0108-342 (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 Exp. Date
0313112(
Date r f .�l Signature of Contractor/z !`i%r_ 7 '
Y+ ! u
-------------------OWNER-'BUIEDE R`DECI.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 OI I have and will maintain workers' compensation insurance, as required by
S ction 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.
CAL 114DEMNITY 111"42174A
(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',; f Applicant ` i > f s ��`
Warning: Failure to secure Workers' Compensation coverage -is unlawful and
shall subject an employer to criminal penalties and civil fines up to $1'00,000, i
addition to the cost of compensation, damages as provided for in Section 370 D
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.* l 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.
i
Signature (Owner/Agerit), !,I ! . ;+ Date //
PERMIT#
BUILDING PERMIT
DATE VALUATION LOT ��.^: TRACT
,
JOB SITE 4 .„ ,.._
ADDRESS
APN
0AK MI.
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PaA. TtHWI ��CEMDENUAL M030CW1011f
DEL MAR PACMC C3F.IlLa:}taf9L C10 -MOR,
O BOY, I W
462 VTTENKN5 hN'�R #302.
1A QUI WYA. CA 922.53
20.i.AAYAWACH CA.. 92W5
(858)792.1500 CM.k1 5 8713
VOC,A !, OFMCE TA, FOt2MA'1 MIN
USE OF PERMIT
.1MCMI+11NT'LC! S
75- 160 ST. CHAR101 ISL
fA-433, 54.421, 54,409 & 14"397 OAK H11A, • BUILD1140 9, TYPE
I OC VOLUNTARY b1`RUCTt%W, MODIFICATIONS
NS
VALUATION 00 x,s
ESIM""M COIN I, 0F CONSINUCTIMUT
t;talIti5Y1 R UC'TION 1744E 103-000-418-000 920,00
STi<+OadU MOTION FXX- leF, 4310 401-000--241-000
W
M5M'[.f":"1TC)ki AST) PI -014" CMCE
$209.00
LEW MR—PAID FERE
S0100
TOTAL Irr"Nv "1' FEES DUE NOW
SNIVDAt
r
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath ���, _
Drywall - Int. Lath
Final /j�y GCC%'GY
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
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures�6�
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
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Page of
DAVE . STEAVENS
Inspection Services
PROJECT'kk tzc 5 Fact Se XJ6 •PROJECT # _6[00 a! -
-ADDRESS-;:54:- Y3 3. *a r, 40?? 3 9 '1 ' CLIENT /I' t�
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,_BLDG. PERMIT # ARCHITECT- Gac A. AP2cW
ENGINEERJw-iid SA'JoI Z"wc., CONTRACTOlUCL 1101A,e
INSPECTION TYPE.
..INSPECTION REPORT 1;
- I
12 y Is A'-35 -n -.C40r^: ��T�
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CERTIFICATION OF COMPLIANCE To.the best of ourknowledge, all.of the reported work; unless°;otherwise noted, I
--)substantially complies with•appro, ed plans, specifications and applicable sect ons tof.ahe building codes: This `report covers `
*,he locations of the work inspected only and di es-not constitute engineering opirnon or project control
I .
CERT. NO. O S'7 J y " S; 0..: INSPECTOR NAME.
DATE / � �A2C I"( �(�(� � '
INSPECTOR SIGNATURE,'
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DAVESTEAVENS .:
Inspection Services
PROJE6TZ)CA z,,E S'=' SSE:° �3 PROJECT # L o?'y c7 x .- O 3
ADDRESS CLIENT ?G. A J %F ST 64 o o
It DATE a (.: MAI' avo Z
BLDG.. PERMIT # -:,: ARCHITECT- 604:12A A/l CH .
�. ENGINEERy.� S5A Je s� � CONTRACTOR t C rr� 142
_ �Acit=iL, t
INSPECTION TYPE
INSPECTION' REPORT .
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CERTIFICATION OF`COMPLIANC,E Toahe best of our knowledge, all of the. reported work, unless otherwise noted,
substantially complies wlth approved. plans; specificationswand applicable sect(ons. of the -building codes: This report covers
,,--.,!the locations of the work. inspected only and does not constdute engineering opinion or project control.
CERT -NO. OZ� 9 _ T B' SO ;- I^NSPECTOA.A
R:NE . 5 1 A JQ. S777
.,
DATE M AR ChI o?G0Z INSPECTOR SIGNATUR "`
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DAVE �STEAVE�NS
.;
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PROJECT +� . �-�1' 5-,- - �«ASs=: ;1 PROJECT •# a vv 'f -- 0 3
ADDRESS: CLIENT A,. k4o A
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DATE c1P' `'M. A2 LW a.00 a.
e
'BLDG. PERMIT # ARCHITECT i�oi.6"A A'e�H
ENGINEER SA�o�a �'�� �CONTRACTOR.L��G �2.'QALi rG
INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE To the best•of our -knowledge, -all of the -46 work, unless otherwise noted,
,.
-� substantially complies with approved plans;_specifications and applicable sections of the:building codes. This report covers
J the locations of the work inspected `only and. does riot constitute engineering?opinion.,or project control.
CERT. NO. INSPECTOR NAME)
Y Pr tear .
DATE �O /y1p2 C_h/ �JI!'Z INSPECTORSIGNATI�Fi g
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-�, Inspection Services
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PROJECT A\ c,,Jc-5 —t- 3�i A 5E PROJECT #yy 2 - o3
ADDRESS 5* 13-9 NO t, 4 0 9 39 -1— CLIENT �C A LZ e S % k o r'N
QAV.N t L- 17LkO 10 3 U 9
BLDG. PERMIT #
ENGINEER la03 0 SAt:YXE: 1►J C...
INSPECTION TYPE 6?o-,t�f
DATE IH. !MA(LC.v! 2oo2-
ARCHITECT 004819 Ae-C)-(
CONTRACTOR L m,q t2 Pfi C i,lr
INSPECTION REPORT
r1oCL0w I&J T tog A: -A) ?c If
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
complies with approved plans, specifications and applicable sections of the building codes. This report covers
%substantially
the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. �ZS �93 O " ��V INSPECTOR NAME. A
�f Print -Cleary),,....,
DATE I �, h( pZr,D INSPECTOR SIGNATUREC�
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Page 2— of Z—
DAVE STEAVENS ..--
Inspection Services
Ask
PROJECT?6AR �JE5r" ?vA kSE I l3 -
ADDRESS As. L. t s Te -,b
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BLDG. PERMIT #
ENGINEER
INSPECTION TYPE
PROJECT # 6.2 – O 3
CLIENT ?�A �WGS�" HOA
DATE 1.8 &AVZCH acxjZ
ARCHITECT -A 60L6/4 X42 GN
CONTRACTOR�)66 nit X12 PACJFG
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 doesanot constitute engineering opinion or -project control.
r CERT. NO. dg SJl 3 8 ' S (� INSPECTOR NAME 0 7NJ r✓ StZA V EO 5
i yS - (Prin learry)
.DATE %t')'i� 2 Gt-r' ago. INSPECTOR SIGNATURE