penaltles and civil fines up to $100,000, in xaddltion to the cost of compensation, damages as provided for in Section 3706 1�7hof the Labor Code, Interest and attorney's fees. IMPORTANT Applloation,is hereby made to the Director of Building and Safety for` a permit', subject ',to the . conditions and restrictions set forth on his ' application. r' 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 ry any permit issued as a result of this applicaton agrees to, & shall, Indemnify ,t r & 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 vold if ;r+ 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 w 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-Mentloned property for Ins ectlon purposes. ~Signature (Owner/Agent) ' ` =VZL�Date .41 - •BUILDING. DATE i h VALUATION JOB SITE ADDRESS +Li OWNER PERMIT NEHM'Tg . , , V� LOT Y TAAvT' • CONTRACTOR/ i� PCNA VIM RWE1'IAi, A8S30C[A'IIAN DEW&A PACMC (HOV3M A, CO)M PO BOX. 1060 4 62 33'f:'AM AVR, W 02 LA QTJ1"A CA 422:63 S;OL ,l NA BEACH CA 92475 (458)792.1500 CE3111 5823 USE OF PERMIT ' EX)CAl, OFFICK fHF0RMtiTY0)4 75.169 Vt. CHAS PL $till.DiYat:7 7 n 5A.9d0, SO•DS✓i(, 31.97�y, 3d•!)9d • VQL►J?Ji't�..1tb ° STRUCTURAL. MODIFiC.ATIONS F� VALUATION 70,400, 00 Ls r IM="T W COXT OF CONSISU•C1i01''r p»bir<'i subs"Ry C3N-STRUCT)ON FEF1 10 J -MX 418-000 $=OWO I<+lfY 0X M - RM.0 101-000,-241-000 t�.Qtr RECEIPT f. OUTS-'X`MAL COM UC'1TM AND FLAN CHEM i.d= P.RI?�PAW 1W.M r) JANJAN* 31 2001 � �. ClirYpF r -IN LQQUINTA WOW.0O $209.00 $0.00 S209MI - BLOCKWALL APPROVA S r INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION l DATE INSPECTOR Approval to Cover BUILDING APPROVALS MECHANICAL APPROVALS Underground Electric Set Backs Underground Pibg. Test Underground Duds Gas Piping Forms & Footings Gas Test Duds Waste Lines Slab Grade Water Piping Return Air Plumbing Top Out Steel Shower Paris Combustion Air Sewer Lateral Roof Deck Sewer Connection Exhaust Fars O.K to Wrap F.A.U. Framing Compressor Insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls Party Wall Insulation Condensate Unes Party Wall Firewall Exterior Lath Drywall - Int. Lath - BLOCKWALL APPROVA 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 Paris O.K. for Finish Piaster Sewer Lateral Pool CovAr Sewer Connection Fnrami tIntinn Final _ COMMENTS: Final Utility Notice (Gas) rl ELECTRICAL APPROVALS Low Voltage' Fudures Main Service Sub Panels ka., � DAVESTEAVENS Page of Inspection Services ow, PROJECT P(n A WEST= .I e. e. 1'11),5 PROJECT # Q%�tJ.� • O � ADDRESS i t- I)Gs ' It +/7 CLIENT ;6 A ta.1 t S ► No r{ BLDG. PERMIT # ENGINEER .hxjW J SAJU. ri /A/C INSPECTION TYPE DATE % ,ris A C ;092— ARCHITECT 1axeZ.ARCHITECT Coo (-Z rl Aol c��t,1 CONTRACTOR ICL 0161 A4Cs e,'C. INSPECTION REPORT �..� ��L� -�o. �. 1"'t 4= �At�►cc.�:/'5-1 - �i!~.UGId1ilC.�. tA•3� �. Le�'I'- � < . ..... � . rr � P � 4r_�' ` � 1 � � • 1 " � �. u � C. ir'rj � fJ 1. U C it / /�„} �� . � �� f�d�. �h%1" f L I �rJ � '"" � t.3.4.iia.!'S)5•"i- LB,L0cwlijer, A- .1,4'4 L?c'l'S �•3�S' �Vr+�(x1 ��T+++c�. !3 t L4, l T 5 - -7 — 5-t) S. - S4,l ILLJSt �LA�- ' J r f�• 3� r.7� — cows -� K • 9 yo 9 n4 9 74,,99 V -xyac poc5 s &ft o 94 &, o6 "'r� S0C.+1,z t I A i i t , r_ ••• IL -T R)L "_ t, AA , Y 04 16 - 7 • 13LACP 'IC tZ PA,?7 4 lilnL;L, Our A 4. At CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially corroies with approved plans, specifications and applicable sections of the building codes. This report covers the IoCftior ill%t#.W*ork inspected only and does not constitute engineering opinion or project control. CERT. NO. _J 7 `I "'�J 1,i INSPECTOR NAME prtu as.r DATE f7 a?GXJ 2- INSPECTOR SIGNATURE ct-"4— A 1 r a DAVE STEAVENS Inspection Services PROJECT S W €ST -.4 ea CA 'S ADDRESS 1-0 BLDG. PERMIT # ENGINEER' L)j SA joiE W s. INSPECTION TYPE • Page �_ of PROJECT # o100,2 - © g CLIENT A i,J£ s T M4 M DATE < Yt4 0E o?rey Z. ARCHITECT GQLdA j4eCO CONTRACTOR d L MAA f Ac r r'r c INSPECTION REPORT lir. X314 - b rtk- A - 3µg (DOI f s -4 4 o, 9-5 g, $ 7, A] ' tQ` 1:5 ii r � iM�{w!►T� i b { S ..� _ .Z 14 �' ' J� 7 • / ��A /� t -y aL4 C'6C' 1C%A f�i�rTc._-Z AW jej ,4 W.4 « A) A 1 L �QAI PL L; 7-9 I CERTIFICATION OF COMPLIANCE: To the best of our know[ dll of the reported -work, unless otherwise noted, substantialhy with approved plans, specifications and�jble sections of the [wilding codes. This report covers � e do S° work inspected only and does not constitute engineering opinion or project,pontroI. i ' CERT. NO. ©5� y� • INSPECTOR NAME I l:tZA V j s » y DATEC;70 C1 Z. INSPECTOR SIGNATURES t � 4 ~ ~ � '• .. , Pagep �.f DAVE STEAVENS `t Inspection Services i PROJECT�k t�JEST•t.C.[.�EIt� PROJECT # c+TODr�..4 4 ADDRESS:SY• ?qO, 951 9Y(v CLIENT P&A w a ST s4o A TU4le (AI@55 00` If ALAJ DATE _ �ta.iJfr ado BLDG. PERMT # ARCHITECT 60"A i o&A ENGINEERIUW0 SA Vo i6 1AI C. 1 CONTRACTOR. wi4le INSPECTION TYPE f INSPECTION REPORT If--rA L .► "7 - $t.WCiet J6, -.7%4 3e�•+ c�r�' -ya IIE-rAIL r D 0 07 X q alta � a s IL • � �5•"I • L�i~•�+5 - L.aJ aLE Tf- ' , .,�F�, ,x E A,yrs 4L?ry y s -- « c.c rd"- i is - 7 &A It 5AIelk AIA t CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise,noted, *' s I with approved plans, specifications and applicable sections of the building codes.This rept CAL 'I inspected only and does not constitute engineering opinion or project control.yh*^ NO. CERT �S7 �.3�" C I INSPECTOR NAME DATE J .`��' ojtr iid Z INSPECTOR SIGNATURQ �� -teZ!3 • t