0104-233 (BLDG)LICENSED CONTRACTOR DECLARATION r
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
7331.52 Z 14C
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).
( ) 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:
Carver Policy No.
!:AL MDa MINITY 3;386,2174.
(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 v
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=bf 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) + - •- 1 4Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0.04-.33 TRACT
MAW
JOB SITE
ADDRESS SD _ 4 9 S
APN 4 `
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PGA W3KZJ' '1i9Kt 7ML ASSOL M'100
DFL MAR PA4MW CiF'NE,iM, CON UWWA
LA QVIXUA. CA 92253
SOLANA BEACM CA 92075
(858)712,,1500 i�xaf. 5023
LOCAL OFFICE INFORMATION
USE OF PERMIT
it�S u'�d%O ?o3
75.160 ST. C24ARUS PL .
,8N501, SNW? '&,94,31:1 C.IAX '1. "Ll, - >313I1,1.?1' o ; - '.r y -PE
9 `trON WTAPY OTR.1Cr`t'CtY*.Ai, MO1)IFICAl 1``3NS 29
VALUATION 20.00E 100 LV
ESIDMIT331 COST 03a 4.OMY1RUC1101i
M!�u4�fzaoti
CON STR U(111O ON FUN 101-000-418-000 g2D7 rj�
S IZOHO MOTION FEE,,, RESID 101,-0004 I-.000 �2.f30
aOA'AI Comb ,t MA"f 1WO HAW CHTC3 `,
$209.00
APR 2 0 20%o NOW
Z .00
UIR 9I LA OUINTA
FINANCE DEPT
RECEIPT
DATE fj
BY
DATE FINALED
INSPECTOR
8,1
M, -:2-1:144110- ', •
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
8_/2/ /
&&I
Final
/Q�Jy%_
Final
_
POOLS - SPAS
BLOCKWALL APPROVA' S
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 Voftage Wiring
Furfures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
,. ., ... - v. r .r6a•_{i ,.•r. .. +. +, .. ." ` -, w a, �:..•.L,y�a_,'i�,:i't�'i7�e- .. � rii:'.0 ��:1 i:..n :.:.-'�.^*:,t:ri.::.�-7` ... ,..
Page 3 of
DAVE STEAVENS
Inspection Services
PROJECT e� A w c 5- - 4A 5 �. I r� PROJECT # oZ /-03
ADDRESS AS L-1 S
BLDG. PERMIT #
ENGINEER'\ i\ y SA Jo(C
INSPECTION TYPE
s� g
CLIENT J)'L"fa (csISi hIuA
DATE
ARCHITECT G',e> dla f i eQ4l TEG7-or2t
� CONTRACTOPa) L m4Z Pf l r• i -C
17 INSPECTION REPORT
f�o_ fay. ' . ' UMC fC _1(L ic. G.,. L� L&.o4-3W—PLiiO .
L-OU3 11jALL_ 7ZAr\. A(LZ =►JSL4 4,AT1uJ'
AIL�!5 S-4 c -&l AJt� QAiLI )( COVAJ)
9_- 3LOcLW C2, A06 A 3c -h - Cow%
-ALL- AZ ,C_ -Z" 1� �c"C fl t L. % C , -t q i S ' 9 - FOAM ►1 Z L�O C -AC W V � A 3 ��
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
1-111he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO.CG59.3 Lily S (7 INSPECTOR NAME ` J tr�S�fl�EAJ �S
DATE - 9 A u L, Zyw- INSPECTOR SIGNAT ;
-y
Sso�_
oi4K
T2Ct
l? -I -A
9
L_.oted
WAWA—fn
QAtt_l k3L
+Ob
STiZ At"P%&2�"--
9_- 3LOcLW C2, A06 A 3c -h - Cow%
-ALL- AZ ,C_ -Z" 1� �c"C fl t L. % C , -t q i S ' 9 - FOAM ►1 Z L�O C -AC W V � A 3 ��
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
1-111he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO.CG59.3 Lily S (7 INSPECTOR NAME ` J tr�S�fl�EAJ �S
DATE - 9 A u L, Zyw- INSPECTOR SIGNAT ;
0:
DAVE STEAVENS
Inspection Services
PROJECT 4 to -1A
ADDRESS * t f_ , S-' c 0
BLDG. PERMIT #
ENGINEER ,1 Ju 1,11,1 'JAUO( rr. .Z•,jr_
INSPECTION TYPE
4/4"
Page A, of Z
PROJECT # !
CLIENT' �J L�l�` _L. ST r4oA
DATE '] AUy
ARCHITECT Go L -R A 4 P ex r T�F c --Tu 2 t�'-
CONTRACTOR -2k L Al AA a C/ F/ c
INSPECTION REPORT.
d�V I? IF ; r ;?C--0 PIL M ►J
Lori(-. t.pik.Lj M1.)/, NAiZ1L'iO4 2...n�►�-iii � st, i 1.x.1 � CA�n�1LFTti
S C 2 - 4) C 4,j b nJ c -F ,) 12_ Al L TS - / i t a w % L a) c, b
�.�At�. �4—,`�tcS-SN�AR �Ji1 �•t_.cJLrC Kil4it;1.1/ate �C•�n.rOLt:.T�
t
L l ter-./ Arc) vDL. q ,VA 1 t_ 1 K e:)wA
(..+ �? / �c - C3,F �Zfl n. , .� o �� c+. 1 1.J to . A - " �S L P i - �4' S .
