Loading...
0104-218 (BLDG)LICENSED. CONTRACTOR.DECLARATION (ZI I hereby affirm under penalty of perjury ihat.1 am licensed under provisions of "Chapter 9 (commencing With Section 7000) of Division 3 of the Business and 04 Professionals Code and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor: OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt f rom.the Contractor's License Law for the. following reason: 'I, as"ownbir 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).. as bwnier, of th 6 `pr6perty,­ am exclusively contracting with licensed contractors -to - co -Instruct -the project.,(q6c. 7044,, Business & Professionals Cdaey� A) I am exempt -under Section B&P.C. for this reason -bate s Signature of Owner,, WORKEWS-COMPENSATION DECLARATION I hereby affirm brider.penalty bf`06_rju ry"one of the. following- declarations.. I ha4`ancl Will mainGn;la-6ertificate of consent- to t-e-'If=i"ri�'s�'ure,-for,w'd-'rkersI compensation,. as provided for 13�'Siqbtion 3700- of the �Labor Code,* for't6e —performance I of the , work for whidfi'this'permif,is.issue"d.. have and will mainiair'work6is`'c,om'p"-ensa"ti'on,-,-i,nsurance, as required by Section .3700 - of..the Labor -.Code,, for tiie j;6rf6rmance of 'tti6r work for which this permit is issued. My workerg' compensation insurance ' ' " carrier & policy no- are: Carrier., Policy NO*.!,, "ALTRIA (This section need ho,t'be completed if the permit valuation. is for. $100.00 or less). I certify that in the performance of the work for _whichlhiis permit is -issued, '��plo: e .11 shall not,.e y any person in_any,, man.ner so as to becom. subject.to the workers' compensation, laws of California, and' agrde,that if Fshould become —Subject to the Workers' cpmpensitiofi provisions of S6.cti.dn 3700 of the Labor Cocle, bshall forthwith comply,with those provisions. Date: Applicant Wairning: Failure,to secure Workers'. Compensation -coverage is unlawful and 'shall subject'�n employer I t . o criminal penalties and I -civi , I . ;fines up to $ . 100,000, . in addition to the cost of compensation, damagestas 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 applicatan agrees to, & shall, indemnity & 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 his 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) L Date BUILDING PERMIT PERMIT# DATE VALUATION LOT 03.(A -2 1, 13 TRACT --z, xx JOB SITE APN ADDRESS OWNER CONTRACTOR/DESIGNER/EN (NEER 11' ]ITA CA i2 2 3 20 1 t 4.k B RA Ck -CA ?R` 5823 7 C) -RAWFORM.AT Or4,.?.l USE OR PERMIT 5160 ST. CTLARIAKFI%ft A -i . )75:16y0• 0 .V. i -I VA OAK Lh,f i i;YV;r V• S VA.UJATCite 1. .,l k FYIMUVJTJ) 09f 0.F&0MVrY?1JC11K),I`4 2 .00! 01 -009-11 84)(N) cf(w muric"'P4 Ff,'K • lz:us If'.) wl-orlo-,2-411-000 PRE -PAID FFY,3 * �. $0,00 PDD 1 X ]MY'NOW L1 I $2091W CITY OF LA QU!NfA FINANCE DEPT RECEIPT DATE BY r7ALED INSPECTOR -' .Page of ''DAVE STEAVENS t Inspection Services PROJECT \..04:ST okSE I 1 PROJECT # oZ. OU / -0 3 . ADDRESS :•WS CiCLIENT,-F_ ST t40F DATE J'4 74k J C:2yy 'BLDG. PERMIT. # ARCHITECT GoL-.d IA Aeci,4 ► re-cru-a-E ENGINEER) "Q JU�f✓ `r�L CONTRACTOR,bE Mig2 t)ALI AIC. INSPECTION TYPE INSPECTION REPORT', A L E w c l u ►J �. i i �J .C� �4 �' . T i C t 5 C6 Vic_ ' y 3CsZ 1,31 413 eca. -2.9 1�io-Ai�<-rzZ r+ (L A4 kc2.t.. ar� (z v r".Zi-t-_-r- t✓ Sc-lgzw 5 A..Sz •A 0 C-46 2 -7-`A y N-r-e_ Elm r CERTIFICATION'OF COMPLIANCE: To the best of our. knowledge, all of.the'reporied work, unless otherwise noted, ;;jubstantially complies with approved plans, specifications ane. applicable sectlons:.of the.building codes. This•report covers 1,,rihe locations of the work inspected only and does not'constitute engineering opinion or project control. ` CERT. No.0 aSq 3 4S" INSPECTOR NAM�'A J Z _ e. � Print Clearly) DATE ru �- ay INSPECTOR SIGNA �1T R � ..