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0104-220 (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 11111ti2. .3 0113 V. ( 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). ( ) 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: ( ) 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 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: Carrier Policy No: C:.AI; i'l.Ti A�d?Ji; Y 'WiffQ04A. (This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in the performance of the work for which this permit is issued, shall not employ any person in 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 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, indemnity & 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. Signature (Owner/Agent) Date BUILDING PERMIT PERMITq DATE VALUATION LOT 0104.220 TRACT Vito A30.00 JOB SITE APN ADDRESS 0AX..II��!'i OWNER CONTRACTOR/ DESIDNER / EN 'NEER PGA Vd.E;S� r RYAtl:i7.;:MI AL 11.131K C.'tO T1 N I)EL MAR PACMC" GENERAL f."fSN'I� ACt�O I -A. Q111r;P-FA C'A 92253 8OLAWA BFAM . CA 92073 (858)792- 1500 CPI#;'§873 USE OF PERMIT LOCAL OFMCB NFORMATION ,il sCfs'1 AIAH.rl- oUy 73.160 ST.. CHARLES Pl. C .., M. -'396, °�A- -4-74 i�i�3t►-'2fC:AK" l Rk:ij TtI (11.C2:INIf If; Tyn' I ' If, VOL.OWARY STRUCTURAL 140C)WIC.ATi00S V A.1.Al.ATJOH B@,o0U.00 i.s .11M.bl NTED C081'011' CON6TRUC110N 2t?,UUO.00. L'CXI�!;�'1'Rt)t:'.I'1C�tt 3/Ts:t? 1 f►S-ftC+Cl�4'1. �1C3flf) 5707.00 �_ :,'1'1?rraC) b4c.)VII' I FEF. .RE SID 101-000-2.11 -00"it) D �A :tCFr)MM L RU(MOX OX A101) FLAK C:I1KM p uU �'�.�.t•.7�le�i 91xe0�9.00 .T .l%SS rLMS riv,w APR 2 0 2001 ' IT MAJI f ' ; ME NOW OW100 CITY OF LA OUINTA FINANCE DEPT RECEIPT DATE BY DATE FINALED INSPECTOR . P ; = , . Page of Z DAVEST- i VENS Inspection a Services PROJECIP�I U)�� NA.3 M PROJECT #: - wol. - O 3 ' - ADDRESS lk 5.' L S't n f CLIENT ` DATE BLDG. PERMIT # ARCHITECT S Q,, tT'C;�.Tu+2t. i i ENGINEER u� J iJ J o i'E << Si) L CONTRACTOR /nf� 02cr '!-t C. INSPECTION TYPE INSPECTION.REPORT 3i3CA Lw �l ]C {� \ L _ S " (. : •I Li J � � p � • \1 �' � e t. '1 1' S - q .. { T \ y c- 7\�L . C -L,/ S:.i f� iJ I r.J C, , 'IF 4- 3a2 k4 Z26(11 3 - 1 - 9' 3 Lo.LK . A ►�� `t. ►.J,A \ 1.. t oC� LS - wLk Laj . C7 4�x—. ,.11 w *41 6"e -k. TT ► C. =— O -T---r��ii �-vl�f� �b�' I—s � `��7Cp' • — �S bk 1-x-0 CERTIFICATION OF.COMPLIANCE To the best of ourinowledge, all of the reported work; unless otherwise noted, substantially complies wlthYapproved plans; specifications and applicable sections of..the building codes. This report covers he locations of the work inspected -only and does not constltute`englneering opinion or pro�ecf-control: CERT. NO. O�.3`'7 -�� Y INSPECTOR NAME DATE 5J Sk oZ v p. / INSPECTOR SIGNATURE. a Page of DAVE-rSTEAVENS[ Inspection Services PROJECT/�{�FSTTu+�s (.� PROJECT # i — o ADDRESS r3� LS7 �".�%' CLIENT�.fl DATE Sih;J i1 oZcSo I BLDG. PERMIT # Aqx�k �T�cz�aZr ENGINEER`, `�.�,,� CONTRACTOR 'btL_ _►FSC INSPECTION TYPE INSPECTION REPORT 32(A -A AD ./7 �- (ZArrl.3A6Z� _ I SDS 4r.er'�e )� A til i) Ar 1 R.: ij. LACom_ -7 .,j I Sy --3 (20 3'1. 4 I °Q a�' T A L I r Tj �-1 (S: q` ��u C► Y_' t'A 3 S - C o r+•� 7 L.0 T �-i-T C.. hET At L (SPT -`4'S r.. 9L5 �L L �: � ATT c� �it A r;. , ,.� c : L�l oc t� rJ 2v ; A.-r'T" LEAJ .SAEAZZ OA I l_-I,J,_,/_y C C_ i SW .