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0301-371 (RER)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 7:%3152 B 1310 3/31103 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). W I, as owner of the property, am exclusively contracting with licensed flbntractors to construct the project (Sec. 7044, Bu mess &� Prof ssionals Code). () I am ex p under Section B&P.C. fo "this re/ ; Date Signature of Ownert ^� 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- 1 have and will maintain workers' compensation insurance, as required by S6ctlon 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: CS!"rier Vibl'.f! KIM) . Policy No. 04601 UNIT D0094 * (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 shbuld become subject to the workers' compehsation proviplons ofection 3`1 of the Lalior Code, I h I}"fo hvA comply with those pr visions/,may: Date: Applicant �- If Warning: Failure to secure Workers' Compel tion coverage is unlawf4l4nd shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for In Section 3706 of the Labor Code, Interest and attorney's fees. IMPORTANT Application Is hereby made to the Director of Building and Safety for' a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit Issued as a result of this applicaton agrees to, & shall, Indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit Issued as a result of this application becomes null and void If work Is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above Information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatiyes of this City to enter upon the above-mentioned property r inspe5tionn puxposes. Signature (Owner/Agent•) I,/ � • /� -:-L. -V Dated -'� � = BUILDING PERMIT 0301371 DATE VALUATION LOT TRACT s r; JOB SITE ADDRESS DLDG..X.4 1.E( .FJW$ .. IlNVJ3=�TS APN OWNER CONTRACTOR/DESIGNER/EN (NEER TK3A WFZf its )DIN'MU, ASSN DFL MAR PACIFIC OLNER ASL CT.11 TltA.CM P101 BOX 1069 250 T -A Q11:"1'A CA 92253 r.'AR1:'::(FF Y ITE b''1+A CA 92fI17 (160%,35-:1010 CIM.4 5823 USE OF PERMIT 8LD0.33: 34.3:52, ".31M, NA,i96, 91,2W. VOLU•NTA.R.Y STRUCTUPALMOIAIiIdA'1' 041`3 ti� Al.(7,�93'1C?'tl d0,'riQ+;?. fiCl 1. t FS.11:te KI1,7F3) •i'091, (70' 4�Ea.Nfi1'1e`.'i7t��]9:f.71Y €J,{Hf)fD-d)Ii) t'-rJ1187'.1�t1C`T6Cs'N :"i?!r 'l U'1 • Uilt)•.�1 i 1t•O�X►. $�D'F.1►b S7 l:.OlMt7 !uY' �'T'(C)N iri?}� • FtNw°;l1") f 01-000-2.1 f • (i(i!) $2.{tg1 & i! FEB 0 3 'LUU3 CITY OF LA QUIN7A FINANCE DEPT SUB-1110TAT., t.'sr_)l ia'P.ti:IW11IU:I:I .Awl)11"AN $209.00 &,,0.00 RECEIPT DATE_.,. DATE INALE INS R XBY z) = INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Stab 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 F; Final Final ;POOLS -SPAS BLOCKWALL APPROV LS 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 oP P �.� �� e- �f •o � 5-? Utility Notice (Gas) 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) OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Stab 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 F; Final Final ;POOLS -SPAS BLOCKWALL APPROV LS 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 oP P �.� �� e- �f •o � 5-? Utility Notice (Gas) 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) =rsV;"�r-.t"�'�+Q.s►''�fX,r��+•43:�F+t%: �3WPM'�i'`„t„�5':;��!P`t`� ^e��asr".' r+�1�:^1i`rFtTVWti-:i.t�".'i.`1:�.;+{�•s;.,:r.%.^..s..+.:: sif:.+�'y.-r-"'�.�:�: DAVE STEAVENS Inspection Services PROJECT 1;vf\ WCS-1 ADDRESS BLDG. PERMIT # ENGINEER(_.,jO Sr\J + : oG INSPECTION TYPE Page f of Z_ PROJECT # ;2,,-,o 3 y l CLIENT C, A w L.,s?' 14 v A DATE S_ J"� 0 C P c.,�o 3 ARCHITECT 6000 t}tQ— CONTRACTOR 14::t W I -le ID14 C. t r r INSPECTION REPORT 1 Ls - ' I is - ZL 0 C_ he A &�.6 A�0 G,- est ,c• C IrS C -ry r � —7-oP d F dJ A L c 'it ,J b A% i c. i;LlG - (2�2ri-I ;: 4 C -i'C_ a RC1, tl f1 AJA f C j A J [ .. r- 1. C f Z ►�# �°s t C `i ,: -{. -- L i7 A,% Aui� P4 JA 'P CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, 000substantially 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 t:. (Print Clearty) DATE' �-� �"� r-J�-c. �U INSPECTOR SIGNATURE'S Page of DAVE STEAVENS Inspection Services PROJECT PROJECT # of ADDRESS 3(q, aCLIENT-P(--F\ DATE BLDG. PERMIT # ENGINEER 0f, J&J &-x-Jc) f e-- :7� c - INSPECTION TYPE ARCHITECT.r�01-6A A'2 Ck-1 CONTRACTOR le(— ,'IAt2 INSPECTION REPORT jr, 'Vo 7i 4A -7 A)A I L t J C --7( 7 L s 7 -- 1 ` A TA I 7 -7 3 x. Nf4 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.5 3 INSPECTOR NAME --s ---N (Prini'Clearty) DATE J'i-( 4,45 17 VC> _5 SIGNATURE``1` SIGNATURE