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0108-340 (BLDG)LICENSED CONTRACTOR DECLARATION i�hmrebyaffirm under penalty of perjury that |amlicensed under Chanteo(commencing with Section 7onu mDivision xuvthe uuomesand Professionals Code, and myLicense ioinfull force and effect. i umnxvw un.c/uos Exp. Date 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: ( ) 1, as owner of the -property; or my employees with wages as their -sole corrip�risation; will do the work, and the structurelis not, intended or offered for 1, as owner. -of tI4e.pr60erty,,a , m exclU . sively contracting:, with 'licensed 1� 0 am exempt under Se ction,_, B&P.C. for t his reason Date, Signature of Owner WORKER'S COMPENSATION'DECLARATION I hereby'affirm 6hder'penalty of perjury one of the following' declarations: I have. and Will maintain a certificate of consent,to. self-i6sure for 'Workers' compensation, at -provided for by Section 3700 of'the Labor,, CodeL- for the performanceof the' work for Which this permitis issued, Bye art W. Carrier.., Policy NO`.- Or- I[�hissedo� need.riot be completed if the permit valuation is for vw'.60�orless). Warninj._Failurb to S e""cUre Workers' Compensation *coverage is unlawful and addition to t I he cost -of coirii5e�sation,.d - arnages as pro , �idecl for in Section 3706 of the' Labor bode, interest and attorney's fees. for a . permit subject to the -conditions and restrictions *.-set forth on his applicatlom 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 p as a. result of this applicatori, 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. | certify hat | have read this application and state that the above information io correct. | agree mcomply with on City, and State laws relating mthe building nonstmction, and hereby authorize epeoontun"ax of this City tventer upon the above-mentioned property for inspection purposes. BUILDING PERMIT PERMIT # DATE VALUATION LOT TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR DESIGNER EN61NEER VN F0 USE OF PERMIT 201,000.00 F(tCEIPT DATE BY DATE FINALED INSPECTOR ... v- .. .. >.,:yn�f, n,� 4i!..uz';..�: �rfi .,orf, ..• •¢'S'Y-7MY4'r'�:t:!°Yik; r..re;,,r ;'ti -S l.we�"tiv", ....',.ni:Zr?.,r a+:r.F�r'.. �aa'�.-�7=�r-„'"-'_—. -... _ .. Page ( of \ i DAVE- STEAV�NS Inspection Services PROJECT k'IPROJECT # cAa6,,: _ b .1 ,ADDRESS�S�I-S'y1, �2�#,��1 4S oS w'CLIENTKj f't,JCST ' pA�l N t l_L DATE . -6y� A a id o 2_ BLDG. PERMIT # ARCHITECT 6.6L3A. AYZCH ENGINEER b u ►3►J 'CONTRACTOR,, .. F 4. F . e o. �J % T "INSPECTION TYPE r INSPECTION REPORT- Y kj A Lt -5 N 4 X12 ,J A I 'L:1 `j -0 0 s7 ­4 J COMP LE r J• 7- c - 1 3 .,c3co� i C� - 35 5 Caw PLL �. 1Tl �-S C-rA L S 3T s CERTIFICATION OF COMPLIANCE To the best of our knowledge, all of the reported work,{unless otherwise noted, substantially complies withlapproved plans, specifications and applicalile`sections of the building`'codes. This report covers J the locations of the work inspected only,and does 4not�constitute engineering:opinion or broject control:`' CIE NO. _CQ S �' 3 Ta ' S�C� x !INSPECTOR NAME DATE MA12 Off` INSPECTOR SIGNATURE" : . �.. i Page �_ of DAVE:aSTEAVENS Inspection Seivices PROJECT }hr;tA �'PROJECT. # 02. o o A - p 3 -ADDRESS S y- Sy P; 5��9, S%?