0104-214 (BLDG)LICENSED CONTRACTOR DECLARATION
I
hereAWirm under penalty of perjury that I am licensed under provisions of
;Cha (commencing with Section 7000) of Division 3 of the Business and
OrofesMThals Code, and my License is in full force and effect.
License # Lic. Class . Exp. Date
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).
( ) 1, 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.
(x) 1 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. y�
wAL,%T�>urXhlifilry �Ic3:+c7+NP A
(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: Applicant kJ c.. .
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 forthon 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) r y •: .t .� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.04-214 TRACT •
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lR YrV3tiSW'><fdW)'
JOB SITE
ADDRESS
iF14ivu'`'. •�'...�i LTC
APN
-' -
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
PGA WESC REMEWTIAL aA SHOMMOR
M, MAR PRWTC.' OLVE 'tAL CON MAG"UM
]PC7.WX ] C0)
462 MI'VER51 AYE, #302:
1A.QU:11M, d:.`.4� 922W
SOLMA CA 9205
5823
1ACAlL OFMCE I FORKATION
USE OF PERMIT
71%. 160 TF, CHARLES PL.
144139, 5A.1,97% 54,414 &. x4,907 QAK TREX — F4fFBi, t0 �-rypn
'ittVOLUNTARY STRUC'T#:►M, MOU3114C..ATIONS C1
VAI.UA` 01..4 7 . 11 I's
EffrMAIM CIMIT &1:i► COMMUMOR
20,000,00
CONSTRUCTION REF, I.0I-3004MOOO 1307.00
S'd'd�.�,dO i?Jf�.?'PbQT+7 O`er � ifik�sl43 �t33-t�Pi3��it9, �fikd�f# x"7.00
1=19 PRB-PAID PRES
Wt 00
APR 2 0 2001
CITY OF LA OUINTA
R
B
DATE FINALED
INSPECTOR
8,3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
J OPERATION
DATE
INSPECTOR
i 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
I F.A.U.
Framing
_
l
= Compressor
Insulation
If Vents
Fireplace P.L.
{ Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath3o
_
a
Drywall - Int. Lath
Final ��3%f15! I/X2
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
�al
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
[,E.).deriorReceptacles
F-I.
.oke Detectors
mp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
Page 2 of 2 -
DAVE STEAVENS
Inspection Services
PROJECT 1"�A v.�� 5 '� P#0456
ADDRESS A5 Ll S TCL)
BLDG. PERMIT #
ENGINEER u 0 d 5411016 I"J(--
INSPECTION TYPE
PROJECT # cV v -o 1 '0 3
CLIENT PGR WE -51- /-/0P+
DATE 6?5' %'h Iq -/ -) 00 �
ARCHITECT GC>0(-64
CONTRACTOR OE - Mlqft �'f�CIFiL
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
&
ubstantially 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. O63.S /37Y3'�y INSPECTORNAME_S
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
&
ubstantially 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. O63.S /37Y3'�y INSPECTORNAME_S
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- DAVE STEAVENS
Inspection Services
PROJECT -�(A WC5-r / PANSC A-
ADDRESS A.5 Lt sT.,-- J
BLDG. PERMIT #
ENGINEER \ u oij SAJzx z�L
INSPECTION TYPE
PROJECT # (:5� cx) t - 0 3
CLIENT PG NvJr, s i 140-A
DATE 3 M i -1y vo 1
ARCHITECT r�de.$q }rZC►� �t�t-s�•.�Zt
CONTRACTOR "DE:. MASLL ;�p cj iF t c_
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise ' noted,
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— he locations of the work inspected only and does not constitute engineering opinion or project control.
". CERT. NO. Og�-� 9 :a,+ G S� I� INSPECTOR NAME
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DATE 2� M fl y 42 00 1 INSPECTOR SIGNATUR; , -7
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DAVE STEAVENS
Inspection Services e I TY
PROJECT- (,--F� U -)Zs i - '�ocz (A. PROJECT # 92 c -;D 1 - 4 3
ADDRESS
BLDG. PERMIT #
ENGINEE')Lk F,l SflJ i of ;%J L
INSPECTION TYPE
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DATE (Lo M�'A
ARCHITECT 60t_3A NP-' c„K
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INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
* ub
hestantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. l./'f 3 s -g31/9 - S-0 INSPECTOR NAME
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DATE E mAl aoof INSPECTOR SIGNATURE``.) QAA �J