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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
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).
(y ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt ruder Section , B&RC. for this reason
Date —"i. :' r Signature of Owner r• ; / , + i 1
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.
"T!,14: f'i.4!2r3 IvYr
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 1 certify that in the performance of the work for which this permit is issued,
I 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.
j:
Date: t 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, 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. f
Signature (Owner/Agent) �•- `` ' , �' �� Date ' /AL' /.1
'•
BUILDING PERMIT PERMITN
s
/
i
DATE , ., ; / VALUATION LOT
TRACT
JOB SITE
APN
ADDRESS
0A.K •TH.'f.. F
OWNER
CONTRACTOR / DESIGNER / EN (NEER
!'EJ'KIPELTi.` .R.raMi_>3:iJA , I.ttlAtd:R�' I&MI11-MMALD
ROOFING, INC.
LA ("'lil:Id':t'Ah
)N 10
CA. 92201 .
(760)347..9869
CRUt 978
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1
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USE OF PERMIT
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R11!-W',02n't•'VJTH l:'I, &;.A lAP,.'TLrlilf't_;3• 1400 V- 54-67f, �i4.6bf,
'd:r�.1,0.i,TFC+It 13GO,pu !�
SEP 18 2001.
CITY OF LA QUINTA
FINANCE DEPT.
h..a.mIA7.vo cC>sr i.)Tf C opus'illurr-m mAll
II�
4'd�:I.<.itr�.t'.t .ta•.F,,:c�� t�"(Sli�t;1(f.A:.A�'i�
# ,
101 -000-418-000
t1rS -'t"e }!f',l: ��(:i>i,1 't'9?arc:r,e �3k lijj)P1..A H C WA
1 i
$, O.aa
TF:3�3 PRE -PAID FFY-3
"•f.'(Xi�'s�I .#"Jt Fr(:MtI':Es'%i> :S ME: NOW
W
RECEIPT
DATE
/ '
BY
DATE FINALEDINSPECTOR
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.l am licensed under provisions of
F- .,chapter 9 (commencing with Section 7000)'of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Llc. Class Exp. Date
�
Cy L
rZ
cZ r- Date Signature of Contractor
CID rr
J U � OWNER -BUILDER DECLARATION
LIJJ r' I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL U) License Law for the following reason:
Z_ ( ) 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).
M () I am exempt under Section , B&P.C. for this reason
U)
N Date Signature of Owner
ON
O)
d Q WORKER'S COMPENSATION DECLARATION
CD Q I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
O O Section 3700 of the Labor Code, for the performance of the work for which this
Il permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
ob t°f.).., iF1T::T,t1�9:ts1`!'Y' 1..1961174A
J (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,
I 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, 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 t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.04-217 `I TRACT I
��i)ti%!fT,Lti)
JOB SITE
ADDRESS
APN f
OWNER
CONTRACTOR/DESIGNER/EN (NEER
L
t t
i6GA Vlk%&W:t+-V31f)' N 3'3:A:1'. ASSC11: IA'.ION
1:1.M, MAP .PACJ.1-1C G1-. --kAL C)ON IUACIIO
:1-ALU41-A. CA 92253
SOLANA BEACH CA 52075
(85€f)792-1500 MW 5523
USE OF PERMIT
Ik)C.A.L;)fggCP IAkPOPLIKATION
i1 :Et3C:'jYl� .!ik]A?•C)E'?£i
75.160 ST. CHARLE'S PL
54,&1t,'A.6.46—IM &..!i4,612 0AK. TRHTr - ItUII.J",IN(.J/'f PLr
10V )I.MN';:'ARVSIAIi1)S" U11AI.,A4001FICATiONS /� t
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VA:L.E3,ATI0,14 2rs 00t►.00 L`d•
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.N;S'.T'l:XA'i7,U C.t?":i' 0,11A, CONIVtlr.i7MC0.P'i
Page_ c� of o2
DAVE STEAVENS
Inspection Services
.PROJECT i.\Cs i -+� HA5 1P%
PROJECT ^# v� - d 3
ADDRESS A S C.i STPD CLIENT HoA
BLDG. PERMIT #
ENGINEER-1u►,1,J SAJoc.�C .
INSPECTION TYPE
[7a
DATE `7 SSu ,J E o7 Lm 1
ARCHITECT Go`8g 4RC,.4 I re cru�C
CONTRACTOR Ic L rn,g /1 Vr24c , Fi c -
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. inS3 < INSPECTOR NAME
-7D 3u-+`1 t 2 o v I
ATE' INSPECTOR SIGNAIU� OP4+-
DAVE STEAVENS
Page -1— of
Inspection Services
PROJECT- I(,A Q Z 5 1' (7 N ASE IN PROJECT # d
ADDRESS A 5 L 1 ST C Z)
�3LD(_ I a
BLDG._PERMIT #
ENGINEEItN�,kyi SPyo,p, -:x:.jc
INSPECTION TYPE
CLIENT {�. ,A Oe—s-1 M0A
DATE (o --"U A) E .Zyy I
ARCHITECT Go"
A A2c,+
rTcc.T
u f2 �-
CONTRACTOR
JR`r_ m1A (z }7A
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Fr C.
