0301-367 (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 3:x'15 2 D 111C . 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).
�) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
()a G�y p}}��and r Section , B&P.C. r this
Yaatee ffSignature of Owner: -�
WORKER'S COMPENSATION DECLARATIO
1 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.
1 have and will maintain workers' compensation insurance, as required by
Sbction 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:
Canter STATE FLYND Policy No. 046011,1N1T00994I3
:y g (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,
1 shall not employ any person in any manner so as to become subject to the
workers' compensation laws of California, an agree that if I huld become
subject to the orkers' compensation provisiIs of Se ion 0 of the Labor'.
Code, I all f ith comply with those pr isions. , /
Date: d ) Applicant :�Ql•....
Warning: Failure to secure Workers' Compensation coverage is unlawful and
f : shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
I ; IMPORTANT Application is hereby made to the Director of Building and Safety
for 'a permit subject to, the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
:..; permit, or cessation of work for 180 days will subject permit to cancellation.
j, I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property fo�inspec` I) puro es.
Signature (Owner/Agent). 9fe
BUILDING PERMIT
DATE VALUATION msmm LOT
JOB ADDRESS }lLI{?Ci. I.ECNIDS ]�I►
OWNER
POA VHWr R EMDWr AL ASM'
P.O. BOX 1060
LA Q111 TA CA 92253
USE OF PERMIT
r3R2J1:M Ai..:f?,L1I X X040
0301-367
TRACT F.
APN
CONTRACTOR/
UI,:L MAR PA Mq(-' <304EP-q, CO.N'IirAC
27533:3i.)fMIC;(.)AW, . MMWAYS".M 250
C'PJZ1').HP BX 1TI1a SEA CA 12 1I
(7tsoy.35,1010 CF•UX 51123
FIL D0.29►: 54.604, 54.58$, 14.571, 54.555. VOLUNTARY
S'L'RYC'I URAI,MODItfICATIONS
VAMIAMNI
ESFMA.7:F. ) C'O.Tr`Xr (,CftK[TOC 10M
CONSTRUCT1014 FRE. 1101-000-418-000 1707.00
STI2C' INO Mt:OTION 1 E - RFZ110 1101 _000.2411-() 0
e
I!'
FEB 0 3 1UU3 L
CITY OF LA QUINTA
FINANCE DEPT.
fiCi13-'T�']'f�Y.. C'C)AiS'].:raCl'c'"f1vN.�.2,1'13 •F�;.,+�U rlxL;��C:
Ip"Iw fq�,O '.AM) ;tr.I'MS
RECEIPT DATE : , BY' DATE
20,01.00
S=9.00 9.00
INSPECTION RECORD
1
I
i
I
(
i
f
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
OX 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
Final
Final
BLOCKWALL APPROVA S
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 Con. iection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Page 'of
DAVE STEAVENS
Inspection Services
PROJECT '}(., � W .S� L,6_&G,J0S
ADDRESS q� [r.5`7 a X1,9. (W)L4
Lo
BLDG. PERMIT #
ENGINEER Biu, 0 J SA Ja ris ::7::✓ c..
INSPECTION TYPE
PROJECT # 6700 3 09
CLIENT S, ,, W i; %-T t 400-\
{
DATE ,:Rn M A `t cg c;o a
ARCHITECT Gol_2A A iLIZ. t-1
CONTRACTOR L. M+AZ ?hC1l= !L.
y
INSPECTION REPORT
4'
`4' "i t.
`) t` -IN � L5 - L4 eNN I S -'% - � �'Z 1 ~t �l A L,
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k) A L A06 PLY
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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
h`elocations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. OC7 L/y INSPECTOR NAME `. ' A (JC' S� ,-I /t: L) <,
3(Print Clearly)
DATE � J� U INSPECTOR SIGNATURE—� `�....�
"'� �;%5i�rr Ji�i;�+%'gr'S1P�+l+i'NFriYy`ami'�!F+il�Cyca"�i.°�Y+����}z�E"'}`S'�,'`qe."`'!"'x'�'fp`��?i"�"p..�:}'✓`'"'�
Page of
DAVE STEAVENS
Inspection Services
PROJECT 3& K W C"" i !. %:, C 5 PROJECT # c2 0,::0-5
ADDRESS—" S_ S <;
BLDG. PERMIT #
ENGINEER,_,. `;;,J SNJ�_J# r ,�r_
INSPECTION TYPE
CLIENT P( A
DATE c) 3
ARCHITECT 60e_ 8A �4 te> c f-/
CONTRACTOR. /V) P412 A C ► '
INSPECTION REPORT
b Vf � i s , S It -7 21- o C, le / J G P ' 3 44
�. ! l4.-� ��.1 a�f' �3 ��W7.��1.�; (V �� rQ�.�VI.� 9`rei. C t
. r
C' co L., e- 'r .i�..
,
.a .
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
jhe locations of the work inspected only and does not, constitute engineering opinion or project control:.
CERT. NO. 0 �"3 4-5 14 3 4 P - S -S D INSPECTOR NAME
(Print Clearly) h
DATE t1l A iC"a
s Q 00 � INSPECTOR SIGNATURE ) .-F_,..a � :-