� Sa S ' CLIENT 1 W t QS T 6o a .77 ..aLO.DATE � ' C- 7 ;g� BLDG. PERMIT # 3 ARCHITECT, 066.L6 A ARc,N . ENGINEER u,,�i) -S.A Jd i E:. i'�1 c' CONTRACTOR` ,INSPECTION TYPE EPO INSPECTIONtaREPORT ' C�t..Lacyr A-ACLoc,4re QAJS- EPvxy S t v.� ��'A.�) •E-'T'F -F x �, 1� 0~! 1 '..�+ NOL 9!5.15 1) C: FP U-4 i� 4 LUQ �' i�_ 121 '1 Sirl t=_`i i f w� �C_' A ©` (_ .0 4312 S t AfRUcAi oto y4QD. IA(_LA-r'Sf_130 �l9yS Sy 5y I o'Ak N L L _ 1 E��� --oi Lor- Ok ,.�E ��. (I u. r of S Lti1 • a LUGS' ` 0:L',gS',5 �'� EPTH'J%y'���, i2v'D5' IS'LEa1��'1-(, s/g�' DIA, 5y S 9 Dpi K 114 t [,.L; ,Bt'D�� LvGS • Hvc-+:;:5— 4P! -Z4 P'.TH `1�.�� PloO'S'. T,,r`.� A. If 12 • ?.Coes. KOl-C 5. -../a1'.1�G'TN 1 ` D "a. 17, LCn1c.TN le b A, ���.fir , 2 �x:a?r=2 1V Cvc ' i1cc.E �..Z-r J+�c':;PTF-1 I<''D•I IA j'7 t-�l�'T�', $. r A 5 LO- 1-10 �� l 2 c��,PTi'-sr 3�y ' , A o .+7 — (5 S'�Y O- ICK H I L�.... h t_Ay� t L0CS '� c.t� 504TH l�C—>�clo��- +t.• DEPTK` l 7K. O��nRTrl Lt�c- �OC � "' °l�2 li�.�?W'. �'•4 . l�iA>. � •�'Ot�, (5 L.�►J�GTO� "� D r'*. . CERTIFICATION OF COMPLIANCE To the best of our knowledge, all of ,the reported work; unless otherwise noted, substantially complies with approved plans, specifications aod'spplica6le sectionsof`the building-codes.This report covers the locations of the work inspected ;only and does: not constitute eh' sneering opinion or project control: ^ .r .. . y . �_ rr 1 ii•s,+sem f -� i , a�y4 c `, CERT. NO. - O 3, _ 5D., ,+ INSPECTOR NAME . ' _�� DARE. aDDo'2 INSPECTOR 1:: PROJECT ISG A ' v� E 5T ADDRESS ���` 14! 5 11 BLDG. PERMIT # ENGINEER SA J0 r 6 �,J L, INSPECTION TYPE Page l of 1 PROJECT # a CLIENT t�G f� -jt .5 % d->lOA DATE:' I . ►�`igiZ ac>o dL ARCHITECT. _ 6.04 -RA A 2C4 CONTRACTOR 112 PAG! r l c INSPECTION REPORT . A ftCA 5 M A f2 F� 1E,b r v i2 = Z -AT N_Oel S CERTIFICATION OF COMPLIANCE To the best•of ouc.knowledge, all of the. reported work, unless otherwise noted, substantially complies with approved plansfic , speciations and applicable.sections of the building codes. This report covers the locations of the work inspectedoynly and does not constitute engineering :opinion or project control. CERT. NO. O S 5-9 37 ,6 ' ,INSPECTOR NAME '� :-- A��' � CA ✓� ro` tCleir DATE �� o?Oy 2:. INSPECTORSIGNATUI s SSt 7 s'os QA4 H1.(LL- c 6. "T -Fszp. n:, ►� c , -1,NQZ WR12.0 -?'� �u�� ; �•\� -Gam.,,. �>r i S� S SGr2.tL.15 A0 0. le 1JPCr5 - 7-1.6iw:nttjc-1 I Sof -tA37co t 3 rso t. oAt1 LA(, -.c-' ,� LA tj. `� L3�C)e, Lv;c:►.1 ... ►� .. . C y' i`J oc,� t_ �,►:) . C' .o �, cr � r'�" W -s' . T k c 5' - :t_.oCi.0 Q S 04. c A' V3-4 l LC Z C. - Co,_mac— i I ��� -- .(vq-1 'C.o`�S :(Q.-1 � lo'l01 O�� � tom'-.... �L� ►J � (l' y ��,_L1)C� � { . A ftCA 5 M A f2 F� 1E,b r v i2 = Z -AT N_Oel S CERTIFICATION OF COMPLIANCE To the best•of ouc.knowledge, all of the. reported work, unless otherwise noted, substantially complies with approved plansfic , speciations and applicable.sections of the building codes. This report covers the locations of the work inspectedoynly and does not constitute engineering :opinion or project control. CERT. NO. O S 5-9 37 ,6 ' ,INSPECTOR NAME '� :-- A��' � CA ✓� ro` tCleir DATE �� o?Oy 2:. INSPECTORSIGNATUI s