0104-234 (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 Ekp. Date
73,315 s 112:
Date / Signature of Contractor 41
OWNER -BUILDER DEC'_ARATION
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:
Cartier Policy No.
CAL Wt:)A'1'a ITY
(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 ' L
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) ""' Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.04-2.34 TRACT
JOB SITE
APN
ADDRESS
OAX,' 107. D -5l
OWNER
CONTRACTOR/DESIGNER/ENGINEER
PGA WEST 'SSMA ;f A1, ASOMA7 ION
DEL MAR PA IC 4 �WERAL C<.JNM&MO)R
DOX, 1060
462 3TEMM AMR, 030.2
LA QUW- A CA. W?233
SOL AWAI RACIA CIS 92W S
C858)792.1500 MIX 5623
1,�;'Yi�.f►..;'.� w3�![�Tt:E. IYIS�t3��;tA'1`In3<F
USE OF PERMIT
mI.". 1- M:# OUS
.'S-A6f3 ST. CILARLEB PL
�0» :i °d FfflvS :�, t 2Y•53d &90•S37OAS,' it t�� IIETFLFa1�+fK , 2`i' t;
r0 ii"t. 6UNTA�l' Y ST>'trrCTi)EdM, MC+I)IM'A+TIMS 30
V,,ALUATION 12
,=nW1.'.TKD COST MY CONSIMUCtION
2000.00
plimii' M, t9Ul.Mgi++ ARY
00NIS 'iiUM ION 103-000-418-000 $20700
S`I'T��"otTu i4�K7'�iGid i;�:t, • iti,ESI.O t Sit --?1d 3-il�t�t $�.1?6
`i- CIO iT
yPlr9m.Ta. N �':�'$%` Y.
Y".19 �I;� AVID
PRY
S209.100
00APR
-PAW
FF
2 0 2001 7`.. ' Fr I M, FRES, DUCO NOW
00.00
CITY OF LA OUINTA
FINANCE DEPT
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
�r4 t •: I x t
. .
.80
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.
Framing
W-6, —
Compressor
p
Insulation
Vents
Fireplace P.L.
`•
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
_
Drywall -It- Lath
%f/l�tr
591°
Final
_
/.6�d_�T _
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
_Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
s
Underground Conduit
3
Rough Wiring
1
Low Voltage Wiring
Fixtures
Main Service
,
Sub Panels
,
Exterior Receptacles
G.F.I.
Smoke Detectors
j
Temp. Use of Power
r
Final
Utility Notice (Perm)
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Page �( _ of
DAVE STEAVENS
Inspection Services
PROJECT- 6sf\ t7- HP,,SE t A PROJECT # „1 cry, t - 03
ADDRESS CLIENT -:�C, A t,Je ST t-� o R
BLDG. PERMIT #
ENGINEER'Nt�L,
e
INSPECTION TYPE
DATE a oo
ARCHITECT Coot-gA 7q►ZC.4 /7-,Cu5-u rzt
CONTRACTOR 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. �� S % 3 T� ,' C' INSPECTOR NAME J E►J 3
NAME, --
(Print Clearly) _ J
DATE 1-:�, INSPECTORSIGNATUR,E�
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Page 3 of 3
DAVE STEAVENS
Inspection Services
PROJECT-& A5T - t�N SE I k PROJECT #
ADDRESS 4S L.t C, —t<-1)
BLDG. PERMIT #
ENGINEER�v,VJ N SN Jot C. i hJ t`
INSPECTION TYPE
CLIENT PK JA W S i tuft
DATE 9 Au
ARCHITECT Gt>L.,(A f I QGNI -rcc-ro tzC
CONTRACTOP,IC,L M41 PXCI t--/ C
5-t.57 5�, s3 S-37 NSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
Issubstantially 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.QS5 93 Ll 5 Ci INSPECTOR NAME
�Pr � cieariy�
DATE u to 2 y U 1 INSPECTOR SIGNATU �.�..e_ �i�-►��
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DAVE STEAVEINS!
Page . I of a
Inspection Services
PROJECT �)G�\ Oe: s N - -NN SF I A PROJECT # vD 1 a 3
ADDRESS 90- 6-11 S',2 .r :531 5 3 Z
U A r�`r2 3 (.Oa zD A-1
BLDG. PERMIT #
ENGINEERI k,j k) S,4Jo(C ! KI L
INSPECTION TYPE t P"\1
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DATE `T AL,[, A o a f
ARCHITECT GaL9 A
CONTRACTOR N k;� L rAA tt aAl:!-t r (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
.he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. INSPECTOR NAME :�IAC/irS-hc,4 (J 4-d S
(P int Clearly)
DATE 7 A V INSPECTOR SIGNATU<R;-; C� 7, _ . 7
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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. INSPECTOR NAME :�IAC/irS-hc,4 (J 4-d S
(P int Clearly)
DATE 7 A V INSPECTOR SIGNATU<R;-; C� 7, _ . 7
Page of
P e
DAVE STEAVENS
Inspection Services
PROJECT p,59: A
ADDRESS
BLDG. PERMIT #
ENGINEER &jot tr SalC
INSPECTION TYPE
PROJECT
CLIENT
A
DATE I &f C.
ARCHITECT Go (-Z A A e Q-4 I T -E c -r g
CONTRACTOR �c L.
4 $'_ ,
1 "2j t t4 Q A, e L N I kJ
F R L_c C_►< A - -1 L PT,-.- Q, 03'.
CERTIFICATION OF COMPLIANCE::To the best of our knowledge, all of the reported work, unless' otherwise noted,
substantially complies with approved pIans, specifications a n*d'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.
INSPECTOR NAME � A U C0
(Prmt C")
DATE 7 IN 'PECTOR SIGNAT'URE,-�� —9