0104-215 (BLDG)I LICENSED CONTRACTOR DECLARATION
I here' ffirm under penalty of perjury that I am licensed under provisions of
�— Chaps (commencing with Section 7000) of Division 3 of the Business and
04 w Professionals Code, and my License is in full force and effect.
C ch License # Lia Class Exp. Date
u7
LU r
ti i:i .71 s 1: 0313 112(
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0
Date Signature of Contractor
Orr
U m OWNER -BUILDER DECLARATION
HLU I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CAI License Law for the following reason:
Z ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
O N Date Signature of Owner
rn
zWORKER'S COMPENSATION DECLARATION
p _—_ M I hereby affirm under penalty of perjury one of the following declarations:
Lo � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q C) ( ) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
0) Z permit is issued. My workers' compensation insurance carrier & policy no, are:
Carrier Policy No, y
r 0
J(This section need not be completed if the p,-,rmit 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: 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 subjeci 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) Date
BUILDING PERMIT PERMIT#
DATEi VALUATION LOT TRACT
�a�.1�0l1fi•U{1
JOB SITE
APN
ADDRESS
0AK'TREX
CONTRACTOR / DESIGNER / ENGINEER
P"i7m3lw. ASS;iDC3 F11'IUAI
3ali, t 1i T' "iF iE° C3 i k lli . C'i�Nl7#A "Il]
110 MA 3.060
'462 STYVEM AVX N302
LA Q113.k ir1k CIA ''JW53
'.;0 ..�sWADF.;A J'H CA 92675A
i85isOP1Y.111111 tiE"3
USE OF PERMIT
1-rC�A[. raNi+iCN. tfiii�lgi►A,P�'f1C.N
14.7740 SVOF,',4:776 &34-7!W OAK 7'F;'t!If - hL;1tJJINUX'1'Yk'1s
1> 14 oJAMT ikHYSTR 0(111)t At, MC)DIPTUATIONS
Vh3..11 IJON s%00010 1.4
jE: d 'F3rll {'01V!' (Yv MNYMt 1711'.10
['h;iM M Y—KE b'YJIW I'�r4 tV
�`-03��T17iif.'.'� [[71+) WH:L: 1 Cil .l�[�►,..31 i�•t7ilil x3t�i, W
;3712F�1�i i ldi]iil 7�d i•' . - kL�:;I11 1 Li i-t2(317-?fi I � 3:i %z n0
f-11)'9I-. •: r' 17_M14AN,i]PL./'NC'H.R�
FF
$209.00
E_ A7 .141Y
APR 2 0 200
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
I
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Sat Backs
Underground Ducts
Forms & Footings
] Ducts
Slab Grade
Return Air
Steel
Combustion Air
_ _
Root Deck
J ^
Exhaust Fans
j
0. K, to Wrap 1
I F.A-U.
Compressor
1
Framing
Jp�� I
Insulation _ I _f
Fireplace P L.
Fireplace T.O I
Party Wali Insulation
Party Wail Firewall P
Exterior Lath
Drywall - Ent. ,./ 1
i
1
fir 3i
Set Backs J �I
{ Fc +lIngs - - �� — -
Bond team - - - —
Vents
f Grills
Fans & Controls
`
Condensate Lines J
J
1
}
J Final l
POOLS -SPAS
steel
Electric Bond
Main Drain
_
Approval to Cover—
V I E.quipmEnt Location — J
if Underground Electric -
_ Underground Plbg. Test j
Gas Piping !
- � Gas Test
. PL�.�."�E4J� G APP OWil..S Electric Fina!
:".rile Lines i - — Heater Final — - -
Water Piping I Plumbing Final -i
Plumbing Top Out J _ � Equipment Enclosure �
Shower Pans r 0 K. for Finish Plaster
Sewer Lateral �� _ _ Pool Cover
Sewer Connection ! Encapsulation J
Gas Piping
Gas Test
Appliances _I J
Final
I COMMENTS:
Utility Notice (Gas) J J
ELECTRICAL APPROVALS
Temp, Power Pole I
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
Detectors
Use of Power
Final
Utility Notice (Perm)
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p I O 1+ - 02 15 Page of 2
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-DAVE STEAVENS
Inspection Services
PROJECT \0 e ST' 1A04SC,
- 1 l� PROJECT # c;
r
ADDRESS ,p� L� A t cb
BLDG. PERMIT #
CLIENT PG h w E.5r • 40 A
DATE 3o M A y 0001
ARCHITECT Got..$r1 �o2c� i TG�► w 2G
ENGINEER tA-J SAJ a �C CONTRACTOR, L M70Z -PAG( r c -
INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially
complies with approved plans,, specifications and applicable sections of the building codes. This report covers
he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO.54.� q 9 - SSC% INSPECTOR NAME �` J��i / CI�'J
�DATE qD M 1!9 A -I Q 1 INSPECTOR SIGNATUQ
� r
Page off- of 2
-DAVE STEAVENS
,-� Inspection Services
PROJECT I k PROJECT #
.ADDRESS CLIENT ?G A LA.) ES 1 . l40 A
BLDG. PERMIT #
ENGINEER t&J SAJ a f e &)c
INSPECTION TYPE 1
DATE 3o MA-( i9ao l
ARCHITECT Goi_ZA -AR-c w , mac_ t A -
CONTRACTOR �Df L MA 1? -PAGE F i c -
INSPECTION REPORT.
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
'substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
-_/the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT.NO.Q&S_Q,3 (4 g - S u INSPECTORNAMEN�fA,J C S"tZA dreJS,
DATE 10 1M A `J ' OO 1 INSPECTOR SIGNATU�tE1 �.
" Page of
DAVE STEAVENS
" . Inspection Services
PROJECTq�-A PROJECT # c)- v a f -0 3
ADDRESS CLIENT A -Uji:S ( t� O 1�
BLDG. PERMIT #
ENGINEER.1v.NY,) SAJo(r., MOL
INSPECTION TYPE
DATE c� 3 M -A -( a v o (
ARCHITECT GoLl A Aeoq /TELT`u2t-.-"
CONTRACTOR,11 L MA4 Pkc.(F►G..
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT NO.De-593Jy t' INSPECTOR NAME C. Z: st &•AL+.i�
• � (Print C early)
DATE �3 MA`/ a00 INSPECTOR SIGNATURE, 4,,_
.L•
r'
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I 1
- Page I of
DAVE STEAVENS
Inspection Services
PROJECT ?C, A. w tt S 1 NAS` t A PROJECT # 07
ADDRESS -A 5 c-. I ST�c Z� CLIENT y7C=-AW S T hN610+
BLDG. PERMIT #
ENGINEERD "Q tJ SAy v I E I rJ L.
INSPECTION TYPE
DATE
ARCHITECT ac.,RA 4r2c-Pq )T Ec:, L tzZ
CONTRACTOR1CL IMA2 rr+GIFF/G
INSPECTION REPORT
S�{ - '700F(,ii, Ca94 ,1 3- 0AK &t_J cnti
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Fit- bv-"?-o — JUAILI Jc, COM PLttj E aAJ RUAI2 Cac.LkK4is
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantiaily complies with approved plans, specifications and applicable sections of the building codes. This report covers
he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 3 5 INSPECTOR NAME
-int Cleary)
DATE �'_�i� c�0 1 INSPECTOR SIGNATU