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0104-239 (BLDG)I herF' *affirm under penalty of perjury that I am licensed under provisions of Chaj. (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License N Lic. Class Exp. Date i J 2 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 Policy No. CAT, (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 BUILDING PERMIT DATE VALUATION LOT (vi 04 TRACT d' v JOB SITE APN ADDRESS OAX 99_ 80 _6 q3 OWNER CONTRACTOR / DESIGNER / EN (NEER f".:;'1 +:rti;::..' i>l:; ltla '.id'!'i °.E• r, :i�:?i�?t`.'}':(:)P 4;%tet..• to^.til? l'' ;,i °;k'u..' [ �J< d.i';t�.:,L L't:?i•7'I`lir'•S :"i'o;i , :` +..lt.:l:%.t•(•.n. "`•i'. �'t :. .l;:d l;iV�, f''!'•.I ,SY !Tar, �; USE OF PERMIT t,,�_;,1. ,�.l:l:st•y: fi;�t+t,i°.!.'i'I:;?.f i':'+;5�'ti' 1,.! \I`i.!'.! ;)l ii; •r�.,.! r,iti :i �'. l�1 i.i'.l; i.:;:; PL aL'•,: ;. �;J.r.. :{, S.'b'r`7 ,4 �i'i.:1_'; i:;A K ';';?w{;{: tt17Ji.)'l;itii rt't.li..lyli;Ai,tA.t'i'•'YI(_!s;'P 111.i'11 S:iA!`},'ji t,.•`CPS,I t.:,u. ("i„tf+i :Ii 'f';1X 7.f•4,Gt4)1,.+,t4ifY �•.` 'iii: `i!,1,;;"1`lt>+t iii°: 1i1 tt,}!i �ti}!..tiq!!,! Yrtiii'lI! :i'¢ _s:j.t{'; :?C,;`1,:)P•i rK... ..:f`.:9i 1 lt.i! al•"'!,.24 i i'i:i1 us.Rif . �'i 't�, , . .�I•� i_ . �:fti,�' '.j. !', . .1 �s..i.4.'r i'!.•._ .t1 C". .:.1:: ..0,,.•1... ' n.l 1...�,.f A rr? < < 1 ?i'i! '� Z,';f I t!; 7; 6 �i+`1.�',) CITY OF LA CUM iA FMArdCE DEF1 _V RECEIPT DATE BY DATE FINALED INSPECTOR DAVE Sr. X _JLJ r'vAVENS Page ;2- of Z. Inspection Services PROJECT�;k L..Nc; in •W4.,sp, - I A PROJECT # gl, 0 3 14 ADDRESS CLIENT JN BLDG. PERMIT # ENGINEER Jam, ot3 INSPECTION TYPE DATE ,,)e Av-(-, ago I ARCHITECT 60,.ZA 'A11C*4 CONTRACTOR�Lty\Ak *)AC_-%F,c_- . INSPECTION REPORT' LDS A*31� 1P., L%AL i oe- - Vic, �,ko it- L)1,7, (_W-TCNAei_ TAILS I k 4 11; T� 1,_ 0 Cie 4.00 V)Kxk_w(a- Q,0MDet Te Atib t %_.kto --13 xg . c S ©AVC-'er.E 3S IZI-AQ 7 A IRLos-W AQrn -fzHe4NA__ t,3 A I Lt V3 C_ (2-0 ev., Z) L C -r -e 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. 1�92- INSPECTOR (OQ5 NAME k/ Iz !�i7ltAveJ5 TU I DATE 2(30/ INSPECTOR SIGN, TU ALA_ 14 camVC-CrE --13 xg . c S ©AVC-'er.E 3S IZI-AQ 7 A IRLos-W AQrn -fzHe4NA__ t,3 A I Lt V3 C_ (2-0 ev., Z) L C -r -e 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. 1�92- INSPECTOR (OQ5 NAME k/ Iz !�i7ltAveJ5 TU I DATE 2(30/ INSPECTOR SIGN, TU Page of DAVE STEAVENS Inspection Services PROJECT;;)G P u,)EF.