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0208-087 (RR)LICENSED CONTRACTOR DECLARATION I hueeby 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. Licens6 #r7 t-7 ! i LLic. �Claa�ssz�y rr! Exp. Date1/71/03 ?y 5 /tA /Date `s' ` 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 contractors to construct the project (Sec. 7044, Business & Professionals Code). (.) I am exempt under Section , B&P.C. for this reason Date Signature of Owner 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. 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: Carrier 4TATt�. !" Policy No. 007624-02 (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 the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provi� ios �+' Date: Applicant- Warning: pplicant 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. y 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, 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, orcessation 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 for inspection pfuu ses. Signature (Owner/Agent) �"'� Date BUILDING PERMIT PERMIT# -{ DATE VALUATION LOT TRACT ' f,, y o JOB SITE.e1sr(�a� ADDRESS . �i.'xMffL1SS �..� APN OWNER CONTRACTOR DESIGNER ENGINEER _PGA A4S.VESTIRLPA4AiUid3N G PO BOX ] 000 3462 & rCAMPAY3A -91MY Lk QUDJTA CAL 92253 PAUM, rSPxutTOR C, & 9226?J (760)416-5877 LMLO '4293 USE OF PERMIT 01117.. . R,13L: E FC, Tl 171:i3�1.i:�, �ri� �i����t,:�•4#'7� S4•ff94: t2.�i?tit�5C7%I'�ti';tFi P OL'N`UUTHANZ, FOAM VALUATION M.?'wmmA+A ) Cos r -or commSBZI,giS.Vn 19ROOFRP 3 �� . �L1'�•�f������iC1t� ��.�SE .; U •'w AI.IG R ZUU1 WY OF LAQUINTA FlNANCEDEPT. J. .10IR-TOTAL 09MMUC, R' 01T MD PIM 04WK LEW PUR.F M PM WOO TOTAL PERMIT 1P M- DUE NOW S30M "f RECEIPT DATE BY DATE FI ALED INSPECTQR 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 ��y_� G� BLOCKWALL PPROVALS Final POOLS - SPAS Steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final I 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: 00W. 016, PROJECTP(n tJ�ls ADDRESS L? 4. G �r J C + DAVE STEAVENS Inspection Services BLDG. PERMIT # ENGINEER . tJA.J AJfJ.#t /A/t- INSPECTION TYPE Page l of PROJECT # ca;6 0A CLIENT t16 A O t~ S T 1Y& A DATE V Z4AJIC c9&W2- ARCHITECT C6y L,1A Aa C �.1 CONTRACTOR JCC- Agfa I C, INSPECTION REPORT 'q-(A6,20%QD. &4A.'7OG 6KVAULb ?AL,Nt�Z ]aL.QG0*1 -1 %L.% - (.o. 9. 11 OL 6AIt-%"t: A - I , bL T- K ak -- ,A-'t-CLaas4 1--5 � �'r.�Cle/"ktG. sN,tft[. VI+ -,LIAJG — LL' 0e-TV\1 c._S -1, 3.4. qo,. 1$�5• �t • BLOcW Qe,_ A - 114'-s L --7a 1 s A.11 li-cT 04 C2 •�VV 95421 Q95-ZA%dCR075 —,L qkj Alto x3&y(,#/`6r .. .I- CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, Osubstantially cortVies with approved plans, specifications and applicable sections of the building codes. This report covers kx Ciott+�klhg'�rork inspected only and does not constitute engineering opinion or project control. CERT NO.S9 INSPECTOR NAME �y DATE _ ! 7 uAx .2lX.! Z. INSPECTOR SIGNATURE S►-� � - f Page , of . DAVE. STEAVENS Inspection Services ' PROJECT PROJECT # 002 -Q"r� ADDRESS L'0 ��. �" y Ag CLIENT 1 t,�J£ s T No H DATE 3u ,J BLDG. PERMIT # ARCHITECT (SQ L.d A 4i?C t ENGINEER',bL&t,,]+J Sd Jo xg- W �C- CONTRACTORA) dL M A A ?AC t f* C' - INSPECTION TYPE INSPECTION REPORT �'�:� O 3 y ©y 4� a LeC. `�`w3 � � e. �,:7► +� S �. ' ' � �,,�; ,� a' c..�h<'� �`[ �► �t eqr, 914 c. i�r. �! �"JL 'A - 3 .45 L.?;r-'i 1 r -i a' � �►�.� a.. �, -� A �". !r �i'7 LS .j • int *W 1 J(, S,D e. S S &e-W,t 76 s B �C) c+L I J G A - 3 S'Z - Ir4 -q 4o, 915f3 9 "Al t1W ,- t ..-i � .! f S A - i L0 c'int' f�Atyr *E, T Adl q V)A 0A, PL L 7-9 r INt 1 • S 77777--.i CERTIFICATION OF COMPLIANCE: To the best'of our knowl 4MI of the reported work, unless otherwise noted,. substantial with approved plans, spe6ffications a sections of the WIding codes This covers,.4,", ! e'ira work inspected only and does not constitute engineering opinion or proj&t,Dontrol.`� { CERT. NO. ©�_ �`7�► .� G� j INSPECTOR NAME DATE .3 Jl'u&4-: C;200 Z. INSPECTOR SIGNATURE �, Y ...-v ..L .-....- .-w+�+r.r-.�wr.rr.•,.. rnw'we:iiv+.•`Mw+w ^,t.+kti Yl..i�'j'n.,y+"".+St+li`��iv Mi:+ t Nl.'ti"• r l:rc.. i' M#rW'. r'... F"_ .,-'•.V+�f •,`""Mi6y°^•.:•^m�.'r M Page of • ,,� DAVE STEAVENS + Inspection Services �, PROJECT A 6T-- L r -e- a e J -J 0- % ADDRESSIY 'Y O, -9 10, 976, q q q T-AJddd �Ale 55 PT A A J BLDG. PERMIT # ENGINEER wiJ�J -5A did e E 1-1 C- � INSPECTION TYPE 1� rajtL - .t% - 7 PROJECT^# r �-,C 0d " 4 `� CLIENT t A "-)F-57 00A DATE .;�. ARCHITECT C�64 CONTRACTOR 4)0:1. OI A Z f H G r- (4 - INSPECTION REPORT -sG WE (Al -5 r)4 W e; -bt51TAL r« C "L-7- -3�r> 4?7'- V- 4 - 7e'j' S4,aevliJ6 — ' i r a r L , l 5 - ? 6n Z 5A1eo41Z Al A I4LO CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, Osubstantially compliesywith approved plans, specifications and applicable sections of the building codes. This report covers the locations'of the,'W'ork inspected only and does not constitute engineering opinion or project control. CERT. NO. ��?7 « •� Cr INSPECTOR NAMES _ (Print Clearly DATE2 INSPECTOR SIGNATURES L--