0301-363 (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
Protwsionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
•133152 B TUC 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).
0q I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Prof ssionals
Code).
()
lam tindp Section , B&RC. fQ�this.. as
Date �/ VO � Sionature of Owner••.. 1_.._..-1 C --,!
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.
V) 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:
Camer STATE FUND Policy No. 0460)t1P41T(14994i5
(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
should become
subject to the orkers' compensation pro sions of�Secti n 700 of the Labor
Code, s N f th comply with.those rovisioPC
Date: Applicant
Warning: Failure to secure Workers' Compen ation coverage is unlaw&and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, Interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnity
& hold harmless the City of La Quinta, Its officers, agents and employees.
2. Any permit Issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
t • I certify that I have read this application and state that the above information is
} • correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize repr senta�jvep of this City to enter upon
the above-mentioned property (or inspe Ion p rp ses.
Signature (Owner/Ageni)• ,/ - Date - ��
bUILUINU F hHM1I ",� - *V %
/ �i `
DATE / VALUATION �y,LOT TRACT
JOB SITE
ADDRESS BJ.IJ1 O, 25 TZ(3,XN f; - 1t1���A
APN _ fi
OWNER
CONTRACTOR / DESIGNER / EN (NEER
PGA W= R1:I3TTi NTL&L A M
DM_ MAR PAf; IPIC (4MMA,L MId'iit.AC 0
11. 0.1DOX• I L'64
2 5 3 4 11301) I C OAZT HIGHWAY OR 2.50
LA QU,QP TA. CA 9223
(,AiiD,l[T,1r 1Q3Y T %..1 ► CA 92CK)7
or,'U os.1 C11 o Milo- 5823
USE OF PERMIT
C32.TdJ A_,%L f3LTR1 1_,040
B1.1K). 15: 54.674 54-66S,54-664,34-660. VOLUNTARY
S7`RUCTtt> AI, MODIFICATIONS
V.A 1r'U,A.'I'I CYN 20,14!0,00 I'S
1sXIZ.1+fJ.' i�' A.5' NIffINAly AWY
COWSTRUCTION TSE W)-0101.0-418-000 S2011•00
:;'tRCY13Ci MOTIO1d .FElt • RESID 101-000-241-000
FEB 0],3 2003
CITY OF LA QUINTA '$
FINANCE DEPT.
�tr��,•• rcr.�'A1, c•'t,)N•�r�arr.�oa•� .pta:l� a4i.,AA1 cT-�?,;��
s�a�.�n
1XV13 PRE. -PAID YMS,
1.0U
;10TAI, . XVW.f YFFv DUENOW
RECEIPT
DATE
DATE F)NALtW
INSPE R
t
INSPECTION RECORD
OPERATION
DATE `
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Duds
Forms 8 Footings
Duds
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final S3 Q7
POOLS -SPAS
BLOCKWALL APPROVAL6
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
Neater 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: /
Civ
a
Final
Utility Notice )
{ Gas
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage tiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
yw 'Y"Y)'.. .� w :sF •'-; s^wn - vsf' m0 f, '°f Ai iS'Yi-� 1?.M'S rSNCY .0' (i' rt!"il` :.�:j
Page of
DAVE STEAVENS
1Iaispection Services
PROJECT PKA OZ`S % -Leceo&J
ADDRESS
BLDG. PERMIT #
ENGINEER e a,A!a..3 <1ilea IC:. c .
INSPECTION TYPE
PROJECT # c9cAo U
CLIENT P( -;A
DATE 6�c� IVIA J aoo'5
ARCHITECT
CONTRACTOR I)CL M tQ N e) iw:-+ G
INSPECTION REPORT
\��`�'�f,.'. ...R"*'viii• .. '
d•
1J4�a�c �'t�1PJ" i� a(-'�r1 (<11(h'IC:t lTllu S4ai�i iC. 1 R✓f� Lty���
ti
i { • `.! . " t1 p : 6�' L4, 1, fw
Lt) 4 6E' bJ P a L 0-11 f
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 o`f~the work inspected only and does not constitute engineering opinion or project control.
r
CERT. NO. (✓ `Y �7' L/ INSPECTOR NAME !+1"-' J Sr f, yi .{4;J J `M•
r (Print Clearly)
DATE 2 — a4 t4 q INSPECTOR SIGNATU4,-t�
Page of
DAVE STEAVENS
Inspection Services
PROJECT 74��
ADDRESS a 'W-( GQ t®(o`�,Glo '?°7 2-
77 -
BLDG. PERMIT #
ENGINEER,,,O C
INSPECTION TYPE
PROJECT # � 00 -6 - Oct
CLIENT3 ,V1 L,,J z-sT L,40A-
DATE d tom. 1 if a 4:>0 3
ARCHITECT G,0LJ-5 >. A za i.-1
CONTRACTORItL MO -kr, C..6i-1 C,,,
INSPECTION REPORT
4 L.. -lo
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L - -s- lei ° ' '..` �.rc+. ' „-T= _ '�"�c ""'" -f- ' '_.' ` - i ` t t� C-, a.J ...
_ v ,
us - j 4�5 A -% `
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
substantially wcomplies .with approved plans, specifications and applicable sections of the building codes. This report covers
helocafionof the work inspected only and does not constitute engineering opinion or project control.
'.y
r u
r CERT. NO. INSPECTOR NAME
Print Clearly)
DATE e % �"+� 7l V (IJ10 3 INSPECTOR SIGNATURE"' Ca, -4-