0108-339 (BLDG)LICENSED CONTRACTOR DECLARATION
I hereby 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.
License # Lic. Class Exp. Date
13 -7 '- .'.Si. iVii: �.
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:
( ) 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).
O 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:
O 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 maintainworkers, compensation insurance, as required by
.'Section 3700' of -the Labor Code, for -the perforniar ce of the work for which this
permit is-. issued. My workers' compensation' insurance carrier & policy no. are:
Carney'.. Policy No
(This section need not be completed if the permit. valuation is for $100.00 or less):
( )' I certity.that in`lhe performance of the work for which this permit is issued,
I shall not employ any person in any mannerso as to become subject to the
workers"compensation laws of California, and agree that if -1 should become
subject to the workers'• compensaiion provisions of. Section 3700 of the Labor
Code,'I shall forthwith'comply.with those provisions.
Date: 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 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.
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) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT9 TRACT
tor:r,(1`}
JOB SITE
APN
ADDRESS
rz
OWNER
CONTRACTOR / DESIGNER / EN INEER
:
962- . rte, i_.t'31
USE OF PERMIT,
.:0
i:i''`,'r''I.t•!'..'.`.n'� "I; U,: 111 P.' L. Ml01")I,
erVr,V•i�.. .�...
iiC7';(;.�
20,000.0
!'t!:Y.i�21.`1' f'`�::t'` Sf�'.w4`t!�1�a-2:Y •
f`rJ '.,-(�I(?•I';:;j•� ji•}ri: +t)I•liE;:,l•%:;F;;•(ii;t.) �':i?'�;G(?
"N 9 . 1.'Fri''i 0 3 -00( - 2., -600 2
J
.. ". .. �i\1.. .��. �'f'e:. .:, .�.1•Ir''i'�(.)1.` ni'�_\.�)� /li-i:' r'll
tt 7fQ f
_rdCJW
$ 091010
RECEIPT
DATE
BY.
DATE FINALED
INSPECTOR
....t Mi.::r.r. S"., .> •�'»'. [.Y.w e n`!`gi`Xr+'a> ,r?'s' •e+i'y::C."••rY �NwiF�c..r+,�'•-'wY,--�-i.- _.r«•A'lttiii;f47.r. ��jt;�yEvx ri+....•r.-- .... ....i'-�...:.�,.'i':. ."- :,.raL,,...
i' )6: , . Page 1 of.
DAVE STEAVENS
ti
Inspection Services
�•. '�•.. •'fir' � ,�;'
PROJECTlep. ' w 5i -fit NASI 't%3PROJECT`. # 'vo 2 — 0 3
ADDRESS .54=�����'77,16.Z,.253' CLIENT' �GA'.i;J S?' a14 i
0AieWL PLO& /2' PL-A'o lO,. DATE ..
-BLDG. PERMIT # ARCHITECT' l�QCrf i
`ENGINEER cs<iJ I� S J:o t .� i ►J L CONTRACTOR -G /j►#1?
INSPECTION TYPE -
INSPECTION REPORT.
E 7 INct-S t"4 L3Lc]c_ w4�1'o )Ly AJ 'A( ` e
i.
LvL'-,1 w,aLLS - la ���.., 'ST?APt
a
CERTIFICATION OF COMPLIANCE To thebest of our knowledge, aliµof the reporteii 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 inspectedbnliifiddoes not constitute engineerrng_opinion or project'control.
