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0201-059 (RER)*' LICENSED CONTRACTOR DECLARATION hereby affirm under penalty of'perjury that I am licensed under provisions of G�hapter 9 (commencing with Section 7000) of Division 3 of the Business j � UJProfessionals Code, and my License is in full force and effect. Nand. I G M cq License +Y am i. � W r. Lic. Class Exp. Date Zr` / 3a $ 1 i. cdo O Date - 1.— Signature of Contractor 1.'// ( °„r I/ V p W WOWNER-BUILDER DECLARATION 1— a 1 hereby affirm under penalty of ( Z License as, o Law for the following re sonury that I am exempt from the Contractors ( ) 1, f the property, or my employees with wages as their sole tt compensation, will do the work, and the structure is not intended or Offered for sale (Sec. 7044, Business & Professionals Code). O has owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business &Professionals Code). F ,- ( ) I am exenipt'under N Section '0 Date B&PC. for this reason Urn Signature of Owner L Z WORKER'S COMPENSATION DECLARATION. f <,X )hereby affirm under penalty of perjury one of the following declarations: J1- O, () I have and will maintain a certificate of consent to self-insure,for workers' m QJ, compensatlon, as provided for by Section 370s of the Labor Code, for the U Pe rmance of the work for which this permit is Issued. iO ) I have and will maintain workers' tom Q Section 3700 of the Labor Code, for the compensation insurance, s required by a, rn Permit Is Issued. Performance of the work for which this er Z My workers compensation insurance carrier & policy no, are: Cl ill. JHJD V$1 Y' Policy No. ? 'g NX02)WA Permit (This section need not be completed ff the ( )' I certify that in the performance of the Work foruatwhich this permits Issued or ) I shall not employ any person In any manner so as to become subject to the, workers' compensatlon laws of Callforhla, and agree that if I should become subject to the workers' compensatlon provisions of Section 370 f the Labor r Code, 1 s all fo hwith comply with 08e Date: », ,provisions. �1y� Applicant 4 `r „Warning: Failure to secure Workers' Compensation coverage+ls unlawful and ,.shall subject an employer to criminal Penalties and civil fines up to $100,n 37 In 000, in addition to the cost of compensation, damages as provided for in Sectio 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 .I 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 Qulnta, Its officers, agents and employees. I, 2 An 1 t. y 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 ' he'abOve-m and hereby authorize representatives of this City to enter upon the above-mentioned property for Inspection purposes. Signature (Owner/Agent)" ` ` RECEIP Date 'BUILDING PERMIT DATE p VALUATION I I -, LOT JOB SITE ADDRESS �J OWNER / PGA WE"-•PMnDTI NT'IA.L Asir LA cit uI` -fA CA 92243 USE OF PERMIT M °-LLAlEUTI.g 0201. TRACT APN ONTRACTOR/DESIGNER/EN INEER - ` Tiff:. MAR. r AC '(,f 0DJ RAL Clotj J.�2 �►,�."1'c 46 �3 is'►+ tNf3;�Vn, Ern K"C)%/�Rt��1;EcFr14C:II CA 92073 +("S 'P92-1500 �G'.f3l i SB�s IISri C. C)Frei(,X fWF40JIMATION I3UILAI}Jt. < i�1.g4Qr 34,9 ' �•glt�ri9..yge( ' idc�Ll3PJ1AItTl' ' It tri"7'tr A#.c�IitFi E. Afi'lcihr VALUATION dfl,m. fill LS ISjt;►+ti!i(A,I f�tlfo''C3�" GS).tYSzld:UC:'IY1V p 'i jSDil MARY CONSTRUCTIO)4 pEls 10) STRONO MOTION TOED . RESj0 101-(1()0�-41 Et -()0 fl a*11-UO 1207.00 t- + ., � �,•, Vis. , : CTF3-T`�T,.AI, C?O�l ?t�t'iT©IJ AMPLAN cN.TfiCX JAN 31 1002 C ryn,`, - $709,00 ft,00 INSPECTION -RECORD" OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms &'Footings Dui Slab Grade Return Air. Combustion