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0104-221 (BLDG)77 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 k Lic. Class Exp. Date 7 3.3 1 '52 :fl Date Signature of Contractor C; 3P31 /21% OWNER-IBWILDER 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.tfie 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 ofperjury tone of the following declarations: ( .) -1 have and Will maintains certlficat&of'consent.to self -insure for workers' compensation; :.,as provided for by Section -3700 of, the Labor Code, for the pe"rformance of .the' work for which this 0 " i4 is issued. " ( y' I .have and Will inaintain workers oompensatic n Insurance as required; by. Section. 3700_ of the Labor Code,-Jor the performance cf the,work.for, which this' permit is issued: ' My workers': compensation insurance carrier & policy no: are: Carrier Policy No. r_Ar ft•!f)!}hA1<1"f °Y H316: I MA {This section need not be completed if the permit valuation ,is for $100.00 or; less) + O I certlfy"that in the performance of the work for which this permit Is`issued, 1 shall'notem I y any person iri any manner so as to.become subject to the workers'`compensation°laws of'California, and agree'that if I should become subject to the: workers' compensation provisions of. Section 3700 of the Labor .Code; I shall forthwith complywith those provisions. ; Date: Applicant Warning: Failure to secure Workers'• Compensation coverage is unlawful and shall subject an employerto criminal penalties and civil fines up to $100,000, in addition to the cost 'of compensation,: damages as provided for in Section •3706 of the Labor Code; interest and attorney's fees. IMPORTANT, ' Application is hereby made to the Director of Building and Safety for a permitsubject tothe conditions and restrictions set forth ,on his application. I 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is, performed under,or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, orcessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives, of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT// �* ; ,1. DATE VALUATION LOT (1UM-22I TRACT F JOB SITE APN ADDRESS OAK "IRTY ; OWNER CONTRACTOR/ DESIGNER / EN INEER T' GA QVY.'ri..4<fZ).Y;iOCINfIC`N :[SFS., MAR lIACIFIC OF -MW'', COWRAMOIR L .1% Q D -i rA. C'•A 92'253 SOL ANA t3RAC14 ,44 A 9207. (6513)7.41.150!! • l I..t)CAI, OPYIC,E.1NfrC)RM ATION a t ;1� v r } . USE OF PERMIT tI}Ea`f`• I C...11�11:j?451Js`, 75.160 ST. CHARLES M. �; sryk, R9 s�C�_3•f it�i C)Ab� 7'I21�:L. •.iti7 f [?1A'�"1�, TYPEfm. y trrzt.•Cl1d I'fitii:Y 'I't:U'<:."CttRAi MOF1t RIN1'1OAi:3. V ALUA110N 1.3 I . rxc• .. Y; 4 3�>�9aAA1'?1'aCoi4'L's,)F C.:<21Vb"Cl:.�[D�"TdOfY 7A.00 +Yrs t. .. •s C3r1;;'1'T.1.1+ 1`;+:)Pf �'1,1r+ I(+1.•:tU�1•�ili�,.;;r3p '$N:',Uty. rs� i I{l i}Jt3 Rif �'t'iCtt4 i H,1,t - Rl+NI D 101-6 _600-2A 141100 W+ t.. i 'fix. •' Ali, 1 if l ' .. .. .. «,.•+.>+„x kn�� ^ *.fid _►?U0',f1tt:air?tWT.*1.)._,ANOf•€1xC"E,; 1,.W5S P:lt,tS D w �t3.OsD -}:'G�ll3I+ All f l (1 : }y.?3'1�R1:4'C fl'. 'b'I)tCJ:l+ T10 $20?DoC►l) CITY OF LA QUINTA FINANCE DEPT RECEIPT DATE BY DATE FINALED INSPECTOR - -. -„ .. .. _ "•-xev....-,.....;y, •t�vf— "'ti,�`4° �}:'✓^'a,+e,�,s.� ,rf„,;.,i •,� ,r„yy ..w,...:.r,�. „ ..- ,... _,.. _ .- . Page .Z of Z DAVE' STEAVENS , Inspection Services PROTECT;U U)r S7r se .//4 PROJECT # ADDRESS -A5 Lt S'i'p n CLIENT 7 &A u)E.5T WOW . DATE ' ,�,2 S _1-600C 07001 BLDG. PERMIT # ARCHITECT C, oL-AA _Ae e ra c, tr c_-ru 2 fr ENGINES CONTRACTOR])1CL MA"g PACii / C. INSPECTION TYPE INSPECTION. REPORT 5 4 - 3b ,.3 �1, ':3 CA . 