0108-338 (BLDG)LICENSED CONTRACTOR DECLARATION.'
I hereby affirm under penalty of perjury that I am licensed under provisions of
Ch,i,pter 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
-':; �;''�; ;.:•, I -.:Sl; i ;ter
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. Iollowing: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:
O I have and well'maintain a certificate consent to'self insure for workers'
compensation, as. provided. for by,;Section,3700 of the tabor Code, for;tlie
performance of -the; work forwhich this ;permit is issued.
( j .I"have and will"- maintain �workers':compensation' insurance, as required'by
Section 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:
-' PolicyNo..
�Cf1�.. .ei i%i�itr��-+i�i i� ii.�i1 C�..•I /1/
(This section need. not be completed if the permit valuation is for $100.00 or less).
O 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 be.come'subject to the
workers' compensationlaws of California, and agree that=if I should become
subject, to the..workers' compensation provisions of Sectiom3700 of the Labor
Code, I shal6forthwith comply with those provisions.
Dater Applicant
Warning'Failure'to secure Workers' Compensationcoverage is unlawful`,and
shallaubject an employer to criminaf penalties and civil fines up to $100,000, in
additionto the cost ofcompensafion, 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.
BUILDING PERMIT PERMIT JJ
DATE VALUATION LOT =� i3c�" `�`y TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / EN INEER
P 0-A. W ,"S'i 111J. -IL. ASS'(_) t:__If-_1C11`
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51_11.A1 A F.—RAl..-H.f:'A 92075
USE OF -PERMIT
I.,Oo t..L. cii , 1ci'F:
54.0-1, 5j-625, `y 6i'i �t: i 7jI I. I{I 1A, R!_IIl.lANG 5, TYPE
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2£,;CCC.CO
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140, 10uTiC;ld r'i_F:' Ia::�':I? IuI L it;- 1--00 $2.011
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
- Page of -�
DAVE: STEAVENS
Inspection Services.
PROJECT A W'e).r P4A5C 16 `PROJECT # aZ t>0 a:- •4 3
ADDRESSS" lots f ��3 l/or CLIENT tai A-'I.wEsT He Ar
QQtlW D& S DATE a 8 F 3 moo Z
BLDG. PERMIT # ARCHITECT Gd48l� : oA2C.,
ENGINEER 1-U,0 A;J •S9 Jo /..0 :rtj G: CONTRACTOR r-* C' v J S i
INSPECTION TYPE
INSPECTION REPORT
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r CERTIFICATION OF COMPLIANCE:16 the best of our knowledge,:all'of the reported work,, unless�otherwise noted,
f substantially complies.with approved plans, specifications'and.applicable sections of the'building:codes.rhis report covers
' rthe locations of the work.inspected only arid does not constitute engineering opinion or project control.
,
CERT. NO. INSPECTOR NAME
t ( rint Clearly)
DATE INSPECTOR. SIGNATURE�t o
'wuf�--v+..`..^F'+.+�'x�yY..F:.r'+ta►.w=.,err- ,.;yr�y .tet,;-..r,,.Y...•—�....••,
_ Page
DAVE STEAVENS
Inspection Services
PROJECTLa� :��ST• 1�- H1AS. 1�3
ADDRESS
O.AW ICL aLA/, 5 104APJ9
.BLDG. PERMIT #
ENGINEER 04 -TR 1 t rJ T 6 Z.
INSPECTION TYPE
of l
PROJECT # 67 o o.Z -0 3
CLIENT ?e -.I, ti tSST a-ky lk.
DATE PA. *-\ c= -E 3 a.vo Z
ARCHITECT C-,OL6 A R 2.QI,4 gxg, u2C-
CONTRACTOR t
INSPECTION REPORT
Lya.J W •A L4-. M I o ,J . a -z w oa�,e-c —
Sys se-izLws Ao D Aoc.Hee ,/)u -r5
fA>. 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.
d •
CERT. NO. INSPECTOR NAME
DATE '21. INSPECTORSIGNATURE�—gn� JME�=�
f;:s:;>..;`.+.: ".t�:.}rs .»t.. .:•-Y..Py,b,e�w.'�y.;�t'R'S�Gt'`;v2% i'e�'t�',�it a'% �{n•�:r: ��rV.^.�p.:i' -t--..-:..,.. .-., .. ..�'=r-.az+r�•r- .� ...
DAVE-STEAVENS
Inspection Serices,
Page J" of
i..
PROJECT #. ' ayd Z_
CLIENT fk R LlJ e 5'f P0,4
DATE .50 F•C s ' ayo Z
ARCHITECT (;,y'L 8'A X? W i re c.Tu IZC
CONTRACTOR�'tL M %A R'
INSPECTION REPORT
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CERTIFICATION DF COMPLIANCE To the best.of our knowledge, all;of the reported work,'unless otherwise noted,
}substantially complies with.appnived plans; specification's. and,applicable se' ions of the building;codes.Thls report covers
✓the locations of the work inspected only and does not constitute;engineering opinion or.project control:
CERT. NO. INSPECTOR NAME. ✓'j ✓amu
DATE C> Coo d Z-- INSPECTOR SIGNATURE
1 Page l of
DAVE STEAV.,NS:
.Inspection Services
PROJECT ?6 A' U3 e. 5 i
?wk-, CR. PROJECT # .1 vo 2- -0'3
ADDRESS `5 CLIENT
DATE, oo eti
BLDG. PERMIT #. ARCHITECT t!�,DC 3f A&C4
ENGINEER _*bui rJ til S A JOl6 1",J L CONTRACTOR ,ee_ Mil 2 PAG) i= / C_
•INSPECTION TYPE i
INSPECTION. REPORT
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CERTIFICATION OF COMPLIANCE To the best of our:knowledge,.alf of the reportedwork, unless.otherwise noted,
substantially complies with approved plans, specifications and'appllca6le sections of.the;building codes. This report covers {
the locations of the work inspected.only and does, not constitute'engineenng oPmion or:p�oject control
..
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CERT. NO. O S 9 T [5 C� INSPECTOR NAME t.` ��� S1 �A'j/eQ
Prmt0earI r� .
DATE I �� INSPECTOR SIGNATU
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