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0104-219 (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 P.,rofessionals Code, and my License Is in full force and effect. License # Lic. Class Exp. Date 1:3:3 } 5 k B {l;'!:? ! CZE Date Signature of Contractor OWNER -BUILDER DECLARATION N I hereby affirmunder penalty of.perjury;that I am exempt from the Contractor's License Law for the following reason:' ( ) I, as owner:of theproperty, 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'B:ProfessionalsCode).-, ( ) I, as `owner of the property, ani ,exclusively contracting with.`licensed contractors to construct the project (Sec. 7044, Business & Professionals ._ 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 of perjury,one of the following 'declarations: - (p I have and will maintain'a certificate of consent to,self'insure for workers' compensation, as.. provided 'for by Section 3700 of ahe Labor Code, f& -the performance,of the work forwhich:this permit is issued.'. (,) i have and wtll maintainworkers compensation • insurance, asrregwred by Secti6n,3700 of the Labor.Code:-fot�it e, performan a of the worWfor which°this . permit is Issued. My workers compensation Insurance carrier & policy no. are: Carrier"-Poky,40. 010.11 11N 01W 1,11 VVY (This section need not be completed cif 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 a'ny•person in, any 'ma- nner so as to'become subject to:the workers' compensation laws of..Callfornia, 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:. Fa'ilure.to secure Workers' Compensationcoverage 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 who 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. Signature (Owner/Agent) Date - -, PERMIT# BUILDING PERMIT , DATE VALUATION LOT 0104-239 TRACT JOB SITE APN ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER I�{T1� 4d,f'.��3 1;.is:uil:>Etis r1J%.11 A,'1?S0(_'.}:,f';['XA4 U-N7...�d.Ak: PAr—JEW 01HAY:EZ.HLCUN!'it.Eef,;;' O Si FO B01Y.'.1061%) i-62 a7Iwim 03102 LAi 'ON'7•.A. ('..A 9 2.5 3, 4i?I.ANABRAC1.1 CP :92075 � USE OF PERMIT I;O(W, OFFICE fiNF't1it.@kA now } ;• �. t�l't; ',t?5 }-OcAl�i)4?;� 'DS }Fp 5T C'}iARL]3y PI. �'' .;���'• M54 4 1 &: 511.422 0)X FU,E• tc �/- a'Jc?t:�:f h1 i Asia' :t`lr�.t.�c�•rvft.,:t;. _f�c�I�IK•tc�.E►•ri�:�]J�s x rg :. • - ._ . �:a,.f3'lVLJ�'IG�'�};� C:e71ti.1 5>:�� t'•�.l�iS'1i7.�?.irc�'%�c�ra • �tQ,fMif3,(}U >i'i��:f�-t�'i:f`1; }�.H::t!:2it1!'.d1.f�€A:fiY' ;•.... ." :�. !'c�►, "i'Ftr]t°i)! �1 I�E?s 101 0DU•4is:'•ft{!t4 (• 169 •(;d.0f! $3.0 t!?r-i>11:f MC. 11C 73i !:-!.'.Sti)l:; 10 )ijll . Ss, w, • n ,, ..., . ..,,• -<., 'E9:!'i:;Cl�:';�30:rJ �.�J1:?.hi.,r'..ty , �i i�.(�1e. S2U�7.i:,u �. I:faJS :I'R1,'41.AII? Je)K Z $$a w lnl Z•: ':�9J< �`:fr;i2jV9l.d':I''i«;F.;�'U�1.)�: ,NG�W $2090,1 APR 2 0 2001 i CITY OF LA OUINTA i 6; RECEIPT E BY DATE FINALED INSPECTOR J ;)L-rAc- 7, A -r-r' c - A' xf L4 2 AWT a i L Ck Ck- —6 .... .... CERTIFICATION OFOOMPLIANCE:.T6-th'e:�best:-oi*our -knowledge, all of the reported work unless otherwise noted, hubstantially Dcomplies'wlth',Aipp�;qy6i P'0Ii6abId,-66ctq6ni-m t building rt codes. This repocovers e locations of work inspected only'does riot-don-stit9�—e ePT910 opinion io-n o T. project control. ' CERT. NO. _Q1! q 3 4 IR INSPECT6k NAME INSPECTOR SIGNATURE DATE .. .. .. ... ... , e :; ;;. ter.. : ..:.:::..: . .