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0201-066 (BLDG)LICENSED CONTRACTOR DECLARATION 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 Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date '13152 E 03/14 12C Date .i f % ? 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. STATE FIXO0 134601 UNIT0009415 (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 provisions. Date: I�Applicant 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 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) I . %1 /l t t f Date BUILDING PERMIT PERMIT# DATE VALUATION LOT (ffl— a�ItSC/ TRACT IiJ JOB SITE r L/ 14/ ADDRESS 'PX8 APN %F DJEA018�1 C UVJ ' OWNER CONTRACTOR/ DESIGNER / EN INEER PO BOX' 10610 2533 5Gf 1 a.` M, - T I11011WAY ZoTZ 250 LA Q!i1.t TA Cdr. 92253 CA.1:UA DY 'IM SFA CA. 92(10 i (760)564-9500 tmUf 5823 USE OF PERMIT MR UIS SUJILDiNU 104 t 16*.4;V, - VOLUNTARY a �7RfJt,'f'tfRAY, 1�i01?2�xCA,TI�Af VALUATION 32%q ,00 i's WT.1.W&*J%D fw.09x, OF 17Q.fW1:1'.iUC',r10N .1P1t,'1L kIfB'CFrRESTTMMA.1?.Y C'.<3?dSTRU0"!`ION FEY: ; 1011.000-413.000 $207,00 STRONO MOTION �*FX- R SW 101 -000 -241 -WO f t . Si11"3"`3`OT'ALC.OMI-R iClUON.�1,.'4�l'.PiLA CVCKi $209.00 'i.1 S. ?_,H-PfflD 1,1;1?+# $0.00 TOTAL rERT-r 1' ES PH SOW MW* RECEIPT DATE ' BY DATP FIKALEV INSP T R rti i I -2 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 8 Controls Party Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath I Final Final BLOCKWALL APPROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I I 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 (Perm) COMMENTS: i ,n ►7I, . DAVE STEAVENS .Inspection Services PROJECTJ)6A w C S'T' • Ce C eODS . ADDRESS ' t. t'� t� • rx +r # 3 BLDG. PERMIT ## ENGINEER'bd&_ Z'SAjOlda z4c. Page , of .Z...= PROJECT # ?cpo l - 0 � CLIENT'N A t,,acsT' M4 A DATE C219 Ai A � Zt 00;L ARCHITECT 6044A g4 f2 C q CONTRACTOR )�EL M04 -ft INSPECTION 04-ft INSPECTION TYPE INSPECTION REPORT go - `1 :Pvt L A i2 00L,46 I . X t- K._., t . A 4 ©M 4 Z�o. 4'x % 44'0 s AWIN -Alt IA'AA . z. r CERTIFICATION OP COMPLIANCE. To the best of our knowledge, all of Elie reported work, unless otherwise noted, substantially comQti"mith.approved plans, specffications and -applicable sections of -the building codes. This reportcovers e inspected only and does not constitute engineering opinion or project control. CERT. NO.� S,3'�'� INSPECTOR NAME„ DATE��G7C? .�. INSPECTOR SIGNATU ��_� • .. - .. � � � :' , • Page �» of � °DAVE:STE-A ; ENS :.. Inspection Services -" y PROJECT ►R:- Coei"f `PROJECT-# " t; 0049 -14D R ADDRESSIn--420 +k f t, CLIENT '. &J 7"I'A_ DATE A, A 14 613 w • y T • BLDG. PERNW # ARCHITECT (S(A, 6 +A_ Aileq ENGINEER utJr,,3 i)Q4 ' R •:CONTRACTOR. `INSPECTION TYPE f INSPECTION -REPORT ; '���•,''� f. � ) .`,'4r.\�W.. - . 6,t.IQ ` .r' il►\ �,.'�` tw- _. S Fi rjeA i►11I1; ti1i r 4. *4 r« 4 (A L t CERTIFICATION.OF COMPLIANCE: To the best of our knowledge, all of the.reported work, unless otherwise noted, Osubstantially complies.with approved plans,•specffications and applicable sections of the building codes. This4report covers the locations of the work inspected"only and does not,constitute engineering opinion or project control. ' �• - Q i�'•. CERT NO. �7 X `. i „INSPECTOR NAME �.�1 I� '01V RATE ' INSPECTOR SIGNATUR�,