�-i L2 . �.1�3�.4yCo 5 3 DA4lTiL6t: a � `,j i ti�°' rJ0 INSET CERTIFICATION OF COMPLIANCE Tosthe best.of our knowledge; all of the reported work;'Lnless,otherwise noted, —"'substantially -complies with approved plans; specifications and appfcable sections of.the buildingcodes-This report covers i the locations of the work inspected only and does not cor st(tute.engineenng opirnon `or project.control. 1II CERT. NO. Or.L 1�30 INSPECTOR NAME 1 : �J L. RE DATE , S _TAA'u r` rJD) INSPECTOR SIGNATU,✓ Page of DAVE :SThEAVENS In'spe.010ji. Services .PROJECT PROJECT # 02 BO I - p 3 ADDRESS :� S C_ts-r.�� ' - CLIENT' ��,A t.e).EST a-Fy'� ` DATE'. fq, tt ., .BLDG. PERMIT. # ARCHITECT-Goo:.RA . f c4.4 ► rccri At ENGINEER u►J+J AJ��e CONTRACTOR. 1-`is�g2 4uF�C_ INSPECTION TYPE INSPECTION REPORT: sy- Ue?;>S-v4. sl�. sagKT��Ec� �-..., 43 E:TA i c: s .— I, ,a '� , °� } 9:a i �-1: f s - 9 3 c..oc:►C A. 0b. r� (u l ifa� �: ASL t x e l u, tJ A t � i �J C� Al� 5y 3Co� `+, 3e(a;:.3g:� �.AI`piLzi' E-is1.�Z�1W'ii�'Zt., A '� Yas ,��i~ Orn "JV�Ti✓' S� S Scr2E�,JS ' . A�� ... .AtJC:Ho2 �u�c Sy •T � NT���� . -77 jhe ERTIFICATION OF' COMPLIANCE To the best of our knowledge, all'of the reported work, :unless. otherwise noted,' ubstantiallycomplies witFi .approved plans, specifications and applicable sections of.the building codes. This:reportcovers locations of the work.inspected.only and does not constitute engmeenng opinion or project control. rs + 4 .: CERT. NO. D 38 ' SD INSPECTOR NiMA ' 'AJ .t✓� 14�J'��5.'' DATE l Tu �JL o� v c�` �. INSPECTOR SIGNA A • . . "�`".'" + :!`^..,.t'�,,..'1^r'q+J�+F .. 1�..-'.�'..q (•.'rt�tir'.V`11�+. T"".�f'. .. ``S .+.y^c...�..+.--._.. ,.. .. } Page / of DAVE •STEAVENS Inspection Services PROJECT?(^,�\ -t G Af SC PROJECT # o2 ov / ' y 3 ADDRESS A.� t_ t Sit CLIENT G A u3 p- 5 fHo t4 L)fc. DATE 1.3 -T&e 4Jc a. c�,o 1 BLDG. PERMIT # ARCHITECT Goci3 A A,? ch4 rTC [ 7-u <<?Cr- l ENGINEEiilu,,a.Jfi SflJoIE trJ L CONTRACTORICL MA4 -?Acrr rL INSPECTION TYPE : r - Pax y INSPECTION REPORT . 3 .0- f'o t -Los✓] r w1 c-, - Lv c.l�.--r � o ►a s � i�y x Y • S r n„2 s o ,�1 ETic r -x off, Ii -1 a c..r Dc107-g C►A Eclt'e-z e LC+�J. ni=�� ►-32tS , A�Pc_r LA-�r o�.I ip�.uD A 2 fgNS. -zC�.:rtiv l 3 to VE, 3" PS L��CS �.� ��0-t� � ���.. ���s s a� ��,��„� % � r�. I L o[; 1'i. hrrPTV4 7/+.1 b,{,t 7;Zb - 1�.�e,s - 1-1���.s- Ie'� be-rPT4 1 �r� ��s "� �'�g - I Mc. -r” Pr -Aa- L,d'- 1 Loo -lave. - l'L��. i'lV4 3 r; � � S r, 14. D;A. L) /5 i.QJ&# H /64)fA :R A2 C�:..,-t EaZ - LoL- -�0�,�.5' f Z ��-c�T+►l I`-1 0�A . 'yz) 5 - iS� LE►JGTN'48 6,r'� 54.3&, 0+'\k-Feco' ' Pimm. cZ Ce#J'rZ- a c.oc. • �a� y' POL�: � s _ t a- L? T%4 3,., �, r-g� '�/ rr %w D„� R00t; - 15 �—ra br.A �o,�►Tr1 lZ tiA2 L� � - I LO c %IoLC - C Z. � rs�h►. 3� (r .4, of R,00R,00- 1$1 L E+JC�T►-I � c%r q a � - � LOC!-, • ;i -- „ 17 Jia too L)5,-- �7 �c.►:��T� /8 Jr , aAk-10Ze t-7 LN 3 3 „ CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, rjubstantially complies with approved plans,,specifications and applicable sections,of the building codes. This report covers he locations of the work inspected only and does not constitute engineering opinion or project, control. CERT. NO. ©C3 a:7.,3 B " ��O INSPECTOR NAME , ' JAQ 6 / (Print Clearly) DATE oP L> I INSPECTOR SIGNATUFt s-.