-•: •..... -:.: a=.«.::N' w!i',w.b�i�rq`4+t'�.'ilciaT:i*7d'�'/d!Y�,'f4��"ir,M,ts'27"�'k�f s`u''�'t1W'jt, "�'r•t15• _ ......,,.:,�. .+. rv.r,... y�.✓',. .,artr� ' Page of d� DAVE STE " VENS Inspection' Servickk es 1 ' PROJECT. N S �I A L PROJECT # CO 3 G A.- t�J E i -r PHA s �. ADDRESS. A s L -t S Tc0 CLIENT pt.w es—r f4 PA r Y�-� C a `_ DATE• ii 3 ZLKc. BLDG PERMIT # ARCHITECT; ` G6 L-aes ENGINEER�u�J rJ... St Jo+E S�3 C.. CONTRACTOIZ� L .. M A 2 ,aAGt Fi c. - INSPECTION TYPE jINSPECTION •REPORT: LA �C-rAkLS - t9.3: �:. I Q - i�t.oc�:►v +Lt:so���Lef,I.QG F`f - 6-4 D t-\K'T•IZ::EE ��'�: L'i.g.'+ i,: •S ,1 • S 4• ��o Lk.'�� �' 3 � r 5 C cay.� ►_ � t'c. • . f ' N (. N : A�tZ � c �r:T t t l /5-� - t' a,M�.,w►c� nc:�c+a C�. -3 5 �. i 4 5 AV.J A0'1�i1Z a(Z-<-T�:C. zp•+:�. (9{�.�5 `'Z. L C -%k az') „L.O-VJ. l�$�'.l.L`a �iiR*12.•Y,•j I�l`►rI►JC�°j E\a,\l.,S-('.1 1.(�G:K1aJ"L�-:VA-•35•�S •'Co��LET- -.. r .. 1A\"1��-1 i-r�.�:c_:��++,i.�:: ��5=9PArm►.J`lo::at.dcECr�IC�:1�-35s:'��:SH.[A�.NA�uu6�o,►�Tt Loo IAiaAIL'i;Jca :k `J-�rZei P►:�:J G� ev►.� aL�-1 ►1'x12 t4\tL�t ' � 5= � I`.2► 3, a.4. �5 �q .�i:.o�.►c.r►.1 G � A-.35;� '.e.©n^.;J�.t✓�r, Low v.�a.� 9 SNc.fkiL IJ,A, t.l►J G..,. 9. � £ , r�r�- `'i' 5 q. S: r7�1A r►J �- Cour r, :; �.' jv •CERTIFICATION"OF COMPLIANCE Tchhe best of our, knowledge, -all of the reported work, unless otherwise noted, �•:�. , ubstantially.complies with approved:plans„'specrfrcations and applicable sections`of the.building'codes.This report covers Elie locations of the'.wo�k inspected only and`does not constitute eJngineenngyopinion orproject control. o;GERT. N0. ����7 13Y �- �O INSPECTOR. NAME >•, E J/'�1�i�E►.�.. . . i . • .�, �: (Print cl NI BATE 3 :.T� ►•� E o� O,D I INSPECTOR $IGNATUF71} °� . r�;. Page. a of CP- PROJECT 2 PROJECT # oP � CLIENT' 'i ',4� A `; t,JcES T HOA DATE ARCHITECT. Gv�.g�} Af?C�4 I -rc C-ruQr CONTRACTOR 'C L rn,q R C Ez A, L S - ►.. �. I S.._ q - P, VL 'oKT_2Et 3 1 4 �.-,' Page of DAVE -STEAV, ENS. _ . Inspedion.Services PROJECT�..,A tj S'T-:>i•fASE I.A ADDRESS BLDG. PERMIT # ENGINEER' -w �' SN\) o. E INSPECTION TYPE PROJECT # C� va - 3 CLIENT k=k Lott k40A DATE ARCHITECT �o3A-1�zC,.+-r-t�Tu2t CONTRACTOR S M 2 �,A Lk F% c INSPECTION. REPORT Fi... ". _ 1 1 i � — — — — .. � /'—'•t1 �., .i* is _ 1 _ 1 .�—.-:. _t) P?'N• c t FF c1( Eil .2,2u slkl �) a jJ b `.`e f Lg;3 ,)c*C5e.,Vs Q Pry o CA ► /,)j Ak] [) =tJ 3 % A LL 4T/ywf -A S 'RR,Fz A. _--rc.LL 4 -?,V S r 4 � # - J. Loc _ ��c ,; }3� gyp.. 005 i%� C.EN[,%''( S� r�rR Ria LIJ S JUC-s'--0ocC' I 1 J EEP'T=! t 1�g Roby' 3D V2O�;rti-t �S ►� �(� R L-4?C_ 6,Lc A-22 .T , 3/y'��, ., 1 ,6Ck j 1-1.. '7/5k" b (A' AL'b a t?TN ��' ��A i�,pS S -I ~,G..c►JGTN '/$, (�rA r\: 4�•St-I�o1,Le-0GXH S49 DrA 14g'�~DiA S'f-SaB. "DA'K-he tt 'i�Li4'�.1 3'• ' CERTIFICATION: OF -COM PLIANCE To the best of our•knowledd6,'-' ::6f the `reported work;yunless otherwise noted, u6stantially complies with approved5plans, specifications and -'`applicable sections of the building.codes.This report covers he locations of the work irispected,„only and doesnotconstitute engineering;opinion or pro�'ect,control: CERT NO. g3 IQ 5 O INSPECTOR NAMEli\' — s: rte. ..r,, DATE ( -0 -' lam -a r- a J 0 7 TINSPECTOR SIGNATOR fqd r, t