0112-175 (PAT)LICENSED CONTRACTOR DECLARATION
I her; by 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
584857 162(
Date ' 1 a Signature of Contractor
OWNER -BUILDER DECLARATION
1 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 LWION LNS (>r'�, Policy No. 1' `+.tfi17797
(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 proVisior
eis., `s .
s r y,�r :w...-.....
Date:''. Applicant—
Warning:
pplicant 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.
,n
IMPORTANT Application is hereby made to the Director of Building and Safety
for. a pormit cubjoct to tha cnnditinn5 and re?strlotion.5 het forth on HW
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) may° ' Y ` •' Date • it
BUILDING PERMIT PERMIT#' '
DATE VALUATION, LOT TRACT
JOB SITE
ADDRESS��`.
APN
OWNER
CONTRACT OESSIGNER/EN (NEER
VM HariI 41fa
BOB I WAPS 'C'01d'8''3.RUC:110.1
A.1 -507 R tW10R.Ak
7A-920 MR -4b 'r'4.DRIVE '
LA. Qit:I1+r1:A CA 92253
IA41I:�°t:til'�'A CA. 92253
C160)T15-7933 3212
USE OF PERMIT'
PATio
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SUB- a'M.Al. c".alb MU 7110 i• AW) Pi4W GHEXX
$1:,1418
IAMB 1-N.F-PAID DIM
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Cl®FER9TA
RECEIPT;
DATE V €
BY
INA
17
11
L.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings J/
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap _
Framing✓tb _
Insulation
F.A.U.
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
_
Final _
BLOCKWALL APPROVAL
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Bin City Of La Quinta
Building a Safety Division
Permit # j — P.O. Box 1504, 78-495 Calle Tampico
l la Quinta, CA 92253 - (760) 777-7012
Al vi - SPA'. Building Permit Application and Tracking Sheet
Project Address:i4 IZ(UlCm € {,(I-ner's Name: X
A. P. Number:
fAddrcss: X (V&oe
Q
Legal Description: JOr6 2�6�7j"2.
Contractor: K �� �j
Cin. ST. Zip: >< QfJ C &'
Telephone:
Address:
Project Description: X
City. ST. Zip: yr-y-7T7O
I
Telephone: X 7 749 p r 7�
State Lic. # : X,
Laic.
-�Ciizty
*AFeh-:-E*gt.. Designer: 3Er::V
Address: (—CO ZS
I I .ZS 2X 3. 14 39-T7
City. ST. Zip:FA-cm
Telephone:
Construction Type: cu Pancy:
State Lic. #:
Project type (circle one): Ne Add'n Alter Repair Demo
Name of Contact Person: x
q. Ft.: a/ Stories:
# Units:
Telephone # of Contact Person: -77!>'— 7t-2Estimated
Value of Proiect: X
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
3
Plan Sets
Plan Check submitted
It !m
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person &ZJ 1.6A
P.an Check Balance •
Title 24 C21c5.
Plans picked up I�A-th f�gN►�At„
Construction •
Flood plain plan
Plans resubmitted
N-echanical
Grading plan
21" Review. ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
C rading
IN HOUSE:
3' Review. ready for corrections/issue
Ceveloper Impact Fee
Planning Approval
Called Contact Person
p.I.P P
Pub. Wks. Appr
Date of permit issue
School Fees
09 :s5v,5r
A9 0/
r
Total Permit Fees
�¢ 1/29/02 15:12 C7bu //o -5t i i 1r►C Mmn.aK —r -
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
November 26, 2001
Mr. Charles Smith
790 Spring Canyon Place
Newbury Park, CA 91320
Reference: 80-512.Riviera, La Quints, CA
Architectural Request - Lattice Patio Cover
Dear Mr. Smith:
The Architectural Committee reviewed your plans at its November 13, 2001 meeting and unanimously
approved your application.
Review by the Committee is only for general conformance with the architectural guidelines. 'It is the
responsibility of the owner to fully understand and conform to the architectural guidelines criteria whether
or not all deficiencies are noted during review. It is also the owner's full responsibility to field verify all
existing conditions. The Committee's decision with regard to project design will be final. Please refer to
the Architectural Rules for all required submittals.
r Approvals given by the Architectural Committee are good for only six months from the date on the
i approval letter. After that time a new application must be submitted.
Please contact Javier Contreras, supervisor for Valley Gardening Service at 760/399-1844 and Ca of Fuller,
the Associiiion-Manager, prior to any irrigation modifications associated with this change. Damage to the
•- landscaping, i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The landscaping
must be brought back to its original condition when the project is completed.
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller, Association
Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST ii RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File