Air ` Steel � - -- - Roof Deck Exhaust Fans OX to Wrap _ F A.U. Framina I I I Compresses Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wail Firewall Exterior Lath Drywall - Int. Lath BLOCKWALL APPROV Backs 6ngs d Beam Final PLUMBING APPROVALS Shower Pans Sewer Lateral Sewer Conner Gas Piping Gas Test Utility Notice (Gas) I- ELECTRICAL. APPROVALS Temp. Power Pole Underqround Conduit Low Vottagi Fixtures Main Servic Sub Panels Vents Grills Fans & Controls Condensate Lines - 3 Final .c POOLS - SPAS , Steel Electric Bond Main Drain Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Gas Piping :s Gas Test Electric Final Heater Final Plumbing Final t Equipment Enclosure - O.K. for Finish Plaster _ = Pool Cover Encapsulation Final - z COMMENTS: A4w fir/ r . F • t - t v. t • t i0 �, t t � DAVE STEAVENS Page of !^` , � Inspection Services i PROJECT N) k� �li�.S 'M, Cam +►3 �5 PROJECT # e>20 CJ •� - ADDRESS Z4 0 G If G +/7- • CLIENT :k A 06S T f& A BLDG. PERMIT # ENGINEER .1AIJAJ 5AdU'e WIL INSPECTION TYPE DATE 7 ,1-4,UIC ARCHITECT C. O L ILA Ail c Irl CONTRACTOR le -l- #W4Z A�--r PC. INSPECTION REPORT C,.qD. �azK. i1 49 (.AAAL c /5--t - bLue-atilt_ rA-A, s. /-P-r- Y �..oMDL+cre _�t.'f� ►l,. +'t [S •1 " "L"Lt1St T� FLWCKr,,Jt-�- 514r'A L 4,4re.,J6 Cv ^' L E TE" 1�T�� s - t. 3. �. �a. t8s• c.�ck �,.lc� Q•��� L-7a*s 11.315• ,� `T��,�._�� � t�_��5 •?- Sc?�•Sratt�S, ��ac.il,�.1c,. /�•3w �: �� 7� j— d'�-•9�v 9 % 44V 'bro a1s.-, G/S • -7 — soruiiz k)ti# L s.,,c., — Con, p `e ra, -I- Ai o CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, 0tsubstantially complies with approved plans, specffications and applicable sections of the building codes. This report coven; he Iodftorift Ittidwork inspected only and does not constitute engineering opinion or project control. CERT. NO. 3 qi -S 6 INSPECTOR NAME ` = , J ^ �DATE 7 7ii'/r d2,00XZINSPECTOR SIGNATURE-m� rp' f t - Page �_ of DAVE STEAVENS Inspection Services 0I 1 PROJECT WCST-Ie4cA t?5 PROJECT # 0200;1 -o" " . ADDRESS CLIENT', A L,)C S T No A 1 , DATE ,JQ o? qu2, BLDG. PERMIT # ARCHITECT &�-OLrSA A ec d + ENGINEERA1,J SA JU +E I&.. CONI'RACTORD eL.. MAA ?A t r p* C, INSPECTION TYPE INSPECTION REPORT �' !S L� rte,,. 1� • � µS Lt'T 4 � �o,w. 7 L�Tr 1 ; tr'A 3 � LeC i` 1,�} t j 'r 4 5 8 174 -+-- �j QQ 1 1 ^ � "•"r �©+ ( 7 (. � t Is pA�,1 A��. N�1,�+� e�MPLL T W. VLO WA A rL. 1 CERTIFICATION OF COMPLIANCE: To the best of our knowiieMWAI of the. reported'work, unless otherwise noted, substantial, with approved plans, specifications and ' e sections of the Building codes. This report covers e tit' v ork inspected only end does not constitute en ineedn opinion or ro ect control. g 9 P P r . CERT NO. Q Q y 1 INSPECTOR NAME + tJ C ;�C JA Vr d c% �+- DATE 49 AJC-: 007t� 0 2,. INSPECTOR SfGNATURE + Page of • DAVE STEAVENS Inspection Services JV PROJECT,-�►A Wsr- .c PROJECT # rDf1,v7 -- D 9 ADDRESSSY• QYV� 9 4? &4 CLIENT ?CA tAJ a ,5r s -LOA ` 7welfA1955 AUG If RAJ DATE ;*q;k BLDG. PERMIT # ARCHITECT C-jo" I As&H ENGINEER iJtJ SA 1%,e IRJ G ; CONTRACTORJ)� MAK' rl Gr jcf t INSPECTION TYPE INSPECTION REPORT -r A f L - (LS • -] ^'~' A2 6X!.J m m ADO o7 x q 0J &.04 A'"S C* -7 t b ' �- 4 -7 - :rs I.?Ir ails L • ?v' vcwi.//, -- � i CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, s substaptia)ly complies with approved plans, specifications and applicable sections of the building codes. This report covers loczst VCrk.inspected only and does not constitute engineering opinion or project control. CERT. NO. 41*%'T93449"' O INSPECTOR NAME 1 f 1115 !S%C#4UF.JS► DATE _ J Z 1 4A adZINSPECTOR SIGNATUR; iC2d a � t 0