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0201-058 (RER)• N LU O � M P� CY LC) W id Z'�` co 'Wad U) Z M U) N O� UQ vaZ ,acr F -O O J Q Ica Q tJ ai , rn Z n'd :s s� • l.Vly 1 nAl. I Vn uGI,LHnMI iuN I hereby affirm under penalty of perjury that 1 am licensed under provisions of r.ihapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date /LL'"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 pepormance 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: qulw- C.AL. )Nf» NINI.TY Policy No. - N314474A (This section need not be completed N 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 3700gh the Labor Code, I shall fo hwith comply with thoseiprgvislons. f / Date: _ '— —� We 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. Al lEach 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 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 abpve 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 /'a f _ Date ��"� 1:.--•- BUILDING PERMIT PERMITk DATE VALUATION LOT 0201-058 TRACT JOB SITE /_ ADDRESS O / (Q J APN - V OWNER CONTRACTOR / DESIGNER / EN INEER PGA ,,V&qr REZMWfTAL ,AS30C1A7f0N LWL MAR PA01707 GENMAL COPrfRACTOR PSI BOX 1060 462 MEVEN13,AVF;, Ji.30 I -A OU190, (row. 92253 501.. 'i.14AL i,ACH CA 92071 (35111)'/92.15CO (Wit 58?.. N� USE OF PERMIT 1,� 0AT.t�'t'irli�R )A!�'c�IiM.A.7'iCt�a ZY1lSaU'...X.ANE'OUD 75•If0 ts'P. C.tfA)'J.,W! •P1, BUtl,.MNIG '? .35-014 3-0XL 35.041, 55.0,56. V01,Uri'PARYVRUr TURA1.A13ODIFI(i A'fiVh"J 'Pill ,I VALUATION L .6+J.L Umm Con. 20stW.00 CON13TRUCTION iI 1101-000-418-000 s2 l.oa STRONG MOTION FER, PIFS10 101-000-241-000 �7•� SUB-1WAL CONSTRU (MO.R 1+H.01% AN C.'HE.0'K $20.9.00 TOTAL PMW FM DLE NOW $209,00 F RECEIPT DATE BY „ DAT F E SP OR 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 APPROV 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 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) lPage I_ of J— ' 0 DAVE STEAVENS ` Inspection Services ? I PROJECT CGA W &ST -L c4 Eya} 5 PROJECT # ADDRESS. (l Lo &, i y / L CLIENT t>& A Lje S T NO A DATE o7 as Z BLDG. PERNIIT # ARCHITECT (-,;4)L 6A .4 o?c+ ENGINEER�tj&)� Sd,O sE t�9 S. CONTRACTOR trL. MAA ?A G r fel t INSPECTION TYPE I � ' INSPECTION REPORT I 1 � � €'� a. � �."� � f ,� � � - 7 ► � t �Lr,.! rdL. F1 • � 4 5 �-t' 7 = y � • 4� o �.•� c.,>r't' �' • 4o 9 5V 174 t � l5 - 7 �Jy JA f amp, r Tt NAdl .r VvA Lt- I F 1 CERTIFICATION OF COMPLIANCE: To the best of our know) 4WI of the reported'work, unless otherwise noted, i substanti=oofes;with approved plans, specifications and a sections of the building codes. This report covers 0 e fd tiiwork inspected only and does not constitute engineering opinion or project.control. I CERT. NO. ©� Y� y� ' .� (,j j INSPECTOR NAME T124A Ur d S DATE +ru A�f-s C;70 d Z. INSPECTOR SIGNATURE _ 1 '�`