0301-366 (RER)�u VVI•IIIIIV IVII WVI.. VIII. -I IVIV
/ 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
733132 $ HIC 3/31/£13
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
tractors to construct the project (Sec. 7044, Business & Professionals
Code). ff
O I aet mp under Section B&P.C. f�r this rea$on
Datm e ' '� ' '? Signature of Owner•._. ! --•
ORKER'S COMPENSATION DECLAR TION _
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 have and will maintain workers' compensation insurance, as required by
action 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 STATE FUND Policy No. 0469WHIT0009413
(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 he workers' compensation pr isions of'Sect- n00 of the Labor
Code, h Il�fo hw h comply with those rovisio
Date: Applicant � -
Warning: Failure to secure Workers' Compen atio coverage is unla and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, Interest and attorney's fees.
IMPORTANT Application is, hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon wfiose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit Issued as a result of this application becomes null and void if
.work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
UILDING PERMIT PERMIT# _ =.
DATE { VALUATIONS LOT TRACTJOB SITE
ADDRESS I%1�i7'CL 231ANOXMS - �1'P1iKIR APN _
OWNER CONTRACTOR/DESIGNER/EN INEER
PGAWESTiU.MrrLAt ABON DFL )�W PAMIC ORNFRA . CONUAMOI
P.U. SOY 1060 2,533 R;O'LlnI C'OAIR:[IWIMAY V'M 250
LA QTXN'rA CA 92253 C/QVi 111 BY 1.°131$ 3F_A CA 92007
«t7ti(J7f+"33-lU1tJ C'133 -H 5923
USE OF PERMIT
OFNERALl"On—DYN (I
13L.00. &' 54.624, 5,1.610, 54.6tfi, 54.61
STRUCTURAI, MODIFICATIONS
V ALUATIOP
11010110.00 11131
('091'01r C 0XS f ltdilC'Z10N
P'.S". IM.1" WK SUMMARY
CONSTRUCTION 1ri,'.R 101.000A18-000 SMI -00
5'iRONCt MO i I:'1'H FEE • RKSID 101--W.1-241-000 $1. tit►
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 pf this City to enter upon
the above-mentioned property for inspection pur o s.
,• RECEIPT DATE
/Signature (Owner/Agent': �"` r - ' Date r !
�:.
I�
FEB 0 3 1003
t
CITY OF LA QUINTA
CILIA u _ ___
10130 Pkii-PAW PER.")
xcXIA1, 111-M I. -Ir 811)'QUr .NT0W
DATE
20.(M.00
$209.00
$0.00
$17-09100
4
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I 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
Final 13POOLS
- SPAS
BLOCKWALL APPROVA S
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
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)
'aFP;-h1�J7�
DAVE STEAVENS
ztInspection Services
PROJECT R i\ w es -i - Lt. -
ADDRESS b-24
-Z0l (1r~, kZ00Css RIM S
BLDG. PERMIT #
ENGINEER bLA l,.,,, SAJotC
INSPECTION TYPE
� p..t�'tikt'cyi".�•irr.,a"'(.F;Cr^NtiJ"�+ii'4' s..r�
Page of `
PROJECT # vq =->0 3 - U
CLIENT 'q) G, F�-
DATE c� 1' rl\ F -\-i
ARCHITECT oL 43.A A r2 c i-1
CONTRACTOR o -A rA 2 P\ t t-( c
INSPECTION REPORT -
4
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
Wubstantially 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.
e�,C�ERT. NO. INSPECTOR NAME ��'� `^�~ A'aJ J
'(Print Clearly)
DATE . ,_ rf� I G%._.
Y INSPECTOR SIGNATURE ����Q-°-����a`��•.�' '
�ilw�'�•e7sl�r'�t�,y;`r.�frw.y. d,.r`s..«:�v—c:�.c-+cra'k:7�+�;'wz�;'j'"'"Ya'ti'M�'+§':ti%i�i'"r�."'� �''i'r�vri'�"�'�v"'t�'���"its..�'�''��i�j,`7�'r4:yt�^:fi„�ss"YF7Ft<';►'�„e'��.; .�"Y��RyK:�+"`.J"r.i+y'•
Page of
DAVE STEAVENS
r�
Inspection Services
PROJECT r ( ►�� S PROJECT # POO
ADDRESS :W -61 .C, IG,( dV, G 1.14
w
CLIENT ?G iN w �. ST "OiN
DATE r�l 9� Vei i\ `4 c c:vu _S
BLDG. PERMIT # ARCHITECT GO L
ENGINEER 33,ow1 '5^JC CONTRACTOR��C..
INSPECTION TYPE
INSPECTION REPORT
-"-I -- L�L0CW_,L)C_. A-
. �,Wc-14104a. A -'s'1 t',e
Z_rK+
CS 4 e-- 1 2 (- L C Tt�
AILI
L TC
V,$1,J(_
'CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
subs complies with approved plans, specifications and applicable sections of the building codes. This report covers
am fie focatioris.of-the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. ® �� `T�' �rL INSPECTOR NAME Jt Ay) + S* A Vd o f9
(r . Cple�ar-ly))
DATE ` i t� J INSPECTO� J
R SIGNATURE .r ,.f�a ,