0208-116 (RR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Fes- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N W Professionals Code, and my License is in full force and effect.
M License # Lic. Class Exp. Date
w 235717 C-�9 P, IMS, �s 1/31/03
oZ r- /bate 7-410 L, Signature of Contractor
CD 0-
J U 6 OWNER -BUILDER DECLARATION
Ha I hereby affirm under penalty of perjury that I am exempt from the Contractor's
N License Law for the following reason:
Z_ ( ) 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).
c') () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
ON
O)
L)
z WORKER'S COMPENSATION DECLARATION
o cr I hereby affirm under penalty of perjury one of the following declarations:
FZp () 1 have and will maintain a certificate of consent to self -insure for workers'
X W L= compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this.permit is issued.
m Q U `( ') I have and will maintain workers' compensation insurance, as required by
p U Q Section 3700 of the Labor Code, for the performance of the work for which this
CL v Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier ST,ATV M40 Policy No. I:49762442
obs
I- d
J (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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date:F Applicant
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 d estrictions 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 agwees 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.
_ Signature (Owner/Agent) _. f-•� r {'��' Date 7~�"� t,
BUILDING PERMIT PERMIT#
M8x'i ib
DATE VALUATION $,17,92$M LOT TRACT
JOB SITE ADDRESS t_41(,DGL X FIRWt~ciNX
APN
OWNER'
CONTRACTOR I DESIGNER/EN (NEER
PGA NGG yJpIAL q-TOYMQPyS.!W6271
:NPC+L0 9.0INo
PO BOX 1060
3 362 LA C-A��1+ PI A,WA Y
I-xQCaar1'A, CA. 9-223
PALM ST-IRMG9 CA 92262
(7f 0>416.567'7 CH -W 4393,E
USE OF PERMIT
tKLt 0,31: S3'p}�}, 55%2, '.i, 5.5415, 53-21n ta.F,oRGO'?WITH
Poi.lr'Upa?,, EIAN FOAM a? ACRYLIC COATMO RC►Oi!.?INQ1 BY'STElif
VALUATION 17190,04 t.3
.F'rpeY,I+,".i.1.�. ) TN4J17F Wr COINS,6C14JL.r.Ldi.I
.YI dCJotO
&"A:..X.0.Wda�ri d1 ��.i 1')4.1v/Xk3'.X8"iSS. J4
-I C. Fs'1 ` �" J 3 i71.41i�4= '1 ?*ilfl mop
••
A(�r, 1001
CITYOFLAQUINTA
FINANCEDEP'T
ate€ ' , Ct7.1 'a x b 7.S�t �%91'IaA "i' l kat°1C
3 0. 00
Tom . PIi -PA U)z� E ?
$0.00
Ir . Prim Wrims 1taOW
0M
RECEIPT
DATE
- ti^ -
BY
DAT NAL
a�
INSP
i- f f
.Y'4/
"a A.
F
1
....._-_. •.. "�_" ... .+.rte
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
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 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:
DAVE STEAVENS
Inspection Services
PROJECT P 6 W r. • `E.t a.e.r>>
ADDRESS .ate• 221
. •� S•; �0 3 tW!
BLDG. PERMIT #
ENGINEER )tg JpJ JVIC -, s Z-.
INSPECTION TYPE
Page of
PROJECT # .2 -fy 2 - v 9
CLIENT PGA HJR'' IZ,�" A
DATE ?'6tt• `>I Z4 --w L
ARCHITECT (moo& d A r1 A r - t-1
CONTRACTOR ,Dcr! *" A n P,! � # #= , t;.
f
1
y
INSPECTION REPORT
4
f
i
.bf- ffir'1��.'�. &J, A^JJ ,)4Y 41.4 c ,aJr: W1 AitCi r
.' r r1 tt. `�=�_ Q r� 7 11 � r y +fir + i ��'+S Sr1 t i
„L7 T r� r L 5 _ 4=► , '"I; 0A f . 'g .. PIC. -IA ,x.1,4 , t -i r.1 G sj ,l r -i u,.1 e L %... -A a./8 /�(- Y
11 AJNsL,.,J.- .
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
S substantially comp ti with approved plans, specifications and applicpble sections of the building codes. This report covers
ons
ioP=rk inspected only and does not constitute engineering opinion or project control.
� c
CERT. NO. _0 9K • SV INSPECTOR NAME
DATE " fiK Y Z4*4' Z. INSPECTOR SIGNATURE�.�-�.
t
4
Page ,� of
0A DAVE STEAVENS
Inspection Services
PROJECT)P&A LZ�s;*L :►D'S __ PROJECT # -Z
ADDRESS S' 1.0 • T ao 4„1 CLIENT A. A W c. 3 —r o4v A
fits r u.JG E•�,,t, �" �" �'cA� '.�+` DATE .? Ju 4 ti .w v 2.
BLDG. PERMIT #
ENGINEER -A. -W SAj*j#Z t.sG.-
INSPECTION TYPE
ARCHITECT 601-44
CONTRACTOR �*
t t #P#,4,1 ?.4 C
►r'•G
INSPECTION REPORT
rn�s q. �{r9, ��'?. /6/ -�-7os d4&-cKr4t. Sas wtecqx A
A r L 3 /711 1 - 'I " RCOC A.r0 4t� PW �+ m , ,.S tom. A - 3 S 1 - s� �w �Z i rd"OF
Tt�/L�j /'71•�-'� t� ,�nylt.�c.c r C_ dSG?' " S-4r;A►1 A%A1tt,JG
MAS 0,0 2t.K iC! AJt.. r ,P r1 -di'.i i !v L r1 i - -1 5
- •5� L - i saa r� .'1L t r tr
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 oovers
the loci ris ofthb4iiork inspected only and'does not constitute engineering opinion or project control.
CERT. NO. INSPECTOR NAME 15 A J c: S t� ri ✓ t wJ
`�IL�
DATE INSPECTOR SIGNgTU�►g"t.
.i
i
r