0108-334 (BLDG)i
LICENSED CONTRACTOR DECLARATION
I hereby affirm under,penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section noo) of Division 3 of the Business and
Professionals . Code, and my License is in full force and -effect.
License # Lic. Class Exp. Date
73. 1
Date . . Signature of Contractor
OWN ER-BUILDERDECLARATION
I h . ereby,affirm under penalty,of perjury that I am exempt from the Contractor's
License Liw for the following reason:
C 4. I, as owner of"thii pioperty, or,my employees -with wages as their sole.
do the Work, and the'structure, Is not Intended or offered for
Sale. (Sed. 7044,713usiness &-'Professionals. Code).
'[,�ag owner of the pr6oe"ity, am exc4si.vely-,cchracting with licensed
contractors to . 7
Construct the project.'(Sec044, Business & Professionals
'di
).,-Ftmex6mpt under Section B.&P.C., f6r this reason -
Date Signature 'of OWner"
WORKER'S CO_MP'E4S*T1ONJ04CLARATION
I hereby affirm un , der -,,penalty , :of penury ,one of the. following declarations:
O 1-h44 arid.will rhaintain'a certif ica4'of Conseint,fo, self-! ns,u re for workers'
compensation -,,'as provided forby. Section 3700 of the.Labor Code, f.or.the
peiiormanc'e of 6e wc_rkicr w'hfi-c'H-ifi is perrnft isjssued-,�
O lz-' ma-int�i6��o�erg'.�bbfnoe�i�ii6n,insuiance.is-rL-quired�b
ljha�e,and,i�iil , y
,,,Secfim3700 of the Labor> Code rfor the, performance of the .1work'f6r.. which,this
L.per�`is -_-'- issued. My wo�4is- ��m H
ISS pensation insurance c ' arrier & policy. no. are:,
P@1Cy N6.
,carrier
(This section"heed'not be6ompletectif the permit valuation is--Jor $190:00 or less).,r
�i - .. 11 tit( Wp
I certify t6qin_th� p6rf�rrnancei of rk-for ;v6*fch this permit is issued;,;.,
I-shall.,not . empoy anypersqpin any - 1"' n manner so,-asI6 become subject,to the"..
F
, ,-.
workers'
compensation' . law4 s of California,-Caland agree that if) sh661d..Pecome
subject to the- workers' tomp eins4ation provisions of Section . 370 0 of the Labor
-4 ('�Dd; 4 shall:forthwitfi comply With those pkoyisions.
� - ., Z;�_ ._ , . , - .
-:Date: Applicant
Warning: Failure to secure Workers'Compensation coverage . is,unla� -ul and
shall'subject-an employer,to criminal penalties and civil fin"B's up to $100'.000, in
addition -to . the e Cos h t of compensation,. . 'd . am' ages as-provicl6d'for in Section:3706
Of . t .hd,Labor Code,I nterest and attomey's.f e.es.
IMPORTANT Application is'hereby inade.to the Director of Building and Safety
for A permit subject to the. conditions and restrictions set f6irth on 'his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whos& benefit work is performe ' d under or pursuant to
-any permit issued as a result of this applicaton agrees*to, & shall, indemnify
& hold' harmless the City of La Ouinta, 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.
este
-BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0 i 08 _:i 34 TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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B()*l.aA11N fi.. CA
02075
USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
Page.T of
.DAVE STEAVENS
- Inspection= Services °
PROJECTC� A E S - ��-\ASC l 3 PROJECT # .,Q at - c� S
ADDRESS54-81CC194 s-3, CLIENT ?6.A �.JESi 46Pr
f%ILL PL. Aa 12 t�uzl. 1 DATE 5
--BLDG. PERMIT W - A ARCHITECT G o L_3 A A a c -o4 rE cTu;ze:
ENGINEER ui.IJ Q S A c, I (s. M.0 C_ CONTRACTOR EL m A R ?A c T- r C.
INSPECTION TYPE
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work,:unless otherwise noted,
t0,the
substantially complies- with approved. plans, 'specifications and applicable sections of the building.codes. This report.covers
locations of the work inspected only and does not constitute 'engineering opinion or project control.