INSPECTION REPORT
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially 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. �S �% 3 R - 5� D _ INSPECTOR NAME J E 5-tkA (/EJ S.
(print Cl'r
DATE % --j"Lc tiJ C INSPECTOR SIGNATURE. -
Page of
:DAVE STEAVENS
_ Inspection Services
PROJECT,P .,A �,.JE c +`�aRS�• f R PROJECT # cad O.0 1 0 3
ADDRESS A -s _ L s ; c ,�• CLIENT�� A i . %-4,0 A
DATE 30 A,4 ;Loo 1
BLDG. PERMIT # ARCHITECTGot.BA
ENGINEER S AJ olr: La C- CONTRACTOR-beL_ r \Pa
INSPECTION TYPE
INSPECTION REPORT
in)Ca LocA-r•iuoc-, FtjoXY s/MpSOAl ETF ERP. /=03 N�LeS
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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, specification's 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. Q SU INSPECTOR NAME
DATE; _ 3O Pn `I .Z J O ( _ `.'INSPECTORSIGN- -
. 7 _r - lob �f O le T26E .
DAVE STEAVENS
Inspection Services
PROJECT:�Cj� U,S�s '>� HASE (Pt
.ADDRESS A S Li STPD
BLDG. PERMIT #
ENGINEER-1i�
INSPECTION TYPE
Page C_ of CP-
PROJECT
2
PROJECT # <;2 a -V f — O 3
CLIENT JCA 1�1G ST Nor4
DATE `7 Z -c. J C o7 pro I
ARCHITECT RG.1 I re cru k. C
CONTRACTOR'lC L rrf A rL `,24c i r/ c.
INSPECTION REPORT
W.
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R LLL 1 S S F- S A► �1 1�1 t`l C�K 1 u.Z S �Tl �� e -t T t w� E 1�
;::-_ZArnk0[„ . HA2►bwraR�.
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. $� �9 3 `� 5 V INSPECTOR NAME
DATE SL�-�,) t INSPECTOR SIGNATUR
DA E TEA E Page � Of
V S V NS
Inspection Services
PROJECT ' P6A VA -51 445c: 14 PROJECT # a 00 ! — 0 3.
ADDRESS AS L—tS-rt I�
BLDG. PERMIT #
ENGINEER c- 0 0 S Ayo I
INSPECTION TYPE
CLIENT /fie, li GcJ tr S % f-10 A
DATE o?y o 1
ARCHITECT' 60L -dA
CONTRACTOR JJ L M,4 tT
INSPECTION REPORT
li�-rh IL S 3, 1y%-9 --'RLOC�! I►JC. A Lti 3c-crz
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially 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.
DATE
S
INSPECTOR NAME �. -t�A[i t.v
rPrmt Geary)
INSPECTOR SIGNATURE
Page of I
DAVE STEAVENS •
Inspection Services
PROJECTIL A lei - 1 �� R 5c PROJECT # o2cM 1 0 3
ADDRESS A -S L is i e_Z CLIENT�C�A
DATE 1 c�►� E ,2 cid 1
BLDG. PERMIT # ARCHITECT(:)ou3 A A9 -CA 1TECru kC
ENGINEER .,�a�ZSA�c�tc rIJC . ' CONTRACTOR)JEL MAR _PflCtFtL
INSPECTION TYPE
INSPECTION REPORT
0 I.1�7R_EE 3 L:N C ra,
ALS
&1 .i i S --T'+t C 87 N A CACI a 2_Z_ A� 3 Q 5 �-c� Q(_E 1 C
:)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. , 3 9' SIQINSPECTOR NAME c �t'►J1u�AS
c� ear
_y
DATE .- u&i C O 0 1 INSPECTOR SIGNATIJ�
- Page i' of 1
DAVE STEAVENS
Inspection Services
PROJECT ?(fv a t ST NAS`. l A PROJECT # cl u -o
ADDRESS 4 s c.. I c.-ti c CLIENT -?e-A WEST h/ot+
DATE
BLDG. PERMIT # ARCHITECT �,oL A q 4 tZ C -H ► ► E c. i cot z
ENGINEER)D"Qt j 5AyoIE ivJ L CONTRACTOR 3W1- mAi2 )QqC/r/C.
INSPECTION TYPE
INSPECTION REPORT
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t � :�iaLl.4 F,Zfim� ►.3 (, 4?LDGK/tJ i✓SU Lrq % ic7t-)-
RLF-il�T _ Al2eii S r_4_&,w s_s E 6 -rH A. wi Y (T RA
CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially complies with approved plans, specifications and applicable sections of the building codes. This reportcovers
he locations of the work inspected only and does not constitute engineering opinion or project control.
