0301-362 (RER).-.v.-. ..i rLi v. , I IMv I VII /V V►./YI 1I�11�1V
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapfar 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License Is in full force and affect.
License # Uc. Class Exp. Date,
"033152 B HIC 3131103.
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).
(J. I, as owner of the property, am exclusively contracting with licensed
c6ntractors to construct the project (Sec. 7044, Business & Professionals
Code). /
() I am a mp'under Section , B&P.C. {br this r 4o
Date _Signature of Own
0RKER'S COMPENSATION DECLA ATION
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.
kA I have and will maintain workers' compensation Insurance, as required by
SdNon 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 , FFATR FIND Policy No. 0400111N1'POf,EW I $
(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 th t if should become
subject to the workers' compensation pr isions of a on 700 of the Labor
Code, I sh/al
to with comply with those rovision
-Date: Applicant - =—
Warning: re to secure Workers' Compens tion coverage is unla ul and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, Interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit Issued as a result of this applicaton agrees to, & shall, Indemnity
& hold harmless the City of La Quinta, Its officers, agents and employees.
2. Any permit Issued as a result of this application becomes null and void if
work Is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information Is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property or inspe tion u oses.
signature (Owner/Ag t w„ � � Date
PERMIT
BUILDING PERMITS
■pwM��^)
y r Owl30 1
DATE, VALUATION ,LOT 'TRACT to •,..,
) 4
1 .
ADDRESS )���. LIDS - RNSSS Joe
APN
l
OWNER
CONTRACTOR / DESIGNER / EN (NEER .
PGAWWI" ItE.'4XC ENUAL ACJ'
DR. MAR PAMC (i1WIRAL C014 MACM
Plol wx 1ff0
2533 SO= CIOARTIM)HWAY VM 250
LA QUINITA CA 92233
CLARD1•1717 BY"I BEA GA 9,2007
(760)635-1010 r~BT 1 582.3
USE OF PERMIT
0D1ifR AL BtT]IM1140
1fLV0 24: 54.7.30~ U-726,54427,34-71& VOLUNTARY
STRUCTURAi. MODIMA.TIONS
VALUATION ?U,OsiD.Utt 1.3
&1.FI1 NIM) cor..r OF C(M,C°E2:xTCM01.4
Pk!RM1'>b FTM SUMMARY
C01967'1t.UCT1014 IEE 101-000,418-000 V07.00
STRONG MOT014 FEE. Y.fFSID 101-000-2414910 fj2.Op
e o �
FEB 0 3 2UU3 i
CITY OF LA QUINTA
FINANCE DEPT-
8).YB-TOS L C0148M..71'1MIO1s �►tJ a :I'r.1�N Cil e�.i:
M33 3 11A.tl -PXD FPil3:9
X00
TOTAL PERAM i+'I T.S .ME NOW
I�)$.�►
RECEIPT
DATE
BY ,.,- -
DATE F ALED
INSPE R
1 E,
T,111 -INSPECTION RECORD
I
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
O.K to Wrap
FA.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
POOLS �, SPAS
BLOCKWALL
APPROVAL9
steel
Set Backs
Electric Bond
Foo -'Qs
Main Drain
Bond Seam
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
COMME —PS'
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fi)Qures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
DAVE STEAVENS
Inspection ' Services
PROJECT ?& A
ADDRESS SV- 7/?,702, rV14• f77 3o
xiJ d ,dui 1�G�
54 ;IAJ S
BLDG. PERMIT #
ENGINEER ...I t.& o O 'SN Jo4 6 �,�tc
INSPECTION TYPE
Page of
3
PROJECT # t� Ota 3 - O
CLIENT
DATE a I rA N-1
ARCHITECT("ypc.A A 61f?Ck4 �
CONTRACTOR �CL - 01 A (Z ;2A C s t:r i e—
INSPECTION REPORT
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a A � t 5 - � ..j � � • 1 - � N G. �► 2. +� r'�� A �� ISG'! � � � � � ,� - �.•,. Jc. �T c i
I
I
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
_ubstantially complies with approved- plant, specifications and applicable sections of the building codes. This report covers
,a _0e locationirof the work inspected only and does not constitute engineering opinion or project control.
CERT. NO.09' ef3 4/95 - �50 INSPECTOR NAME ..i I�► fJ / �/� � .+�
DATE MPA 'i a-00 3, INSPECTOR SIGNATURE �) e- � • �a, s � .a.wl �yy
PROJECT�N
ADDRESS ;a— 1/1,17;.1. '72t., rl'so
#4
rL-A'z
BLDG. PERMIT #
ENGINEER
-.t�iA,\L3 SA,)cp
INSPECTION TYPE
PROJECT#
;1-003.0 9
CLIENT �6 N
DATE M A -4 V oez� a
ARCHITECT COLGA A(z Q.0
CONTRACTORS tv% A Q PA r- i F,
INSPECTION REPORT
3� C -t A L
L
Is
IL 11
A
fA
nix RLQCW1J�,Y --;'bLOT-0 L 70-., 3Le-7
4
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
bstantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
locationir6f the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. INSPECTOR NAME A d e- Ste A ag- 0 S
RE
DATE too IRA Y INSPECTOR SIGNA'TU