CERT NO. O8S93 `�R ' S[ INSPECTOR NAME r ( J t S 14 cJ Ci�J S
- 1
�>
DATE e� M tZ.C(�`{ a i00 INSPECTORSIGNATU oc �.`
Page 2 of Z'
DAVE: STEAVENS.',.'i
InspectionxSerVices
PROJECT T Gqk We -51
r1 A 5` 3 PROJECT `#. o? v a
ADDRESS._4Sid S: S7 CLIENT -F�7 G r, ST 6-� D ►�
s�
K N I L L a Flo G {�LAr J« DATE 1'7
BLDG. PERMIT # CHITECTL r3 F1 A 2014 ,
ENGINEER �,ur` ti1�.1 SA J o ir_ CONTRACTOR IEL vvi r42 >
INSPECTION TYPE
INS=PECTION REPORT
A;
CERTIFICATION OF COMPLIANCE To the best`of our�knowiedge, all'of the reported work' unless.oth-erwise noted
substantially complies.with approved plans, specifications and applicable sections of:;the building codes This reporfcovers .
�.Jt�he locations.of'the work inspectedonly and"does'-not constitute engineering opinion,or project control.
CCRT.NO.,� Mr
`INSPECTOR NAME Pr
�f! J lr 'S rE A LAC ►J S '
DATE 2 M /q IP C Zpo Z. INSPECTOR SIGNATUR .
DAVE STEAVENS
'
Inspection Services_
PROJECT J344l w�E s; " - t?HKq e I r3
ADDRESS S`1- v39. 577,
7 ^T -SGS. S5'3
BLDG. PERMIT #
ENGINEER�,,"„�
INSPECTION TYPE: .
Page 1 of
5l "
PROJECT # 610-6 Z - O 3.
CLIENTPGA �. z.5T e-ko N
DATE. ' 1 a
ARCHITECT 60c,,&A AQ.c..�4
CONTRACTOR D6 M A /Z PA r i c
INSPECTION- REPORT
FO LLQ t.. it—ac,, Lo c A —1 bQ S CPv x Y SY P" PS o. -J -rF - E x /a- v 3
C' rC�lty.• ��?u�r-f��. eq°,�fl "C�.r�►Jy.�=" �GB�� 5.
A ?f L. l ,C AT) -o J A 0 D r`1 s T, a , 1 A S = e P.-, o" '-t41E S --
T4 =SSOt oAK�.k%LL 'LAO Pc
ZA Cza-Ea a Lo&, a aoLcls= t I �,�w �I'� la��c ���s r 17. �Loi.rH � 7i8 � a � A' •
L 2 SAS - 4 LUGS N���S - t " a ?-I 1 �11F%: ' Ro Z�S (7 LC►3CjY4 �Y� A
5y- S71'. oAr-C.I-Iic-L
2 t2v"DS - 11 cy-r4' /S �., A.
Bch a - 1LucS - 14.OLC5- ta:�i Lta�7H
6'y AW D W H i:L C.- a
s Q r � .. . •
�A
a - •:�:; - •. 1, -7 r,.", . • . .. ..r �,
b::
DAVE. STEAVENS...',
Inspection' ServAces
y.
ADDRESSSq. Sgjp 6111's'61' S'S'3
Q4K/4ALL 2,L D e. 6"
BLDG. PERMIT4
ENGINEER bLArj,--3 SA\J-01r- -r-ic-
INSPEtTION TYPE (ZPv4-,t
L
;,(a VA
00L..
Page Ll_ of -
PROJECT
C W�
LIENT Fk
DATE C
-A (L cry
CONTRACTOR 44tc MA(t
INSPECTfONREPORT'"
po Y.
1'5 kvJ'S-r, A ZLATto.A
47.
L� &)-A i Ll A)
C. iuj
CotA
CERTIFICATION OF COMPLIANCE J6.1hp best ofIo6r,kh`bwled6'e,,,.all otthe reporte" "work, tunleiss oth6rwis-e"noted,
app"r,p. sections -of ' d he b
substantially complies with* approved p, ans; speci an applid�616' t uilding'codcis. Thi's report covers
ficaiion-'s "'d
the locations of the work inspect4d: only and doesnot constitute' engineering opinion or:projecf control.
CERT. NO.
INSPECTOR 14AW. iL
y
DATE . 13 -M,4 act -t ;2;0 0 2--, - INSPECTOR SIG'N'A'T'U'R'Et'U.Cis..IfA--.I
J.