0108-335 (BLDG)'LICENSED CONTRACTOR DECLARATION
under
U),_ �
'` ,Chapter S(co mnmncingwith Sovhon7onn) of Business and
� m
�
NM. | p�oomna|oCode, and mvuoenxeixinou|m�emndeffect.n License # Lic. Class Exp. Date
733}5C
Date _____—_Signature of
'
OWNER-BVILDER DECLARATION
I hereby affirm und * er penalty of perjury that I am exempt from the Contractor's
License Law for the folloiMng reason:
1, as owner of the -Property, or my employees. with wages as their sole
compensation, will do the work, and th e . structure is not intendedor offered f6r
sale (Sec. 7044, Business &.Profei;sionals Code).
1, as owner of the. -property, am exclusively contracting with,lic-ensed
contractors to construct the p'rbj*pct . Sec.- 7 . 044, Business -&'ProfessibnaI4
I am exempt under Section'_.�_, B&P.C. for this reason
Date Signat6re of Owner-.'
WORKEF3,'.SC.0MP1ENSATION DECLARATION
I hereby...,affirm under perialty.,of perjury one -of the following declarations.:
j'�1,ha'v'e and will maintain a pertificate.of "consent to self -insure f6r workers'
,I'hdVe and will maintain workem',compensation AVirance, as- required by
Sect I i I on 3700 of,,thd Labor Code, f . 6 - r. I th . e perfor I mance 6f:the work forv�_hict�-tl�L
Carrier :PblicyNo.�-"
(This section need, iiot'be�'com6iIited if the permit yaluatio6�i�s for:$10 .0.00, or less).
subject to th�e-wbirkelri' compensation, provision ' s of _,S ' ection 370,0 of the Labor
Code, I shall forthwith I comply With thosl'e plr'o'vi�ions.-
,Warhing:'�afl 're t ' s66bure'Workers' Compensation coverage is unlawful and
shall Subject an employer to.criminal penalties.and, civil fines up to $100,000,:,in
',addition to . the c . 6M of compensation, d4mages as provided for in Sectiori 3706
of the Labor Code; interest and attorney's fee&,*�
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
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,agreesAo, & 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 subect 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
constr ' Liction, and hereby authorize representatives of this City to enter upon
the above-mentioried prope�rty for inspection purposes.
.._.--,`__.^_-IN n.+"
PERMIT #
BUILDING PERMIT
DATE VALUATION LOT CI 0 fi 33 TRACT
JOB SITE
APIN
ADDRESS
OWNER
CONTRACTOR DESIGNER ENGINEER
CA 2 07 5
USE OF PERMIT
D 24 000
DATE
BY
INSPECTOR
• > .�.e,�. �;�Y+1�x��:2 a :� :r 7Y't�,`+'a�rsi �c - 'a.`�1J�'� ti —,T- r. r.'s'5�>3'�^..�--.r�t':�vr..; ..., -.,,
Page of
DAVV.STEA., ENS
Inspectionu Service_ s'��
s�
PROJECT' G A I� r'S'�- fel l tq Sr' r PROJECT #
..ADDRESSSW:'7�9 ;7 1.'793 _.�0 CLIENT �fl W.E5T HDA'
DATE I
/3»E�6 1ooZ
'BLDG ,PERNUT #" ARCHITECT GOLBA . �tGH/TtcTuAoc
ENGINEER, . i.,J f' Sffy� a/ C CONTRACTOR 3164. h% . 1e i�i9
'INSPECTION TYPE
. ; � �INSPECTIO_N ' REPORT
ALL L'0 Uj. L.,.1 Al I . l_ 5 . - )� F i� �2. A ► .c::►N, A U t ,� r TA 1 c.
414<ST0AP)>? -6, [.e
> - -
ID-
... .. '•tom .., 0 - �E ... '
„5 .. .e
CERTIFICATION OF COMPLIANCE:
To thetbest of our no .e all:of the reported work,.unless otherwise noted,
substantially complies with approved plans; '066ficAti66s and apppca6le sections of the building codes. This report: covers
.. //the locations of the work inspected only and does: not constrtute englneenng opinion or pcoject control:,
CERT. NO. 0166'9 INSPECTOR NAME f 4,
�'.... 13. F,Es Zcr�Z. E .,t J'}` r_TI zS�y, ,`r i�. ;`� a'J Ji`-'si '>'r .. .'� •,r•, l
WEJJ INSPE-CTORSIGNATUR" t'
--,
I.
' ' r s ':: v-�� ,n:K`•...+w ._ ;.rar}t.. f£1"r'.-•c' �°' .. �,.. ...g-: �9'S=f:.!r'
Page I of 1
DAVE STEAVENS
Inspection Services
PROJECT PROJECT
ADDRESS.Sy=..7.(q'1 s3;f '?9'3; Q`O`M' CLIENT t'_� A .J�,S ;Av A
DAwCNttL ����#a �0�1 DATE 1<a: FE'3`; ayyZ
BLDG PERMIT # ARCHITECT(.,�L'aA �?eH tTt�Tv�2L
ENGINEER ,,�,j SA �o I E ` =ti1: -CONTRACTOR ) �E C. M rat C_ r
INSPECTION TYPE
INSPECTION REPORT
Z 'C C'
IVAi.LILJy AT ��fi'T� Co-
A
vc>�S ��.`1
A TTI
CERTIFICATION OF"COMPLIANCE To the best of our•knowiedge, all of the.'reported work,;unless otherwise noted,
substantially complies tyith approy., plans, specifications and appDcable sections of the building codes. This report covers
the locations of the work inspected only and does _not constitute engineenng opinionorprojectcontrol: .
k 4
CERT. NO. �� S q� �8 � D INSPECTOR NAME`
DX(E y C) 2. INSPECTOR SIGNATU r '
r
•'^+ .. .. ... a' --'va- :7 ,i4' ,.,,,s;:x r -r Sf ti�s"Lsar;;-. J. - _'• ._,.�>r: ,�.v_ . 3
a Page of
DAiV, STEAVENS
�4Inspection Services
PROJECTSze %T : Na ',-zz (0� PROJECT .# °-aw A'- o 3 .