CERT. No. C�1� .> 1375' �y INSPECTOR NAME_ \JA\31EE J �7RiV�,W S
t _ 2 (Prin Clea—ry�}----
DATE O Z INSPECTOR SIGNATURL �-/�Xyr�+-.�--•�
Page ( of �--
DAVE STEAVENS
Inspection Services
0
PROJECT :�(, _ (A) CST = I PROJECT # o? OO 2 - 0 3
ADDRESS Sit-Raq Q'tt.BS3.P,�5
CLIENT ?GA
DATE 1 -FIE b ;L 0 0 2—
BLDG.
BLDG. PERMIT # ARCHITECT 6,oL.0 A r EG i uizC
ENGINEER � LLO Q SA J u l tE I rJ c- CONTRACTOR I EL Nnq.R P AC.t i c c—
INSPECTION TYPE
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.
CERT.NO. �593�1'.5w INSPECTOR NAME AJ is S ! EA d I-
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DATE l / C+ U O Z INSPECTOR SIGNATOR
`�'''ij�`�`"�i`/74iA+i�'R�IIYi''•""°�+0'�i�'�"�Yf!(1i'•`��T��`�•�i'��R6�'�t''��r[•��;��1`•glPr��'•-...r+ _ .rw,m.�wa:ay'�ra.
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Page 'of �•
DAVE; STEAVENS
-Inspection Services -
PROJECT PROJECT # 2 o b ,i -03
ADDRESS f1,5 c. 3 E CLIENT S A .:._L&tS t N R
DATE If r E'8 , a o o Z
BLDG. PERMIT # ARCHITECT �; o L c&N ApuH (re-cr'ucv—
ENGINEERyt tOvJ SA Joy Z CONTRACTOR UL M A, Ii _PAQ r r C
INSPECTION TYPE
INSPECTION• REPORT
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'CERTIFICATION OF COMPLIANCE: To the best of our'knowledge,.all of the-reported work, unlessotherwise 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.
v CERT. NO. D 9 sg 3ye- SV' INSPECTOR NAME �1J� ���. KJ L� S
• it (Prlflt�earlDATE _
�.: � ,. ..r-... .N �. •rw c: . ,;,,,,� K1:X`�if �L r�..st�r1;.._".:.'I?�'�yr Yty.;,�e„y:GS:i:.er::_o„tN:w,:•�-.r�-'>.
DAVE S . EAVENS ..
Inspection= Services,. `
Page.
of
PROJECT-#' ,�PCXY a -0.12)
CLIENTt�E c;J C:ST Pa A
DATE- o%S' F iB: do 0 Z
ARCHITECT�QG`BR i4 eChl t -rcCTu z,
CONTRACTOR �. L Aa4.: PA Ci
INSPECTION REPORT
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CERTIFICATION OF.COMPLIANCE To the best of our,knowledge,:all'of ttie reported work,.unless. otherwise noted,
substantially:complies with approved plans, specification`s and'apphcable sections of;the building codes: This report covers
the locations of the work inspected<only and does notconstitute:englneenng oplrnon`or.project control:
' r r. .
CERT.MO.INSPECTORNAME"` I A J l 5-'>"egJ
DATE�v0 2.- .
-INSPECTOR SIGNATUR
ME
Page of
DAVE STEAVENS
fi•
i Inspecttion : Servlces
.t .�
,.� PROJECT QG A' UJ EST H A'.5 E (Pt ,PROJECT A. of ooe? '_ O 3
'ADDRESS'- L STE a -CLIENT-
45�R EsT N o F�
DATE vO.Z �.
BLDG. PERMIT # ARCHITECT. 8L -A Asca ire,
ENGINEERt i:� S-Ado' 's E WL CONTRACTOR;,�.CL m Ak, PAC_ F? C_ �
INSPECTION TYPE
INSPECTION REPORT i
781 ;:793:::805 : OA:h!N�L� . ....
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sCERTIFICATION OF COMPLIANCE To the best`of our knowledge; all of the reported work; unlessotherwise noted,
ubstantially. complies with;approved plans, specificatioris and app6ca61e sections of.'thebuilding codes. This report covers
,,.,,//the locations of the work inspected':only and does°not constitute.e6girieenng,4ihi6n,or project control:
-
CERT. NO. 09? Is—? 3 qg `y
S"r INSPECTOR NAME:.
f
DATE B o1 O Z„ t INSPECTOR SIGNATOR s ':`