39 �3 � k r2c�L -3 cv#t C. to i�t4 fk*� L_oL,_S Ate•i c_ S4C-0\1• 0f�,tLi 0 C,; . rotes�� c _S, y - 3o2-.t4.32c�: OAK-r2zt��c�i _bE&1*%us-Loc-4 A%�'6 JL4 tjk1l.ioL- C©E 0,t -LS —' t �S-`i - (=AZTt G. — I L-ULV_ AYJ1� �l_1-4 LD" LJ t,,.3tMZ tj lA 111 P u..t t416e-� t C, eDc� / I �^ • GL Qr 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. Oi"5_ 7.3 `7 7'� �� INSPECTOR NAME IA E �.J/ e -ti ✓L�.S rint:Clearyy ; Y DATE 5� Jt'` catyU / INSPECTOR SIGNATURE. 1 A 3%; LP1.4 ��i�TT i C �-r-�a•� c.._s CDT �i l�S- �i :. C�2��- 1s, ,.. , �. c � • ,.�-,7:A,M, ��_ ►� i ,�,.',�.. �r_ wi 4Lt=.Z G `�•••• ..••..............,.vl,IvvavVvn.�r:anxJ.xJVG.7�wc.yvii�uwiccnyn.iGGrn�y;yfJniWnv�.Flff:7JCtilGUlllfUl: .. - y CERT. NO. 06 Sq- _ 13—: C7INs � K PECTORN ` E L x ✓ a DATE .T�/�/ oZ caC�? / INSPECMR SIGNAT E U Y 1 x T � . e,. .4` 4TH•,. _.i' � F � DAVESTEAVENS =,; Inspection Services '\ PROJECT (9t,4 -N e-- JA: ADDRESS..^1 c� BLDG. PERMIT # ENGINEER�.N,I z)-- INSPECTION );INSPECTION TYPE ` T r• Page i of PROJECT # CLIENT �6A DATE ► SwJ O ;2zc o I ARCHITECT Vo, ,q CONTRACTOR INSPECTION REPORT N r&}S,..'L-A /0,.1` A4 ) C -j /v 1Z. lJLA T S 7"i G.W 6-A CZ ISy -1(.2 39�-1 3S✓� . 3� 43 o►1Tt 13LDy �1(p Low "t' t �� 1 y � S .• q ... 13f wu,C, �Y � • A 3.5� .s - C o n� � c:.�TE' 0,—r-rl L 1 4 - q - ► ! _ i� A T 't r �c • 1- 2-4k VV, k.J L_ -,L�LOC.1.c ? n 1 C .. / i A -r~Tr, T� A - 3S �� A r . (Z SN S-f1c l�i�AJ i Stj -L-I 2-2 t4 3 4.4yC. 45,d oAVTR-Et ALDev xf- 15 lµ1 t (��-1 + L.o � A -c--, 5 - 5►r1 G-flZZ t.) IN 110 Ca - osn' , -1.1.. 3, L 9 ( 5 - R - tom, t_�ct! -s �t L`t tJ t ►J C_fl r. J t i �, . 1 {tel.y Ofat U Q fl !1i i I c Or)e,)IN e 066 ._i -sEcce- D. CERTIFICATION OF COMPLIANCE: To thebest of our knowledge, all of the reported work, unless otherwise noted, substantially complies with approved plans, specifications andapplicable sections of. thebuilding codes. This report covers 'e locations of the work inspected only and does'not constitute engineering opinion or. project control. CERT.NO. D 3 �j �Qi `a O INSPECTOR NAME n (Pr l.Cl arlK) _ DATE t f.w C7n I INSPECTOR SIGNATURE K..i^v�::�ti+S"�ti�=�ith3 •�.''..'"'`'i�"�+.{�:�{,i}�y.",w�"'ylr.i;l�"�=h...v.+Gc�`V'ya.r.....r•-.+:�^—`..•. ' ' V �� Ai .. : �,. ... ••7 i:.' is Page / of 2., DAVE STEAVENS Inspection Services PROJECT {PGA W C% -r %4 N A s+c t A. ADDRESS LZ e. fir, BLDG. PERMIT # ENGINEER) Q '--� INSPECTION TYPE PROJECT # CLIENT-N.A L1CSi 14oA DATE /:5- SU rJ E -J-oo I ARCHITECT Ge>LA-a Adzcw i Ttc.-r4ieC- CONTRACTOR M A Z ;)A c l or, L INSPECTION REPORT �ov-4 StvsN�Sor3 .J2,W, .K P:I 2 -02 rrq CK�c.���.�iZc�SKti.� ��►J� e��A� •car ����.��, ��PLtc�T�o� ��� - 1���•_Sd�,��, c_;.� - IL'oC. - Ri-lo�.�,*- I� ���� 3�W ��f�,-i2vi�-1S? L_���r-r...�'�6' ��t� � t L,oCS - Fours - I arc l r IWO% �o�S- I"1 rr�t�v-�►-� /s�' Di -A e� a. - C,04 -S t ko L.r5 I .`�� �-� l r� �i A Lu}4o—F,— I�t. E�'j►,� �r�rA. �OL�'IJ1/cLC�](.T+�;��$, Diff, :T 3 i, i Ae e,'�eZ.- L.oc.g- Hoc.E�A ��r�z��H �`i� -z P+ , RobS- (� Ltuc;r►4 � JtR �2 (Z.ZQTi:::\'L oLt-QC-S - �-tOLz'S-11 Z)ErP VA 3/4 : O rA -�O b5 ' ► `S. LE r. GT H -'S/J3 ,v.\ Liv- l Lc., t- ot-C. f �. t�l`►a ( 3�iA .�h o� l'�. c..t.►Jc�T� �� i7 � . 338 0AK—r4CC 7P L-A' g�j `�,-�c.ucS-I�-Ioe..fs - ! ;2. 11 ►� t ��fl . 1201)5 t -7 JG- '4 �� , JcR �Ao- -! �• a t �r�a . #�o 7. ayT�� /� . CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, substantially complieswith approved plans, specifications -and applicable sections of the building codes. This report:covers k.,Wthe locations of the work inspected only and does not constitute engineering opinion or project control. CCRT. No. f - `�y INSPECTOR NAMEQ( J1E:. ,CA L D' 3 DATE `T� V ®� INSPECTOR SIGNATUREL:?` i.: a