ADDRESS- :�1�
'i' q':''1'8 (�''1��''J� 8t7S •'CL'IENT
Dw" I �.c, 3�DC a .�..J''q DATES 1 \^ V E"i3 a o Z
BLDG PERMIT#
ARCHITECT GA- Arm+4 q'Ee.T eE
ENGINEER,-, ., SP�Jnc E t'L?J: �. ' . CONTRACTOR S L D6, e. A � c_
INSPECTION TYPE,
INSPECTION REPOR,
y. �'T.:� 1 c �,� 5't -I 4�CZ 1 l.fa :� �:.1, /V�,1.L r 7-
,T Co nLc:T
SCt2 F L Y -S :60 z
,
of
-77f•
CERTIFICATION OF COMPLIANCE Tothe best of our knowledge; alhof the reportedwork, "unless -otherwise noted,
substantially complieswith; approved plans, specifications and applicable sections of.the building codes: This report covers
the locations of the work ins pected,only:and does` not•constituteengineering opmior b� project control..'..
f
CERT. NO. -0 9S 9 3 y -' ti D INSPECTOR'NAME
DAfE _r_' �- E.� nZ �n ?�' INSPECTOR SIGNATUR �"
.:• .d. .. r s "�'i.r :4t - t•i.iY iFr:+s.Li^`rtw• riYkf',. s� .:: ^Cui✓: vi`1i".K+Tj .usk.1;4... F._ tygf•:: i-`.•'i�:.�" - _ _ n = __
Page of Z
DAVE:. STEAVENS
Inspection Services .
PROJECT��o vJE ST t� µ S E t PROJECT # �'v02- 03
ADDRESS.YV -'7� 78/; 7F3. '06�51~ CLI°ENT' 6f� b✓ i 11d.A
QAVCN�LL �W� Z �` DATE 7 r t o.oZ
BLDG. PERMIT # ARCHITECT Gyc,?A 49CN / TE -C, t e e
ENGINEER
CONTRACTOR' •C: mq,Z4c� F�
INSPECTION TYPE
INSPECTION REPORT
x,-03*
M 11 ' _ t L_� E3�Z1S
0L1S 1-1C_lir W8DSA
�f 3 0-A14 N ��. Lam ' toff •
Sy -71 1' opal- i,Lt A►J lSCJ* ,.
It
(_0 c..r Q G H 8 J lot
rx
W E�-a t`��P 2dD5 11r'LciJ: -rA �/�r,� A
3
L►� 5 v:1A �- 1 t_o�. 1-�o��-`t., .� H t Jin'. Roos �"j c TH �a
CERTIFICATION, OF COMPLIANCE To the be`t;of our knowledge, ap.of the reported wock,'unless otherwise noted,ubstantiafly. complies with "approved plans;-speciflcations and applicable sections of the;building codes. Tfiis report covers.
--"the locations of the work inspected•:only and does not constrtute englneenng opinion or project control.. sx
CERT. NO. LAS • J _'.
/ U ��� IN,
NAME
_. eiJ'S
17
DATE l- C oT OD Z 'INSPECTQR SIGNATUREt
t
rr...:,y •. or ri}s-wr .._.e.X .,s.-+n.�y..1YR+1:+- .., '-.m;,C•." ,..t .., �:vsc.;'w�:. -. •.
• ' .Page o1- of _.2.
"DAVE ST
Inspection; ervices i
r`k
: PROJECT I"G A t.J E S i W A S E I A PROJECT #.. a'bc�? -03
I
.:'ADDRESS1 5 L r 5`T r� CLIENT .�ft u� EST N o I
DATE rl.•:.�FE$ : cie.�OZ.
BLDG PERMIT-# `ARCHITECT �o�.13A:2eN+TE��RE
ENGINEER i�,J ►.� S .�o f E IJ L CONTRACTOR . E�. �'►'� 1q i Z P' C+ r.-7 G
INSPECTION TYPE
s
INSPECTION REPORT.
7-.AIC5, e *
„ SL OL)C 1A) 6,
rt.
d } .
W A L L5 S �C-..A R; 1JA i u:.iJ � . _.:p r,1 -D 'Sf2 A •� � � �.; �
AL
CERTIFICATION OP COMPLIANCE To the best of our knowledge, alGof the •reported work.,unless otherwise noted,
ubstantially.complieswitt'approveii plans, specifications and applicable sections of'the building:codes.This report covers
the locations of the work inspected only"and does not constitute engineerintI opinlonor project control -
CERT. OgS 9 3 y
A
NO.
INSPECTOR NAME
e 6...4j,
'1 r C 8'
a o o'
on�rE
INSPECTOR SIGNATO R -7