0201-059 (RER)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
Profes3ionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
;3315 13 • 3�'3fr
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&P.C. 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
performance of the work for which this permit is issued.
/) 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 Policy No.
CA),1'tiDf;;'i�l.1411"Y 'N P01621 At".
(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 37004f the Labor
Code, I shall for; hwith comply with those provisions. 17
Date: ' ' ' Applicant 1` ' �, !'
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 1 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. %!
Signature (Owner/Agent)f;�� ! ' ,t, j -``! Date
BUILDING PERMIT
DATE ( VALUATION LOT ()x01.0„5& TRACT
JOB SITE
APN
ADDRESS To few 1Yp (� '7-7
OWNER
CONTRACTOR/DESIGNER/EN INEER
PGA t1d:i?.:'"TR .i1:.r)Xt r1TA:L.AS 0f7[ rJ01,T
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USE OF PERMIT
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�;2.U�Y•�iC�
RECEIPT
DATE tt
BY-- ; -.
D E A E IN E TOR
Y `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
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali 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 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 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 (Penn)
COMMENTS:
0
• DAVE STEAVENS
Inspection Services
PROJECT r 6 K WES-t '- l F&e: JtJ h5
ADDRESS 1(- G I C+ d 7
BLDG. PERMIT #
ENGINEER ._I gJgJ 5,R U0 r1 IAA -
INSPECTION TYPE
Page 1 of
PROJECT # n7ca 6A - v 1
CLIENT -�6 A LJ t S_% #01A
DATE '/ ,r14,JJC r9002 -
ARCHITECT Go L ? A rlra C o
CONTRACTOR I E61- OW A40 ,�7tG.
INSPECTION REPORT
Ccs 4 e: 7�
t;`Y'+�1 trS ' 1, 3.'�. �lsk. 1$ S• 7 - t��cick 1�r., Q• �y � L '�c7+S A •?�ti- �ow�
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14
CERTIFICATION OF COMPUANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
0tsubstantially complies with approved plans, specifications and applicable sections of the building codes. This report overs
he loCftor"IM'work inspected only and does not constitute engineedng opinion or project control.
CERT NO. - 4qe -ToO INSPECTOR NAME 1✓
DATE f7 .YIIAjE ,2gia 2INSPECTOR SIGNATURE
I
. 01
/j
DAVE STEAVENS
Inspection Services
°oit"'
{
PROJECT WC5T-1.C4CA,)y s
I ADDRESS_ f t Ld Ap
I:
BLDG. PERNIIT #
ENGINEER��.j &j 5;A jt),F- 14c -
INSPECTION
4c.INSPECTION TYPE
Page �_ of
—L—
PROJECT # CA 00.2 -o g
CLIENT fI&A u- f. Z T Ho A
DATE :!r 7w r.J t o2 rsu -.
ARCHITECT GOLd A A eC 14
CONTRACTORUL. /MAA ?Ar -to -7c_
INSPECTION REPORT
26
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CERTIFICATION OF COMPLIANCE: To the best' of our knowl 41 of the reported work, unless otherwise noted,
substantial, coal with approved plans, specifications and ble sections of the 'building codes. This report covers
the ±iMio rk 0 inspected only and does not constitute engineering opinion or project.control.
• CERT.NO.r'QS Q _?qA
.J__C;70612.
� �
DATE J(AA.)f; C;7061 2.
INSPECTOR NAME "" A j
INSPECTOR SIGNATURE
• .ti
.o
" #I-
06--- �?^ ' - -' 111� 4-
DAVE STEAVENS
Inspection Services
ADDRESS$Y•VN0,'9$0.976, 994
T-W/lefd%5t BU(, !S PcA*J tj
BLDG. PERMIT #
ENGINEER" 504t/,416 MR.
INSPECTION TYPE
PROJECT #
Page � of
jr
CLIENT V&A to a ibT idoA
DATE 2 :T4uJtS a *a A
ARCHITECT 6o "A AdCH
CONTRACTOR.b4M A'1 A OC r.
INSPECTION REPORT
1& I,AtC•�A/S-i • LPi'�y5 • C..�«+DLE:, "
1
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7A "In 1 *1 A 7 -3:r:, tv%-r- q 5 7'a�, R4 ocwi.4,
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T
I
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially cR, ies.with approved plans, specifications and applicable sections of the building codes. This report covers
loca'Qons dl'. W61k inspected only and does not constitute engineering opinion or project control.
CERT N0. 06 36'• SrA INSPECTOR NAME
G �
DATE .` L'Awl Grd Z INSPECTOR SIGNATURM;
f
a. Id .