0301-361 (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
• 733152 DMC 3131/03
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).
(')p I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Pro essionals
Code).
()
Is 16ri 0er Section B&P.C. r this a f
Date Signature of Owff.4Z ---•• �
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.
y,A 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:
Cattier STATH FUND Policy No. 04601 UNIT0009413
(This section need not be completed if tale 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 agrep that if I ould become
subject to th wo ers' compensation pr isions 0j Sectio 3 0 of the Labor
Code, 1 TO# ort 1t ycomply with those rovisio S.
Date: .- Applicant ,-'T 1 t `
Warning: Failure to secure Workers' Compensation coverage is unlawful 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 Is s relating to the building
construction, and hereby authors representati of this City to enter upon
the above-mentioned property fo Inspect .,ripA/1es.
Signature (Owner/Agents"' -- �• Date �
/BUILDING PERMIT.�
DATE VALUATION��My mm LOT TRACT
/SITE
JOB
ADDRESS HItUChi �3 L�C�138 "V�
APN
y.
OWNER
CONTRACTOR/ / EN (NEER
PGA V&W. 9;ZEiII kVnAL ASSIN
DEJ, PILAR. YACVIC C MM—AL CONTRA.C't01
F'.O, B(m, 1060
2533 ..401MI COAST I GITWAY M +. 250
LA QUINTA CA. 42253
CA1�DT_TV 13Y 1W SEA CA 92007
(160)635.1010 (MIX 3823
USE OF PERMIT
01 .A1`.HuuD IN
BLDG. 7!: M434, 44454 54.7145, 341 I2. VOLUNTARY
STRUCTURAL MC►NFICATfON0
VALUATION I„ S
P..5177yi11!;I'9YIJ COST OF G().f«t;L'.I;dt74"I10H
2.U,0, 0.00
CONSTRUC TRY" FEE 10) -MO-41 8-000 5107.00
STi'ONC.E AlOT:014 ftE - REMD . 1L)i-t�0() 2111 CliK1 %,O4
e
I!jl
FEB 0 3 2003 L/
CITY OF LA QUINTA
FINANCE DEPT.
%UB- C fAL COVISiltT.lC-NON AWL)1'1AM C
5209.00
'X 0 TA -i. ,PF_RWT FUS DX391 NOW
5209.00
'
RECEIPT
DATE'
BY,,
DAT F ALED
2s �3
INSP T R
sir.. _„` • .;�_.�, � •w� µ.+ .--w....�' 1;: ..
INSPECTION RECORD
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
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 d
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 Piaster
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:
/
`
DAVE STEAVENS
Inspection Services
PROJECT
ADDRESS :5q - 7q,�, -7q6, 7 -Yo 7 S' q
BLDG. PERMIT
Page of —(
PROJECT# c�003 - 0 9
CLIENT -�(,,,A Ce:n-T �,l
DATE 1(D M ia�
ARCHITECT (��LdA AZCt-1
ENGINEER-�SL.P&:IL) SA0ei(r, -TOe-
CONTRACTOR%MA4Z PA C I
INSPECTION TYPE
INSPECTION REPORT
Vs
'C
�A R74 M L -t_ A J 6 Pi- JA 1 t,.(aJ
IN, c, -:s F4�C1tz 7-e—/'Z A A10
rTA S f-ki-I PA F7-,,: 7a P a r-, 4.,)
"CERTIFICATION OF COMPLIANCE: To the best of our knowle4l e, all of the reported work, unless otherwise noted,
sul. stantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
hENocaiio'nni the work inspected only and does not constitute- engineering opinion or project control.
CERT. NO. INSPECTOR NAME
(Nnt Clearly)
DATE 6,
INSPECTOR SIGNATURE
PROJECT PG, A
DAVE STEAVENS
Inspection Services
ADDRESS 5q - 'Na, r7146, 7 "1 S q
t-f�Z'1,
BLDG. PERMIT
ENGINEER 3-,j StWotE. TPJ(,
INSPECTION TYPE
Page of
PROJECT # C�00'R 09
CLIENT -�G A ti, t-4 &A
DATE / 11
J
ARCHITECT
CONTRACTOR �C4- A'10 r? i�A�ClFlc
INSPECTION REPORT
O.
i4ft- L
i' -7 A - -1 - L. - '?U 1, 3- �,
J
A
4- P
VIA
LP7-*t4'-.',
L
. C 0 -%" -n I vl—r'�r
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
thel'?'cation's'�6f the work inspected only and does not constitute engineering opinion or project control.
CERT. N 0. 9 9 49 INSPECTOR NAME
(Prt.qt Clearly)
DATE 1Y)A V 00 'R .7
INSPECTOR SIGNATURE X