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0104-238 (BLDG).I herf' affirm under penalty of perjury that I am licensed under provisions of Chaff (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License Jt 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). ( ) 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 Poli„ y No. (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: ADDlicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such 'permit, or cessation of work for 180 days will subject permit to cancellation. 1 certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PF-HIVIIT DATE VALUATION LOT t),I ��'}• ` TRACT JOB SITE APN ADDRESS [[ 8Q .. .. OWNER CONTRACTOR/DESIGNER/ENGINEER :':;.f.�,r-'.::.;!'rt.c.e�ii�iir:r•1`1'tr'•_i.:;�:�l�;c:;i.:f!t;�'S,t.ti'� i.�t�i:ivit�,)L.i{�,C_.rr`f:�,CJI:;i••ia?i�.i�:t..�..t.)"Ca'.f.'id.:�,1:.;1'::i9 ll,.'' i'•(.��-'. iL`i"•O 1F,;t• a:''(.!-�"�1 � il;i ��,°;'1:: >i ;t?,�. ..,1'. 1, � i.i•t !..t1 ! „1'.. �: /../. �. _. i)'.. `i..✓'�I �`{ f', .l.!i:'.1^,r �S l i. �l't Si,,�1a /.tE USE OF PERMIT I J:}I,`,"-,i• 1,J1.'.hl'.'i'. ihi�`.'t1/t��.:.'11{=h1 i3Oi­­$:. %).b'9" 1S_ 114 6.'i5 ..�:;. '1 •`.{C, kfllli:?';I.i•J; �;,/. � ,;',.,,.;:. ,11;.; h.i ,�f':.'•k!„';t.�rt;'�':.•lt•:.f tn.!'i 'iii);•; p.; z"i:>f,(a.ifi . ;.1f 1:"I'Ar i. 1, .,'!'j��t: Ct'i. :F �(}�..i f;il l: •'I !!j•(,!171I _ytirj.�l1�j ,.:'i:,:I_i'. s�li.t'i'i�,:^1. i�{i:l?' i; i'?�,!; iiii-illi!•.. '!•{.i(i(� :i•.Li�i,'i 'I�� L) 57i i •i!.�n:> i'fii7:^?.�'.f�,i1.1 �T�l ;'j;li E i; i ri i �' � ' i'%3 ii h Y. fs.� �:; ct.14:i.1"!" .4;'.h:�}.';;�; :I;I t i i�: -`•".'6 ;1'S�i �: �Cf:).t, t::} CITY OF LA OUINFA FINANCE DEPT J RECEIPT DATE BY DATE FINALED INSPECTOR DAVE STEAVENS Inspection Services PROJECT ADDRESS �p0��1T oAcL ± SCC 3Q (,"r' 3y 10 PL A,) BLDG. PERMIT # ENGINEER,'�v.,,1 cJ PROJECT. # '� vovo / - D, CLIENT ?(,A wt ST Page ;- of DATE S A U l,, Ivo l ARCHITECT.6,0c,.¢4 -Acy-r4i i cc -, a ec CONTRACTOR LL MA IZ �AGr F c C - INSPECTION TYPE INSPECTION REPORT �o ��.��� 3,X49.(��S a 4C'r-�2t✓�. �#34 y PL-4Adl 1Q LL Lo L .� _� - SF; t -A iZ �l �A t c C ¢a �) S ►' Z A ? c ►J i, I i 1 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.NAME JNJ E GATE S L I ay0 . •INSPECTOR SIGNATUo� .. . .. •t' . .. .,. . T'4 ., ':'iia:: �. •.f'�:rn .... .F :'..wfa`iii:lt -v�'" ,,r,G��-a+"�rvsXl " •Mkh`-lint ,. h, _�; a: Page 1. of . DAVE STEAVENS • Inspection Services PROJECT; m,\�.J - l�t� sc R PROJECT # Q ADDRESS s t_t s-r�� CLIENT DATE O Av-l-, coo 1 BLDG. PERMIT # ENGINEER,,�� INSPECTION TYPE ARCHITECT G oL i�,4 A RO—P i—t Ecru2 CONTRACTOR I C -L m412 yam- A C I F I e INSPECTION REPORT L0c�.1 v> A�..�', - ��Z-{�M� �l c.. .�1. LoC►� t �J C� N �h >�.