•... r:r r ...., .. s =: . y. t:,r � ...... .....:...-.z..-.,R.- . -.- .... -• ->.. = . Page Z of 7 DAVE STEAVENS Ins, pecti m Sci ' i60S PROJECT. L.�c S� + As . I `PROJECT #''.. ADDRESS CLIENT-1-A'�sTI OFA .DATE BLDG. PERMIT # ARCHITECTGoL B#� ' /a Kc► iT CcT to �'� ' ENGINEERI tt_ .i . � J o %E =--3 CONTRACTOR �t L A1�q C i r i L INSPECTIQ TYPE i 'MSPECTION.REPORT sr►ZAPP.1•a C� m% s5, � l_ R' f z LS CoR`P � T ��S �. 3 1'- .�5 ;q 3Coc�c �-O ��'.O :35�� ,` eow. �r� � . tL �70'� T. A �` '' �`l-.'�; c� S' E :f� %1. .. til A L, iJ C �' v� c7 5 1Z A` �(' �J'h „ C o•M Pr_ E T"t 4 CERTIFICATION OF COMPLIANCE To the best oV. f our.knowledge, allof`the .reported work;unless otherwise noted, ubstantially complies with'appro`ved plans; specifications and applicable sectionsof'the building,codes. 'This report covers he locations of the work inspected"only and does'!not constitute=engineering opinion or project control rw CERT. NO. O85"�?'3 �if�" 5y' . INSPECTOR NAM fiJt 5 p.� s x DATE •4 .1 C:t I�'t ` oZ V'ar INSPECTOR SIGNATU Page_ of 3. DAVE STEAVE NS F i Inspection Services PROJEC P 1.� Si PROJECT ADDRESS A:S L IsTG �' CLIENT DATE . BLDG. PERMIT # 3 ARCHITECT G��A . A;?cH�cTu� ENGINEER l' . �uL►�►1 C] P<.1.�� � %�J''C.. -'CONTRALTO � 1- t C_ r>1a INSPECTION TYPE INSPECTION REPORT. Al 4 3 y. �+yCW L415 R ©A K -r;z t E. l� v4-L� S'' 1-:RA a, ,i LL S.I� ` �rltt-�.J� �4�1l� ,A=IJC.NyIz %iuTS , i�NT�tiIEL . . • .. - .tt 7i .•- - - - CERTIFICATION OF COMPLIANCE To the best of our knowledge,all;of the reported work; unless otherwise noted, Dhubstantially complies-With approved plans `specifications and :applicableaections`of thibuilding codes. This report covers e locations of the, work inspected''only,and does .not constitute engineering,opinion orproject control. • CERT. ND._08S 937 �' Sy> ` .: INSPECTOR NAME (. ` i1 r) �� A Jr•)S AQw— DATE..iNSPECTORSIGNAc�;:,;a F Page of DAVE_.STEAVENS , Inspectimm Services PROJECT 96A kks i PWA 5E . l A _ . PROJECT' # _ 12: C16 / -0 3 I ADDRESS �A 5 (_r 5TCt3CLIENT F&A U)c S h10 fk I S DATE ~L BLDG. PERMIT # ARCHITECT,.,Ga meg/} ft2ey ENGINEER !a ►� S A'J'o� z Z . r CONTRACTOR �, C.. n� f} k- 1' 4 c r F t L INSPECTION TYPE j �a INSPECTION-:REPORT Lo«,�=to,3S Et�o-� y- 5.� t�,�So,3 ETF. Eke (-03. 1-{oL_C5 I Er'� Ct4 UCaC� � �LuS1 r.�. A►Jl� C_L�, r, of �i E3�ZtS fi�i�t�l.�CA�'ta,J cs A LpCS -.46US. 11-,t:.t��1 .,�4 t�LA R0s7.+t_ cQc. -1 �3C.1 'a - a LuE;.S Nom S ( pc t.►-� 1` �j ,Fs ��5;- I(� /z '��=► �z�1 4a PTCA(L KLRTN 1,o-' 1 (.:uc.=',1 ;`J�.�cH 3�y �A..y17 " tS��E►JC���-t DiA ��f1R C LwY'tZ �. 3 l.oC;-r j�2k:.�.c.�"Z�1 .It( `�?�. 1Z0.-. r'�,.`�N4T�l/g'1 DSA h2�A21T�-1 Wt A. l�c blb I.S*. l.tr�1crk REAR SOy.Zi-\ •L �\ t�L. 1:2�•���{_ .3��<*:���1. (�OL1= (.ST l.E.:).C,z.,:1% S�$DI t3 94- 44 S.i3 Qy4r2`rt t t?Lq ►J Y �Ep I t MA-5- e1 LvCS- t-►oc.ES'' Ia t7Et�T►-i I1'.`��t �(�1�`�-.(C. C L02TN 964IL L+J -A :Rob - l�*'°�.�JL: �1 �8 CERTIFICATION OF COMPLIANCE: To the best of our knowledge; all of the,reported work;:unless otherwise noted, substantially complies with approvecJ plans; specifications and-applicable sections-. the building codes. This report covers the locations. of the work inspected only and does not constitute engineermgjoptnon or project control. CERT. NO. �BS�i 3�•(� � dNSPECTQR NAME �' A �% . J`tEAt!JS ..x Kid P CI '--DATE "7 %A JC o^ �'- ..,. l INSPEC70R SIGNATU i;