0108-340 (BLDG)_
LICENSED CONTRACTOR DECLARATION
'' | I*rebyomnn under penalty ufperjury that | am licensed vndo,pmw§iunopv
Chapter. y(commencing with Section 7000of Divi§ion, 8 of the Business and
cv.w/ | Professionals Code, and mwuce,mo|oin�nnommand emmt.
LU
=) ,, | License � uv.o/oou Exp. Date
Date _____�_Signature of Contractor
I hereby affirm Under penalty of perjury that I am exempt from the Contractor's.
License Law for the following reason:
1, as owner -of thei,property, or my employees with wages. as their sole
c6mppns6ti6"n',' will do the� work,' and the structure is not intended or offered -for
`contractors to construct the project I (Sed.7,044, Business & Professionals
I a mi exempt under Section .B&P.C. for this reason
Date gignattire of Owner
I hereby affirm unde�* penalty -.of'p'eirju�y one of. the following declarations:,
performance of the worl0or which this permit is issued
Section 3700 of . the Labor C6d6J6rJhe.perI6'r`m�i6 of Ahe`�v6rk for whi6hthis
Oermii`is isStJ;d. 4. k�fs' compeniatiori insurance carrier po Icy, no. ire:
Carrier P�blicy No."
ied6nlneed n"- t:be.compl6ted if the permit valuati6n is for, ti 00.00 or less)�
(This o
J'I 'c'ehity� that in the p6 r'formince of the work fo'ir which this permit is issu�cl,
-1 should
IMPORTANT, pplication is hereby made to the Dii6ctoir of Bui Ing �;d �afety
for a,,.p�rmit- subject to the conditioris and restrictions* set forth on., his
I. Each person upon whose behalf this application is made & each person at
whose request and for whose be6efit workis performed under or pursuant to
ari`y�perintit issued its a resiJIt of this applicaton agrees to, & shall, indemAify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Ahy-peirmit 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 ofwork for,180 days will subject permit to cancellation.
| certify that |huVe'mudthis application and State that the above information is
correct. | agree m comply with allCnty, and State laws relating mthe building
construction, and, hereby uumvnzo representatives of this City to enter upon
the above-mentioned property for inspection purposes.
PERMIT #
BUILDING PERMIT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR DESIGNER EN61NEER
USE OF PERMIT
44
RECEIPT DATE
BY
DATE FINALED INSPECTOR
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Page ( of .
DAVE STEAVENS
Inspection Services
PROJECT PGk LJG'�;V _PWa1SE I(�
ADDRESS $-4/ - Sry 11, 'J-2Ck 5 -
BLDG.
BLDG. PERMIT #
ENGINEER bu %3Q S-A J 0 1R t tac_.
INSPECTION TYPE
PROJECT # v 0a - d 3
CLIENT .W CST
DATE d N^ A tL
ARCHITECT Go L3 A AyZCH
CONTRACTOR F 4 F Cy 0 S T
INSPECTION REPORT .
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w CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
i substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers
the locations of the work inspected only and does not constitute engineering opinion or project control.
1
CERT. NO. O S9 3 4 is - 45-0 INSPECTOR NAME ) E S-te-Iq J c S '
(Prin"YC1&g1y)__.j_
i)ATE AiA / ` rTy Z► INSPECTOR SIGNATURE
Page �_ of
DAVE STEAVENS
r ; Inspection Services
PROJECT i)(;fA Lo E--(- PHA5E ($ PROJECT # vv - O 3
ADDRESS :514 - f7 S/ ?7 -05- CLIENT ��A w tt S T No a
OA ak L_L. i:.fl►J (1 BOG, DATE ' o2 S
BLDG. PERMIT # + ARCHITECT 60e-6 P+ A RcH ,
ENGINEER W C. CONTRACTOR 1r C'o�5 T,
INSPECTION TYPE EPO x �/
INSPECTION REPORT
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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
the locations of the work inspected only and does not constitute engineering opinion or project control.
6%fERT. NO. Qe J �3 q• `J^� INSPECTOR NAME ►� J �' G. �-)45
cint Cleakty)
4 GATE .,2R /- g,8 ADOoZ INSPECTOR SIGNATURE = Q ---O—
DAVE -STEAVENS-
Inspection Services
TROJECT G A
ADDRESS L.� �' `{ r 5 9
BLDG. PERMIT
ENGINEER ui rJ nJ S A JO i r- C-
e INSPECTION TYPE
Page l of I
PROJECT # . a :v o L -0 3
CLIENT PG /'k, -% 640/{,
DATE` 1 M A rZ a00 11
ARCHITECT 6:02,04. 4 aC14
CONTRACTOR'.UEL M112 PAct F L
INSPECTION REPORT
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/tteA 5 nnAPzkE Al tJZS
)CERTIFICATION OF COMPLIANCE To the best:of our knowledge, all of the.reported work, unless otherwise noted,
substantially complies with approved plans, specification"s and:applicable sections of. the- building:codes.This report covers .
:the locations of the work inspected only and does not constitute englneernng opinion or'project.control..
CERT. NO. O S 9 3 8" J C� INSPECTOR NAME �4J S1.ikye+J
n e 4 . � •n'i bleai , .
DATE I Am INSPECTOR sIGNATU E' ,
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/tteA 5 nnAPzkE Al tJZS
)CERTIFICATION OF COMPLIANCE To the best:of our knowledge, all of the.reported work, unless otherwise noted,
substantially complies with approved plans, specification"s and:applicable sections of. the- building:codes.This report covers .
:the locations of the work inspected only and does not constitute englneernng opinion or'project.control..
CERT. NO. O S 9 3 8" J C� INSPECTOR NAME �4J S1.ikye+J
n e 4 . � •n'i bleai , .
DATE I Am INSPECTOR sIGNATU E' ,