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0106-102 (RER)LICENSED CONTRACTOR DECLARATION I herem under penalty of perjury that I am licensed under provisions of Chapt ommencing with Sectior 70.00) of Division 3 of the Business and li bfess als Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date ,., ' � ''t` . 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 Se tion 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 Policy No. (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 witl�tho a Brovi§ions. Q. . Date: ' a 1' Applicant " °I�. IF.. 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, 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, 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 for inspection purposes. .rJ Z/� t ,Signature (Owner/Agent) }.r i� 1t ! if 7 Date' BUILDING PERMIT PERMIT# DATE . VALUATION LOT 010&192 TRACT • JOB SITE ADDRESS APN OWNER CONTRACTOR / DESIGNER / EN (NEER K) B Ox I ON 462 9TWENB AVE 9Q402 Q'ti.Ci`i•S. , CA 9+2233 A7O.iwriNABSiRDCH CA 9205 (8, 53)?922 1300 CKA 5823 LOW, OFFICE it t'FORKAT.1'ON USE OF PERMIT ?5-160 ST. OHA1' LES PT, 0S1, %3 & ms INV L: E -s- ,1F1:'9.1 dexJO z i"4. Pi, .'F' ., VIVIVIATED COST Or, (110TWIREAMON �•�.p��y��.,C�,+µgr'��a7�/ 3rtiy,r+��y c�i}�yl+s�d'.'�'. 9 rp�p �4y�� e���{ a �j rye} ham+ 101-000-416-00 '4::4�ND 1BRP'b?ril ll 14 N'7t E A 01 -000- 4 A' 6-000 ��i4OM S'3 ONO Warik"m FEE =, i?011L'D '.161-,WO-ZV'1.1000 U00 y s f',��S PRL PAW PERO $0.00 . � TOTAL P3M1 11r .Merk; on NOW 1*97-1t9M RECEIPT DATEll BY/, DATE FINALED INSPECTOR %i INSPECTION RECORD OPERATION ' DATE INSPECTOR OPERATION DATE I INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS 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 1��/ POOLS - SPAS ' BLOCKWALL APPROVALS Steel Sat Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final Gas Piping 0 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 COMMENTS: 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. ke Detectors 0n1p.Use of Power Final Utility Notice (Perm) 4'- 'Page �_ of DAVE STEAVENS Inspection Services PROJECT QZ ST- !-tyEu PROJECT # cicoo I - 0 9 ADDRESS SS' 09 4, o g 1. o 3. 04:50, BLDG. PERMIT # ENGINEERk,�v, INSPECTION TYPE CLIENT P6 A W e. ST /40 A DATE -?I 04 u V, o I ARCHITECT Go (-a A Afe rz i i,cc; u iz CONTRACTOR -ILL ty A(C -Z-�,A c t F i Q INSPECTION REPORT ��s o 81 °r• o� 3 Sa �� ztJ� s s � ��� ty �S-0,45 =tjL) EktJ-sSy7ukQ 36 CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported, work, unless otherwise noted, 0 substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers he locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. o35g.3'�i� ' INSPECTOR NAMA�I� ' _rint-Glearly) DATE 31 Au INSPECTOR SIGNATURE'' O :� :.y; .-....r-.,n.-.�r.�,r..,.r`'�'"!pkv''xiY..=,i�+.�f-1.�*ii:nrs+�'.�.i1.,.r..��y�l?i' . e•• ,:1. Rreard"".�V+wFi1%„'k,...!ii�nn�fT1�,'.'tl:.:fu'�'-'h:�@�!'"�,�'N+. "'�' '. " I . , J .. DAVE STEAVENS --� Inspection Services PROJECT&A c.. eST 1.,EGt� 5 ADDRESS S!5-6 9 4. a 91, o la R a o 5- 7:1- C W�—'SS r� �i� ►i BLDG. PERMIT # Page of PROJECT # o;7 v -o t - o9 CLIENT DATE �.9 A vt�, , ` Z c>o ARCHITECT GOUS A AZC. + t—t ec't uk€ ENGINEER • 'hta0V, S A -Joie t ,3� . CONTRACTOR DU mA t j?6,S, Fi c - INSPECTION TYPE ` INSPECTION REPORT aztaZ �E T�7 ISE 1'O 14/o =M� Ito 0eMEt S s�RA?S-��t�'C�" T A ��, N a e� wA 2� . AZA �, r �, �, �►�tz ��p � s o �. �2r= �. ' S - C>J►�,�-�r�. . im -4. CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, 40substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers he locations of the work inspected only and does not constitute engineering opinion or project control. !1 Sf►e\J+ Z✓�5 CERT. NO. ©�3S'9.3 ��j ` � r O INSPECTOR NAME +Wt!, DATE �-`1 A "�- INSPECTOR SIGNATUIIE-----