0108-341 (BLDG)LICENSED CONTRACTOR DECLARATION
I he 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.
Libense # Lic. Class Exp. Date
Date ' j r Signature of ContractorL y • ' %�
-,.�--- OWNER -BUILDER DECLARATION
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i
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 perry it 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:
Carrier Policy No.
(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.s1hall forthwith comply with°those provisions. /
Date:' ,•Applicant '
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.
fi
Sigrnature•-(Owner7/Agent) .f`,'�` J %- - (' DatP
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT Y
i _ t.T.xiV.7ylYY.F�.4.�SW.7
�
JOB SITE
APN
ADDRESS
OAK..33.W.
- -'
OWNER
CONTRACTOR / DESIGNER / EN INEER x
PGA Wi".,M' RIt'RME\1,riTAL,900.KM)N
DEE R. (J:WJ4,-1f+L,
T-10 BOX 1060
462 MENIMZ AVR 002
I.,A. C D1WTA, C.A,. 92253
SC)L-ANA. B A CH CA 92075
.(536)797;-1500 CM4 5823 '
USE OF PERMIT
LOCAL. CIPTY11E T3dIMMATION
itifUR` J.WBOITS
75.140 ST, CHAR. -PS P1,
4-481,54.403, M-457 cf .OA -443 C'iAAK H&L. • 1. UIL.DMO9, TYPE
34-481,54-409 "
11101 V'OI.li1+YYARY STRUCTURAL MO.DIFICATMS
VALUATION TION L113
C%1S'I'RUCTION FRE 101-000-418-000 9207100
S`Pi20.blG i+ilUMO'N I*'OE . R:SIL), 101-Cid24 Y -000 $2.00
SEP 10 2001
CITY OF LA QUINTA
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FINANCE DEPT.
F [➢t�••1`C'r'xA.I: G' lJi '.i tt7�"I7r_r:t2' , 1 + ¢T. hkJ' l" Ftr
$209.00
LIMIS F Imo:-PAIED 71=1
$0,00
RECEIPT
DATE f"
BY
DATE FINALED
INSPECTOR -
,':I„
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
Framing
�J��j(� p„�
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
3 (Zo10Z �lGC. Crj�O
Drywall - Int. Lath
_
Final 1 %�Y/_�
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
COMMENTS:
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l�Q2O04_
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Final
Utility Notice (Gas)�(�i
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 (Perm)
DAVE STEAVENS .
LnspectionServices :
PROJECT �Jy S i '• %I c� e4 '
ADDRESS S-�- j_�} (meq L-) S r'1 4 4 S
h `
BLDG: PERMIT #
ENGINEERuh1 SA Jyl Er`lC
INSPECTION TYPE
Page of
PROJECT # U;J: -0 3
CLIENT &A .L•J C- !sT
DATE:. f ( . 'h A42 o hl
ARCHITECT ,G&L"1tRA A i2CN
CONTRACTObR L M A ke t?d U t= C
INSPECTION ,REPORT
LyI,J W IA �[,S - St1yt FZ (� l�� I > 6 iy n ST Itj Com-
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CERTIFICATION OF COMPLIANCE: To -the -b6stof our knowledge„all of the,; reported,,work;:unless otherwise noted,
,substantially complies with approvedplans;.specifications and applicable sections'of the'building codes. This report covers
--Jthe locations of the work inspected only and does not constitute-engineenng�opirnon or project control.
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CERT. NO. INSPECTOR NAME t�L' L%k"i
DATE (� fKrec-P ;taw Z-- INSPECTOR SIGNAT11QF-T�,%r%'.'
Page ( of
DAVE STEAVENS
Inspection services
PROJECT] l if�'S % 144,45e / PROJECT'# o�`yo 2. — v 3
ADDRESS'IENTI
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BLDG. PERMIT # ARCHITECT C LdA : Aa CP
:.ENGINEER ahs J Jo r =N L CONTRACTOR
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.INSPECTION TYPE 1
INSPECTION. REPORT
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CERTIFICATION OF COMPLIANCE: To.the bestof"our knowledge, all;of the reported work;;unless'otherwise.noted,,
substantially complies with.approved pians, s%pecifications and applicable sections of.thj building codes:This,report covers
the locations of the work inspected only and does not�constltute englneering;oplNon or project control.
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CERT. NO. INSP.ECTOR.NAME,. r�, ./�F✓�
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DATE �% /'M �4 /1 G H 02yp-Z (PrintCleairy)
INSPECTOR SIGNATOR Vii- Y
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Page L of Z
DAVE STEAVEN&---'
Inspection "Services: T ;.
'PROJECT f- A lid. S'r- 6��-( PSS :". t �5 PROJECT # T v v 2 '= V 3
`ADDRESS S L 5T 1� CLIENT P6,4 ^Gt�LST Poo -
DATE
DATE Age- oZC_ 1 i
...BLDG.•PERMIT # ARCHITECT GpzB.A, f} 2C� }
ESI INEER,c,r,clicl Lk CONTRACTOR _F:!- �� �7�T, I
INSPECTION TYPE
INSPECTION -REPORT
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CERTIFICATION.OF COMPLIANCE To the best,ofour knowledge, all of the reported work; untless otherwise noted;
substantially complies with approved plans; specifications and applicable sections, of:the buiIding'codes. This report covers
the locations of the work inspected "only and does: not constitute,engineenng"opinion or project'control..
CERT. NO. INSPECTOR.NAME . CA S
Z.
DATE INSPECTOR SIGNATOR
DAVE STEAVENS
Page f of 2 -
Inspection Services
PROJECT WVE�; PROJECT # a.vv 2 - O
ADDRESS Sy- (40,46%N5-.2 445_ CLIENT PGI-\ �JGS 1 Irl A
BLDG. PERMIT #
ENGINEER v l u,00 S A Jo I E :r J e -
INSPECTION TYPE G P 0 X Y
DATE (v 04A ACh( ?vo f
ARCHITECT (�30L3 0,
CONTRACTOR r- +F' Co,J ST
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 reportort covers
locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. D/9 ���t� S INSPECTOR NAME 'JA ✓( �� `� c' +
( /' ' (►/ / pZ V 0, R 0 (Print Clearly
DATE � INSPECTOR SIGNATURE GY+-R--