CERT. NO. INSPECTOR NAME
iM Cleary)
DATE j�[ti� `� t�0 r INSPECTOR SIGNATU
•'� :. DAVE STEAVENS
Inspection Services
;. PROJECT QCST PNASt / i
ADDRESS
BLDG. PERMIT #
ENGINEER,bu AIV .5;11,1016 i Al C.
INSPECTION TYPE E PO4 Y
Page ( of 2
PROJECT #
CLIENT l.;.A U) Es ;�
DATE tr # I A `F
.ARCHITECT
CONTRACTOR �L �tZ 7D,C
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INSPECTION REPORT
461a 6AWrZEE
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5-4 - 6 $y
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CERTIFICATION OF COMPLIANCE -To the best.of our knowledge, all.of the reported work, unless otherwise noted,
Dhubstantially complies with approved plans, specifications and applicable sections "of the building codes. This report covers
e locations of the work inspected only and does not constitute engineering opinion.or proiect-control. '
CERT. NO. 0 e 45- .3 T i9 `Jy INSPECTOR NAME A-1� �� V tr i.
��
DATE !� INSPECTOR SIGNATUR _ "'
c. Ldc.Fa-s , o aS �* oxy , r
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CERTIFICATION OF COMPLIANCE -To the best.of our knowledge, all.of the reported work, unless otherwise noted,
Dhubstantially complies with approved plans, specifications and applicable sections "of the building codes. This report covers
e locations of the work inspected only and does not constitute engineering opinion.or proiect-control. '
CERT. NO. 0 e 45- .3 T i9 `Jy INSPECTOR NAME A-1� �� V tr i.
��
DATE !� INSPECTOR SIGNATUR _ "'
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that.l am licensed under provisions of
F- .,chapter 9 (commencing with Section 7000)'of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O =) M License # Llc. Class Exp. Date
�
Cy L
rZ
cZ r- Date Signature of Contractor
CID rr
J U � OWNER -BUILDER DECLARATION
LIJJ r' I hereby affirm under penalty of perjury that I am exempt from the Contractor's
CL U) License Law for the following reason:
Z_ ( ) 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).
M () I am exempt under Section , B&P.C. for this reason
U)
N Date Signature of Owner
ON
O)
d Q WORKER'S COMPENSATION DECLARATION
CD Q I hereby affirm under penalty of perjury one of the following declarations:
Lo H O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W Y= compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q I have and will maintain workers' compensation insurance, as required by
O O Section 3700 of the Labor Code, for the performance of the work for which this
Il permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Cartier Policy No.
ob t°f.).., iF1T::T,t1�9:ts1`!'Y' 1..1961174A
J (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,
I 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, 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 t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 01.04-217 `I TRACT I
��i)ti%!fT,Lti)
JOB SITE
ADDRESS
APN f
OWNER
CONTRACTOR/DESIGNER/EN (NEER
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t t
i6GA Vlk%&W:t+-V31f)' N 3'3:A:1'. ASSC11: IA'.ION
1:1.M, MAP .PACJ.1-1C G1-. --kAL C)ON IUACIIO
:1-ALU41-A. CA 92253
SOLANA BEACH CA 52075
(85€f)792-1500 MW 5523
USE OF PERMIT
Ik)C.A.L;)fggCP IAkPOPLIKATION
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75.160 ST. CHARLE'S PL
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Page_ c� of o2
DAVE STEAVENS
Inspection Services
.PROJECT i.\Cs i -+� HA5 1P%
PROJECT ^# v� - d 3
ADDRESS A S C.i STPD CLIENT HoA
BLDG. PERMIT #
ENGINEER-1u►,1,J SAJoc.�C .
INSPECTION TYPE
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DATE `7 SSu ,J E o7 Lm 1
ARCHITECT Go`8g 4RC,.4 I re cru�C
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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. inS3 < INSPECTOR NAME
-7D 3u-+`1 t 2 o v I
ATE' INSPECTOR SIGNAIU� OP4+-
DAVE STEAVENS
Page -1— of
Inspection Services
PROJECT- I(,A Q Z 5 1' (7 N ASE IN PROJECT # d
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CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted,
ubstantially 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. �S �% 3 R - 5� D _ INSPECTOR NAME J E 5-tkA (/EJ S.
(print Cl'r
DATE % --j"Lc tiJ C INSPECTOR SIGNATURE. -
Page of
:DAVE STEAVENS
_ Inspection Services
PROJECT,P .,A �,.JE c +`�aRS�• f R PROJECT # cad O.0 1 0 3
ADDRESS A -s _ L s ; c ,�• CLIENT�� A i . %-4,0 A
DATE 30 A,4 ;Loo 1
BLDG. PERMIT # ARCHITECTGot.BA
ENGINEER S AJ olr: La C- CONTRACTOR-beL_ r \Pa
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, specification's 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. Q SU INSPECTOR NAME
DATE; _ 3O Pn `I .Z J O ( _ `.'INSPECTORSIGN- -