0201-058 (RER)I hcreiby 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 11 Lic. Class Exp. Date
Ell/
r'ialr
Date -I— � I y �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
pe ormance of the work for which this permit is issued.
have and will maintain workers' compensation insurance, as required by
Sectlon 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:
Cartier Policy No. "'�
c L NDEl�M)TY H30474A
(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 3700 of the Labor
Code, I shall forthwith comply with those.prgvisions. %
Date: I a 171.h Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application Is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
.1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I.certify that I have read this application and state that the ab ve information is •.,
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) % r- JI.%, f Date
BUILDING PERMIT „ "t"M'r"
DATE VALUATION, , LOT TRACT
16.1 1 LV.0 0mm
JOB ADDRES
Ste" o y$
APN
I�► v
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PIG -INU P 1; r-,3TI)F.1,fW, ASSOCIAII014
i
DEL MAR PACIFIC. MaTFR AL C09112AC"xOR
PQ BOX ) 060
462 Vf LNE, N 0 ,AVE 11'3 02,
I. A QU7NI-A. Ir -A. 9225
303-INA"BLACM CA 92075
f3aSj7a2.15Gff (Wil 5SZ3
110C &I X7.111111 "..Ir INFOR KATION
USE OF PERMIT
?A13C-LANE'DUD
?s 160 1* C:uAl-t-Lm n
tiilll.l3tJdCi t 35.OI3, �S•;ZiGL S9 -n, ,15.456.MONO,,
•P: �
Y.OIAMT.ARY 'W1 (T.t CTLIKA1. NIVI . IFI:.ATIO1H'.J r �` • '
VAI. VATICIV 2g4xDo Is _t
WrIMAIND
PhR1u rrFJo!R SUMMARY
(',0113'!!2UC11)0,K MX ) Cf1-000.418-000 $207-00
ti'e i?.ONt1 i1�f_�T1c N 1?i� • i? .:yi.0 101 -000 -241 -OW
3E'TfA-9W Ai', CONMIZ:UC`.TION AW) k'I AU (:REC K $209.00
LEND PRE-11MI, bl-W $0.00
TOTAL rE:i_ •T FEES A1'l E POW
RECEIPT
DATE
BY _ „
,.
DAX;07
/Vn
E��
SP OR
i f
4 `INSPECTION RECORD
OPERATION
: - DATE
.INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
U round Duds;
Forms & Footings
Ducts
Slab Grade
Retum Air
_
Steel
Combustion Air
Roof Deck f
Exhaust Farm
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fats & Controls
Wall Insulation
Condensate tines
Party Walt Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
.
'POOLS -SPAS
BLOCKWALL APPROV S
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 foffinish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
01tr A.W.
{ DAVE.STEAVENS
Inspection Services
PROJECT _P6A WZ:5T--4C4CAV4S
ADDRESS
BLDG. PERMIT #
EN�INEER�u�,�+j SA.1u�E tn0
INSPECTION TYPE
Page of
PROJECT #
CLIENT, A L,)£.%7 NO A
DATE
ARCHITECT 6yLdA ARC A4 ,
CONTRACTORD dt.. MAA ?A t l t
k
Ali. 't
INSPECTION REPORT
O 30 12I
6 JG '�CwJ J E aC ��. S {� C...+� .) t't,�l�'.
I �.►
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.' 1 �1 � � [� /
� " / �'. � �M�.•�►. ► G7Cr� /'� • O [ � f"'f �� 7 � +��i I�
l� �� I C �v' =� - ~t
4A �'
r .'? - tawijcs < 5 e -e.
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A Td`
15"14-4 4o 9 t' 714 91 Y 43
MtAIz
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iTA/e,-
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LO C,
RIF1CATION OF CO�MPUANCCEd.: To the best. of our knowl rill of the reported work, unless otherwise notedapp plans, specifications acrd ble sections of the building codes. This r " rt
oSUbstantial
itte do trk inspegt#d only and does not constitute engineering opinion or proj''6&control.
F
CERT. No- Q e �} ' INSPECTOR NkAE
DATE Ju �f-; f4•� d Z. INSPECTOR SIGNATURE14
I