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0104-238 (BLDG)I herr' affirm under penalty of perjury that I am licensed under provisions of i— Cha( (commencing with Section 7000) of Division 3 of the Business and 04 W Professionals Code, and my License is in full force and effect. CV)License k Lic. Class Exp. Date ' W r` r— }45,.51 i2 Y: +,1:.i/,9.1 l"4 f. cZ ir� Date Signature of Contractor CS O P7. t` 0 CD OWNER -BUILDER DECLARATION FW- dco I hereby affirm under penalty of perjury that I am exempt from the Contractor's 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). cY) () I am exempt under Section LO B&P.C. for this reason N Date Signature of Owner ON rn Q WORKER'S COMPENSATION DECLARATION C) 2 Z I hereby affirm under penalty of perjury one of the following declarations: Q () 1 have and will maintain a certificate of consent to self -insure for workers' X W L= 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 U (,) I have and will maintain workers' compensation insurance, as required by Q U Q Section 3700 of the Labor Code, for the performance of the work for which this rn H permit is issued. My workers' compensation insurance carrier & policy no. are: Z Cartier J t y t Poli<,y No. ob CY 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 3 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 $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to �1 any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. '2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is • correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date t$UILUINU IJLKIVii i DATE VALUATION LOT t7,1 "'Pt -1,38 TRACT JOB SITE APN ADDRESS rfC p„ — OWNER CONTRACTOR/DESIGNER/EN (NEER i. ,,•._ N -4',1 .i ?,Cr'. i. Ei't s�..!._ .3•fst•1:k!:)i�i., i fa•f'k.,�'•,..: f.�::: r j�:I�i j•.{,I•i 3�.1I�,t•? !1',�, p. ���:.••I t.. �.i,% f'�,`i t�-, �i ',t:x . USE OF PERMIT I % i•... t +. � J frig j',' �!: i1'i !� .71r !'a'�.r. ;"t�. aPl w�'«;�., �;).,1. '•.t�ltti'�,)s.'. "" ti70:;`1 /::'I±f.±;i:l!�L ±'i.. ;;;�.ri;. ;:.7-.•{:., ti%i•h•<...+-;';i, ,,:, o .<�;;•. '.1-i!.;',,, F'tii:.';±i•!° j;.; 't';':jf:: 12� i,0100.00 --i r; .:�l''•i.i �+'�••r`1'•.'S' .'i:..� ]l): �^��i )��) ... ('1(tii ��tr 7•tr�r .>'I:.:1�i'%s'GC1'i'is.�^J.�G:f;'' Tc1-':;:I!% i(tl-..•11ii.; •'(..�1(i(r ?a.Glij.i Ff JJ Pin " kl. •- r:,, J I CITY OF LA OUINTA I FINANCE DEPT J RECEIPT DATE BY DATE FINALED INSPECTOR 71 a•e. t.'o DAVE STEAVENS Inspection Services PROJECT t je%-r, 4&%r- 1A ADDRESS Sp (�,: l q-3, Uyg . („S BLDG. PERMIT # ENGINEER, ►.1 SA.lat r= �,J c_ INSPECTION TYPE PROJECT # CLIENT ?4. A tit ST Page ;- of 7_ DATE S A u l,, ?..-vo r ARCHITECT (�,O-A 4d:r4i cc.7j u r -r: CONTRACTOR LL MA tZ �Ac F < INSPECTION REPORT Smt.AiZ t�ldit tL�C, Ate) h S i �ZAt?i►J� J 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 'he locations of the work inspected only and does not constitute engineering opinion or project control, CERT. NO. e9W Z'S 9.3 4/9 INSPECTOR NAME c�NJ t� cJ I E f1 J t� rJ S DATE S t- I UO ( INSPECTOR SIGNATURQ . , _” . -� �. - 1:, �..,. .. '�: •;�;,i;-.