0108-343 (BLDG)} LICENSED CONTRACTOR DECLARATION
,A hereby affirm under penalty of perjury that I am licensed under provisions of
:*thapter 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
Date Signature of Contractor =
OWNER -BUILDER DECLARATION % P.
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.
,�01) 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 ��-c, �gg yy yy--��,,-�-�77��{{��77��GG��,,ryrytt�q Policy No. 1��yp�� y p
t.�L'4l., 9i`(Y/Y:ai NI F 7 .IVJW'3�d��':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, kshall forthwith comply with?those Provisl p;'ns. �. .
Date: �� l'D% , ! APPlicant;ry> •.f..,.r,�, 0�`,!
Warning: Failure to secure Workers' Compensation coverage is unlawful
shall subject an employer to criminal penalties and civil fines up to $100,0010, i
addition to the cost of compensation, damages as provided for in Section 3
of the Labor Code, interest and attorne;''s fees.
IMPORTANT Application is hereby made to the Director of Building and Sa
for a permit subject to the conditions and restrictions set forth on is
application.
1. Each person upon whose behalf this application is made & each perso
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 subje:;t 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. /
Signaturre..(.Ownei:, t). �t.lrk [ ,moi �:. :(__
Date
ABUILDING PERMIT • PERMIT# .'- ,- �� t,•';
DATE •=� ! VALUATION LOT 01.M343 TRACT
JOB SITE
APN
ADDRESS
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PGA °IXS.�.W 1 r,=1KWl1AL. AS8( `°.LA3.[%T
DIRLMAR I: AMFIC OW?�%fl.}M, CC-INIRAC. OR
PO BOX 10610
462NVEN-90 AVE 0.30Z •
Y.,�S.'�,, 7310'A CA 92ZS 3
t
s3C2.[.AMA B.E.A wkd r A 92075
(958)792.1 500 CS114 5823
I)OC`.ALt OF�Fyi,}}Gw�iL�t�')YyyTd��i�9p1�:t�i.TIO14' -•r, -,
USE OF PERMIT
��q�y'}� A,����ggp���q��77
)ALS4. eT'!l.�11.OUD
r%�J 60 V1'. WILAR�.M9 S P1< 1
-30, 3d -:S . 54.381 d1:94.YP OAK HILL • i3UIL9' ONO ICi T•Y'IP'E
1.2C'VOi.f —14TARY STRI .IC"`i•URAL MODIFICATIONS
VAWATJON W
NOl.AAdSO ORT 011 40 AYY471" N
20p000.00- ;
YeYTpIFR UMMAyY
"
CONSTRUCTION W� 101-000-47.8-000 M0,09
STRONG MOTION FB:I?: • .RZSID 1.01-000-241-000
a a
r
SEP 10 2001
CITY OF LA QUINTA
FINANCE DEPT.
SIM- t`t TAL IC;OMliiltil'MON A14D PLM CHEM
$209.00
':a M L :&`MMIT YEES DUE NOW
$2MAJ
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
W
3•,
INSPECTION RECORD
r`
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
O.K. to Wrap
�� OZ �l LL �e{1rOd!
Exhaust Fans f
F.A.U. }
Framing
Compressor {
Insulation
Vents I
Fireplace P.L.
Grills 1.
Fireplace T.O. '
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
{
Exterior Lath
Drywall - Int. Lath
_
��
Final 77'tdGd,eO!v
BLOCKWALL APPROVALS
Final {
POOLS - SPAS
steel t
Set Backs
Electric Bond [
Footings
Main Drain }
Bond Beam
Approval to Cover I
Equipment Location t .
Underground Electric !
Underground Plbg. Test [
Final
Gas Piping i
PLUMBING APPROVALS
Plumbing Top Out
Shower Pans
Sewer Lateral
[ Sewer Connection
Gas Piping
t Gas Test
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
Gas Test [
Electric Final [
Heater Final I
Plumbing Final
Equipment Enclosure }
O.K. for Finish Plaster [
Pool Cover [
Encapsulation {
[
I
[
Final f
COMMENTS:
Page of o�-
-DAVE STEAVENS
.Inspection -Services I
PROJECT ;)(A w EST t�r-� RSA 03
:ADDRESS 3 9!j: 313, 3G to 349
6A"'(U- )LA4. k-).. i3L1YG 10
._ ,BLDG. PERMIT # -
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ENGINEERIwJ tJ 4Jfl Jo t E =-i C_
INSPECTION TYPE EPo'Py
PROJECT #\\ c2 0('>'2- - 0 4
CLIENT `i:t &;A' f4 o i4
DATE _ 1;8 M P P-Ck -.2o42-
ARCHITECT
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ARCHITECT GDS d A. i4!(L Cl-/
CONTRACTOR FL`
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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,
substantiallycomplies with approved plans, specifications and applicable sections of the building: codes. This report covers
J the locations of the work inspected only and does not constitute engineering opinion or projecf'control.
�DS9
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-OA�:ERT. NO. � S
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E�ATEZ INSPECTOR SIGNATOR
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DAVE. STEAVVNS
r` Inspection Services
PROJECTt R �zgsr" ?",ksE I
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ti
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BLDG: PERMIT #
=;ENGINEER.
INSPECTION TYPE
Page Z-- of 2—
PROJECT #. a v d a- 0 3
CLIENT ' P(�- X `W E5- H o A
'DATE 1` 8 - dh A rZ C i .a cX� Z.r
ARCHITECT.: GOL:B/} /Q R GN
CONTRACTOR G MA PA U F C
INSPE&IONAREPORT
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3-72
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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 doesnot,coristltute.engineering opinion orproject control:
,'CERT. NO. 0SJ/ 3
8 V INSPNAME NA % � J �:�w�>g:,J
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[14TE M A 2 G N
r _ aV0 2 INSPECTOR SIGNATURE�Ql.�_ w _
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DAVE STEAVENS 1 Page of
Inspection Services
PROJECT '�� A 9�- -N'k*Jt• 1(3 PROJECT # :;zoo Z -0 3
ADDRESS Ca
BLDG. PERMIT #
ENGINEER'1�0 SAJ o i g 3',.l L
INSPECTION TYPE
CLIENT -�G A LJ e:51 H o �
DATE ('9 M iWC O O d 2
ARCHITECT 111ZC-0
CONTRACTOR )IC --4 M A 2 PACar e c
INSPECTION REPORT
5'4. 385 3"1 .3Ua1� -1 L4 !aAd.[ ult l _ `AL�Com,=. !a hPLAO L
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6 349 + 365 C' o,-�--
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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.
DATE I "I ^q Ie C r/ a OD Z.
INSPECTOR NAME!) A 9/ 6- '5-�COq ►I c'
(Print 6 earlY)—
INSPECTOR SIGNATURE
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