�rL� TrJ St��.p.? ��,�' , -Q,ni_U,_ nL k r iks�Q 2 W u_T % A -3 J S J S 5 L rZ tEUJS = i� � G t -f 7 0 eJL) �L0CAuJ1 coV►.pLEr1 9O- (.6-1 .Lq 9, 5' IRL1) # � �-� j,.o:., � ��7t��S -- S��A� �i A � �� ►�1 � - C' o n^ 1 � � t CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported: work, unless otherwise noted, t-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. Oi3S9 3`� Qi —, V INSPECTOR NAMZ�)iN J I: �- •DATE .3 69 14 � o?tJp / •; _ - ( m leery►. . INSPECTOR SIGNATURE-- � - " Page I of 'Z DAVE STEAVENS Inspection "Services. PROJECT7e,o, ,JEST - 1 oA- ,r , PROJECT # a c;ro (- O 3 .ADDRESS Z -(1 32 _ lei 3 . (924 21 1019-5 BLDG. PERMIT # ENGINEER ,) 'SA.)oE TNS INSPECTION TYPE E�vx CLIENTA �,��ST Irloh DATE ARCHITECT CONTRACTORIC-L M>At2 rAcOz I c_ INSPECTION REPORT ia-1 3`'1 0 AiLr ZtEE 3 IUfl� 3- ZwcS- kax 11 �Ea'n-1 I(�t2ot�S- 1'ltxyc -irk NAr� ilr+1. Ll I/ I Loc-kLG• i1 L; -?%N Ili p(AIZvrl- bi-A �NcaT4 1 61A• V o05- DZr'TH ,J 314 D1IQ, Rob5 - it. LEQ i � �a 641 ".o(A 'k.TrwR UJUZZ .%y - I LO C — �y«a. - 1 J.)Xx1206%S- l_C N-1 T�$rr p1 A LA "3 oZ RptaeEAST LIJ- Wju ,- �40t.t-'.-12..� zxtlz-� Ire D(A. Iib- 17-t t...C. N G.T rF �$ Z I h :1 Le3e KULES -' 11� DI 214 ( biA. w6- I"1`) LJCLX- W ,18 b114. DiA 1'R 3 - J-I.� LS • 1•-� o L� S - I 1 `� P•r H l el n � A 1Zo D S - 1 % 1i �+J i � , �R" b tfA Zzak L) �t-f i ( k) - I Loc - r PT► -4 1 01 r�r Ro bg - I -t" �� c. -r s' A.� Q LL PiZW 6 `nckTio nt F �PD-4-4 �?r>9v�1��� .�,Ll � ► � a►J r,� ��,zl �, A��t..tc+�-rc�\ �� � U��w�T��1 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. e locations of the work inspected only and does not constitute engineering opinion or project control. CERT. NO. n��g3 � `j d INSPECTOR NAME _: J J e Z-,A,J&AJ--% (Prim Clearly) QATE Ole , Q-00 I INSPECTORSIGNATUfi c 4 s-- Page Z of Z DAVE STEAVENS Inspection. Services PROJECT:�(,A � s't -dam► ksp, - 1 A ADDRESS fk S ;.- v ST -clN BLDG.. PERMIT # PROJECT # �J vc, t - 0 3 CLIENT �(,A DATE v')8 ARCHITECT COLZA AIXCN ti Ire-TuQE ENGINEERJNuy,J S��o,� Z.��_ CONTRACTOR -3% S:L 1nA,2 w�ActF�c INSPECTION TYPE INSPECTION REPORT C. 3 3 L-A 1 q L_1)vJ t..'1At_trg -- �t-Icf►.f� -A.�� ST�ZiP.r� I.1f���.�r..— �,�.� a (a\ 3 ANCtko(?— If )tx 'T't C�NT�►�E i TAtI.,,S 1 3 l4 IS - — 11 L OC1C A.,A ,i f_,A �A�l.lrJCa- �m t7C.E"l �oM�LETt . �0.-lo3rj x_43 gib` '��55 ofaK-r2�r. C��34 i7LAwl u- 14 j.-rTt cs - .SI4r,A(Z. - t,)a It_tat=. o��� gn-�G�, �►� 3 . ��9 . t S ©a�cTP_ a s J�.tJ`iAILS - (. 2, 3.11 15-� - ��aG►t Aa1 ���I a,,�At� ��c, - C�nr�Jc..ETE A t..L Ci {�TTt �g ��_TA t c_S Cp ♦ Il�yl R a D `'j H e ANR NAAI LIt3 Ce - Q'Dn-iLtTE 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. C25S t 4A-56 INSPECTOR NAME V � J J DATE A -U I; 2 00 / INSPECTOR SIGN, U