-T —_1 MKSE t fl, PROJECT # ;2 cm 1 0 ..ADDRESS. ks - t -1 sTt b BLDG. PERMIT# INSPECTION TYPE CLIENT'�aAr DATE o74 ARCHITECT CONTRACTORZ)IEL. mA P - INSPECTION REPORT 7 3, t_-7 9, 6 8 S 24-06 3S ta ik_'Id 410 c,� *�L 5 reol q rn) w rA ae _VA'J S c -LA 1-1 14 LC Sic) Ar -J -L Atic-H-iL CERTIFICATION OF COMPLIANCE: To the best of ou'r*knowle*dgp,'all.of the reported work, unless otherwise noted, ---�ubstantially complies with approved plains, 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. Oes-q'? q8 - 50: INSPECTOR, NAME ((prim clearfy) DATE .2-06J INiPE'66R �IGW DAVE STEAVENS Page ( of 2 - Inspection Inspection Services PROJECT ­t G A� )CsT - H os E I N PROJECT # ADDRESS go -(,&1 . (p? 3 (,19 1. S J 10 G4k,/TzEC • B 3'5 t.7 i�nJ - BLDG. PERMIT # ENGINEERJu�tJ SAJoic I zc INSPECTION TYPE. jS:2o V CLIENT "o A DATE ;)- 3 -A ARCHITECT GoLCA Ae-c.,4 ; c ccu QE CONTRACTOR r= r c INSPECTION REPORT or)%—/, t f�LA ►J IRE b' a7 L11 c- o�Es lz 1�i� c*t 1 ��da OSS- 11 L eg, CQ4 �9 rA . JZZAit lx r_5T Lt d dLoLS- E' 12- 4)Z?10 („ 6ft Robs . 1-7"LEO(.TH 80 -(,73 oAiKTzEE. L 1 -IK) oZ �`l3k.IJ a- e2Lyc�- 5EP1 H I oif. RoDS- (7LEQL-7k4 �S )-A. C2��►�2 �►J"rZ�2•1Locs- bef,-rN1•-t,•-1 /� 0 SD - VI R o4As:-rp-e Z7 0- bCP*rq (� &IA. F�onS-11 Ley�,,.� ,t8„zcA ��,42 C>r � 2- r;vc5 - 6-�o�ts • i 2 1 r' �i'►-� I ca �oc� S - 1 7•c.C,rr4 /g vG-.,DtA So' Lid+,\ D Z” Ihc�S'� l.�S.- �-ioLrg-� �c?T••� ( ��� EZciI�S- L1 4$ 13 (Z � T c. c,i- L`c cS - 4oLe- S -w C>'?N II?JDS - l7" 4.E�iG'rNT/Ax A,.A YfdOy� L,OCATIox)g £}fox`/ '51AIP-noo e7-F-,2Eyt? 7-03 HOLE. of >r_8iZt CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reportedwork, unless otherwise noted, .--,substantially complies with approved plans, specifications and applicable sections of the building codes. This report covers ,--,ihe locations of the work inspected only and does not constitute engineering opinion or project control. CERT N.O. 10 INSPECTOR NAME, A�% E 5���i tJE JS (PW 0—M) DATE 3 A u C, , -Lo O f INSPECTOR SIGNATc� ... :.., .. ..._. ..� .... ,, .. .-�..,.. ., .., °. - _...,-r:eci:. .r:c: �•,t:�: ...">>T..n 1Y"'w��K' ::.sn�,,; w ... _:.a.�. ._ Page a- of 2— DAVE STEAVENS Inspection Services PROJECT;{C,# WEsi-;NASE tr1 ADDRESS 90-L1,7. (Q-73, (-7q, G85 F�AuT12E� Q'-�` 3 r /2Pc Aj BLDG. PERMIT # ENGINEEIZ,(. ,,,.1 SAJO r E 1y L INSPECTION TYPE PROJECT # a coo / - o 3 CLIENT ?GA DATE cZ 3 ARCHITECT G oL aA A e 6..H r -, rc c,1r4_a C CONTRACTOR [J EL ,* k Q & c/ e -i L INSPECTION REPORT :,.. AL-L_/�TT� cS � !'�� � �►�(_ �Lo� KIkiG A - 3 'LST y S 4-705 A. 11 '0om ALeT� i�rt•iZ .0 TA/.C--5 /4o6 k 3S s - r i CERTIFICATION OF COMPLIANCE: To the best of our knowledge, all of the reported work, unless otherwise noted, -.substantially complies with approved plans, specifications and ai pplicable 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. 0 O INSP'ECTORNA E I �A" j r4 Jr -US :. Punt Clearly) _ . DATE INSPECTOR SIGNATuno-