L--2 ta' C. O m A L e 7`/-,—
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. 7-9gK'g3 L/10 - 6Q INSPECTOR NAME
(Print Clearly)
DATE f; (.(� a of c7Q J INSPECTOR SIGNATUR
�..•+5,..:...a.*�,A,;�,,,,;•rv�sl„ y;c•• ,.�-4ti�"`�"�rti"�w.`. r:Yis`':*i:..-:aei•L�.:,,A�'i-�:,sVtr•ry37'*-.-��.-.�...�^�Fv+rri.+t•.-w-.""`ti' `"`"~.r�..,...•,.�..,
v Page 1 of 2- _..
DAVE STEAVENS
. "A
Inspection Services
PROJECT ?(z, N1� L.5T - t�HJ�SI~ 1 A PROJECT # a cro (' 0 3
ADDRESS 4;0 - 445. 501. $O"1, 513
�Q) a9 PLA0 9.
BLDG. PERMIT #
ENGINEER ')tWv� S+�JatL
INSPECTION TYPE
CLIENT -:� (o A %.A3 C 57- to D A.
DATE fi kk C., o o 1
ARCHITECT Cao c.3 A A XLN 1 TC C -Tu r2C
CONTRACTOR I� C- M A 2 ;)A c r (=tL
INSPECTION REPORT
SIMPSOZ - ErK FAIP 03 nZ*6T2Z
E .Y D - 12. -0 V.. No i-eS --*tr`-P'TA 0-k1tC-14 CZ) , 3 R SH E 0 . Ra f eLCAO OF
R�� . i4t� t�UC�'T'� a A.J �) $ os-rfi u..,�T r OtS A S
eo
-X145- QKI r%7Z tL Pe..AnJ 3
l;2 -oM2 L t —Ek5 t - I Late - No U- �t )- bf-9Ti-4 3/Mf tD r,P" Roil- 1 !o LZO (--r14
,i
31r �IM 3 ' a t_o(_S- 40LCob c'� �e-'1-rH 1 ,,, � � . 2o�s - t `1 L�f-,Z(T>-A ,�� ��� A.
O - Sa ► o1��c,T�z.�E�cfl�l
251>z 16 -�' UQ- 1 Lvc.- e?T�4 1 D,r-\. �Zojo - 1 (-CoC.rs-t
,., g
2 LOG - 4�OLCZ 1 I �' XnH i111141,rP�. 1 0b5 ' I (oo' LE&V--r4 �Mj;" b, A
�0-Jrbi'1 OAVCT'rZt.t 'ty��A� � .
o 1
QrACL CEOTE(2- a Loc. -904,e5 "1 i- l7EP�i� ��'yrA 4��5-l7rl.E��7a-� �I�D,A, uJc-s r -k
Rr_�a.yrlg-t c_ r .l ' • � LPC - 0ot.E - /:2" D 1° ZNf !3/fit 1 J r►4 . /�V� -1 �,L�aJ�T� '��, "',A) 1 A .
L.oc-s -W0'-r—S- I;L QE-�TH '7,SJrA.
,,
RCA2 LJaCe-,7 L%6 - (LOC -(7. 0 Cr rV4 Y44 .)tA. RO -IG LQJ&TH 8 I> (A.
I.
BftJ¢3*�A'5-���5 NdLCS - ��r. �CP1\4 Z)i A- iZoDS-17`LCOG704 t/Zas4.
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. ene:!5-f :� 7 Z� '�Q INSPECTOR NAME a\ a 1)E ,tel -ttA oe:� s
••
DATE OJ A aa moaio i INSPECTOR SIGNA*TU"R- �(��NucPea�y.r
.nr„��,.�--•�•..�
Page .Z- of Z
DAVE STEAVENS
Inspection. Services
PROJECT '. c�lEsT --1ASt�. t R PROJECT # c; cg& I - c)
ADDRESSIN's CLIENT�A
DATE 0 fw�.Co . ZOa 1
BLDG. PERMIT # ARCHITECT t pi A �A 2Cr� �T ,cTuu�t.
ENGINEER'�6uuo SK601e CONTRACTOF� rrtiyg�2
INSPECTION TYPE
INSPECTION REPORT
O t►.� - t= � M Ca � �� t� �..� f� _ ..�s 4L'a� ► o ►J - i
A ).i-) A oc r+ p L)
%-Lit+J lw.i A l.l—S FdZ4*N vin ' I
Si 5 S�iZCvJS Arid
fi
U— A' r -I C - S c-- 4- Z L.o c g' 1JA i L i rj
, I Ls'- t�y(s-9-ZL.vi`e f�y� ��y ��«�,� - Ca6-,
• `i 4 °�' `-t o Tit o 1
Vy i5�g - L-0 C-1-4 �w cn- `5 t.,
IFN L 5 [. -- 9 i< 5 - °1 - ,2t� m b �W C.il i A IS- L P i 7y
3L if 110 1 E
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
e locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. q�j �Q INSPECTOR NAM
DATE •' Ct' A (A- ['ji
a�%y INSPECTOR SIGNAT