�.4dy;i.�,*f-�S':. vN.., `-„'3�'��aka�c�;i1"�:3ki� ^1`: `3'���:;ia� ,��y�,e.-i.. :_... DAVE STEAVENS Page t of ( Inspection Services PROJECT t�(,� �•J�.S� - !�- fisc PROJECT # ADDRESS S Ll STe�2) BLDG. PERMIT # ENGINEER .,.N.7'� INSPECTION TYPE CLIENT & t Z e.�,T WAP, DATElo ASV cavo l ARCHITECT C� OC.A,4 A Rer4 r?Ec.Tu2£ CONTRACTOR J 4=L m41 Ar- I F I e INSPECTION REPORT L0 7 -\Z -k l.oCl�trJUJ rA S J S 5 C, rZ t� U-) S = T C, t -F 7E 0 c .J) 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. N9. © e:5 9 i V INSPECTOR NAMZ '�? J 0 DATE 3 � � u � o�yV / (rin teary) INSPECTOR SIGNATURE--i� o Page ! of Z DAVE STEAVENS Inspection Services PROJECTy7�,A uJCST - tom- i �r ��PROJECT # a (- 4 3 .ADDRESS BLDG. PERMIT # ENGINEER - k'�j,j y) INSPECTION TYPE E�vx`1t CLIENT *�'Cn DATE � S L 1= mon ARCHITECT rZ)L_-AA -A�cvj 1W c:rtx& CONTRACTOR-'b—rL m A fL t?- Rc« (c - INSPECTION c_ INSPECTION REPORT �JS' 3- 11 1Ta-nA I'I�In. aolS- t'1�1Le-ori A %torr illfl. LEaS, a (I (roc-aOL.✓- 1 .�� �" )iA �wc5 - 01..4S -l 1,<aYti-1 1 SIA0>J5- I-1 1 F01'Z o-4 /a -II,A C, (11 1"1 1' i -' SAD Cr._S E:.a_ 4ts- 6o (.Es DV:iYTH1J 3Lq Dle, t CJS ii.,' LEQc rH �g649 DIA 11 '7&I I =% aJr�-%N - hoc. -1-(Q «- I 1�a-t� 1" t 12ur1S- t'1 Lt Nsa 11-1 $ 411 �a AS -r LIJ- l u - �4uC_'.-I:t.1 Zx.InV4 1 D A.'Rob- 17("N6.Tl ,t$1���h -i= Ly - Irio LAS 11 l PTq (rIJ� A egos- I �t-s:IJ6Tr.l ,/$ �I �,�, 1� a- a��5 - �ioc.i=S - 1 2 �tr,R'H (1 t�1 A. t�DDS- ('f11LE►,s�Tt-t �Ig.1�J1A -ell )LS - ko(_a:S-l11� �c.PTW=l11 1A 20D5-1%1 Ery .'T#! "49 b iA 11 h LST I LOC• Not -E -(� 1)EI TIJ ROIt_�1LrQc.-c-VA It& z' A, ALL A3oQ6 Le)c T"1o7,_,C t: e?o'-4•H '-%%rn25m4 (P S►•/t. 1) & i 1 1") C' A r til t2 1 S t� L.1 C AT t a.1 �5 t�jCj-1 = CZa 4R U; 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 )he locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. INSPECTOR INSPECTOR NAME (Print Clearty) DATE amu((„ a.vo ( INSPECTOR SIGNATUF� � t•t Page Z- of Z DAVE STEAVENS Inspection Services PROJECT::�e-A tJ in• d�1A5e - i A PROJECT # Qo t - 0 3 ADDRESS {kS �.ts'� � CLIENT ;(-.,N BLDG. PERMIT # ENGINEER_o_�3SA\)o,,= S►.'\e_ INSPECTION TYPE DATE o') Q 4,v -c, a oo I ARCHITECT G ao .ZA Allc.N t i Eg-7-Lttzz CONTRACTOR, EL iy\AZ ;�)AC1 Ft c_ INSPECTION REPORT KWA i %A e— TALI -S 1 3 L OC►C AO -N �{ c y �.lA�l.��.►Cm- �,Drn �c.E ► t �� LL • y' .p' �'�� L S - 1� � T A � �� �. T r1 - 3 t,.,o L ►� R �.1 l� '� s-1 t. •A t2 N A t t,,.� rJ Ca ' C.oM�LETt • . �0 - b3rj x-'4'3 �Io`�i �5 a TmT-� oP�KT2� r.. �3� � 34 � �►.� la 2&u— 14 A�'T� cs - `$ SNr.A2 rJA It.t.J ©�L�I - Com?L•F-Tt ,.gv 1Z( -,AQ (gZ, Z; TAIL -s - �. 2, 3T �S-� - 3t_o�►C A+�� 1�- ��I �,,)At` �c, - C�mJc�TE A le_Ta t t_a Co * ♦ qxt'3 Loin( R a D 5 H e A{Z t�A !KI E-•ttil Cs Qe�,!hiLC-re 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. IVO. (OeSgJ TA V INSPECTOR NAME S?" J DATE fou G .Z dD / INSPECTOR SIGN, TU