0301-365 (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 # Uc. Class Exp. Date
733152 B WC 3131/(33
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).
() I'ame egip�t oder Section , B&P.C. r this aso
Date %—� ! Signature of Ownef .•
i
WORKER'S COMPENSATION DECLAATION
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.
U I have and will maintain workers' compensation insurance, as required by
S&don 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 VATS FUND Policy No. 04601 UJB IT0004. 15
(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 sh uld become
subject to he rkers' compensation provi ons of Section 0 of the Labor
Code�-Fjs I f hwith comply with ose p visions
Date Applicant _ -----
Warning: Failure to secure Workers' Compensa ion coverage is unlawfui�d .
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, Indemnity
& 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/6f this City to enter upon
the above-mentioned property f r inspectjOn pu o es. +
�' Signature (Owner/Agent)' r- ' a"� Date `p- ' ""�
�} BUILDING PERMIT
DATE VALUATION �" tip LOT1-; TRACT _ t`� t?
JOB SITE
ADDRESS
APN
OWNER y
CONTRACTOR/DESIGNER/EN INEER
PGA ViWr iZF.MM AL Ami
DEL)AM PAM CiEMAL COMACPO
P.O. BOX 1060
2533 ,401 I C'UAST MWIWAT UM 250
LA QUA4TA CA 92353
CARDOF BY TFE MA CA 92007
(760)635.1010 CEIA 5823
USE OF PERMIT
ODMZAL 131JH DING
t3J..DEL 2T 54.64R, 54.6:36,. VOJ,UNTARY STRUCTURAL
J ODIFICATJOW.9
VAJA IA.TJON 106000.00 I's
' MY14xA;1'ED COST (W CO.I'(,IMUC1101V
20100000
CONSTRUCTJON FEE , 101-M-418-000 $1,1100
STRONG MOTION JEK - RUII) ;10 1 -000-741-000 sl.Rcl
•D °
FEB 0 3 1003 ,
. L
CITY OF LA QUINTA
FINANCE DEPT.
•
9081 TOIW, a"ONJJT1t11C' MON AND PLAN CT11?.C1t
x118.00
LR33 PRU-11AIDI-M
so.clo
_ •j
TOTAL 1110..Mlf B'E'ES DIXE NOW
RECEIPT
DATE / J'
BY
DATE 5tNALEPy
INSPFt YOR
INSPECTION RECORD
OPERATION •
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fomes & 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 2 atz
BLOCKWALL APPROVALS
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
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
R
r.�a.r-r:..,yR.j'C.'r"+.'/�Yu-�T'!WT' +� �ttl•:aci iY� �'��'r.�jY"`sT,�"„'..`�'��#-�!:�m�V`i r",.::'c.::.s:td't"'�".i3�n'�'.r%.;.,f,.",�..:r,,..tirf�r �7aJh �.lt.�i •`,i�ii".:
7i1..
Page of r
DAVE STEAVENS
Inspection Services
PROJECT(...,IN toz A�-\ -Le-
ADDRESS ��Y- �4�•c� F-�d�,���s
BLDG. PERMIT #
ENGINEER. j :SA Uo e
INSPECTION TYPE
PROJECT # o v 0 3- 0 t
CLIENT P\ �,3 e' i
DATE c;? �1 6'ti' 't `I a a Z
ARCHITECT 60 C- 8A A /2 C h%
CONTRACTOR 1O C L MA IZ T,4 e, r t C
INSPECTION REPORT
4
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantiallycomplies with approved plans, specifications and applicable sections of the building codes. This report covers
yW,`e1'16c'atiorQMf-'the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 0 e U INSPECTOR NAME r� J `�''V r~ S
�
0 kmKtbtbe-arrty)
DATE d'r-/ `t 4P o 0 3 INSPECTOR SIGNATURE<::N:�� C �- - s s ✓�l-X -- ,J
l..0CSC
A 03 PC. `1 NA /t. ��J�- �U��� PL -It'-'%
cr
F'.
+\ L rfZ
.t
ti
.-
4
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantiallycomplies with approved plans, specifications and applicable sections of the building codes. This report covers
yW,`e1'16c'atiorQMf-'the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. 0 e U INSPECTOR NAME r� J `�''V r~ S
�
0 kmKtbtbe-arrty)
DATE d'r-/ `t 4P o 0 3 INSPECTOR SIGNATURE<::N:�� C �- - s s ✓�l-X -- ,J
DAVE STEAVENS
Inspection Services
PROJECT 7'C , A
ADDRESS 5 3�p , 4o xC)
Page of
PROJECT # w " - 0'-f
CLIENT t -,--A
DATE . w m *i -t '�z !�
BLDG. PERMIT # ARCHITECT �,r,rd �M �? �(r^� c: t, ►
ENGINEER .� �..�� • "A)CONTRACTOR 'N C.. 04,1 : � ��r�✓
INSPECTION TYPE
INSPECTION REPORT
:� ' l! L la � C. `••�, F97,-. %�_ %
17 ,.1 n>CII.•',J�t/r. S '� ,!'� L l)C�
D:-% P1 t L "a -� < < 15' 'J� G G 4" ,4 ,a t) AJA c • � // � � ra n 7!. t �
- UA , -1 /5 - -) - 17t�l P -r---/L,)A t 1- S
,, [ N (t, S _ -15 - 1 - o? la m 1,v 1'
A'G v
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1- , ta, t_.- - ! 7/� '1 - �Sf�c:,4�t A A/6 /'i `l n JA
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6 qo 1 ..� ✓ x rr ..%t �� xi l 1)'i' V)
r
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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
�e locations of the work inspected only and does not constitute engineering opinion or froject control.
CERT. NO. J ��U INSPECTOR NAME
(Print°Cleaq)
DATE [:2 3 lnI4 y INSPECTOR SIGNATURE r'e-f no-j--m-
10
o-j--m..
1