0204-127 (SOTB)77385 Loma Vista
0204-127
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).
A- -)-'I, as owner,.of he._property,-,am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). \O I am exempt undec1Section B&P.C. for this -reason
Date - •— . = +'' Signature•'bf Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty, of_peijury 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
(K) 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 Applicatiols„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,jand 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 PERMIT#
*02*44-17
DATE f) �y VALUATION d.� m �.Fi�'lJJ LOT - TRACT
A .GN7�
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ADDRESS 1I-,305�wOMAVIYFA JOB SI:t
APN -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
:ItJx31,11.1 : TS01.M(1M
OVINEUiiR(Ti EYhR
7'73 8:5 LO1\t;:EL V13
I.A.QIII': TA CIN 922.53
�'J�ii��g�6•S��>� 1,��
USE OF PERMIT
M4 MZALBLrl1.DW0
RVAQUYL LIX.14T11NIG CIAZY00 S7'RUC'1 UR14 )c3 M,0V X PORTIDN OF
G/.Ipi�i3t'i'(ER D 11`SS'�'�'+bA,i.:�sl1'r;�MOR D-860 ��URO ���,13.�iRANCH
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{KX1�Lt�fi1iAiO �Gg
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VAALIJA`i' ON 1,5oo.001Z
PERAW, TFT Nii14MtR.1 y
PLAN CHECK FEE 701-000.4 19-318 +S31.76
CONSTRUCTION FEE 101-.000.418- 00"3.5.00
i
f'ViA Y 2
CITY OF lA QUINTA
FINANCEDEPT- c
Lusts Prdle1'm) l Y's
r,,_$0.00
TOTAL 1"ERAUT 1111,7S 7YUR HOW
RECEIPT
DATE_ !
�)
BY L
DA , FINALED
2 CiZ
INSPEC
��
5 AF,,------
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck - p
Exhaust Fans
O.K. to Wrap (y-07vt 1.--, B
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
Drywall -Int. Lath� i
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
A pliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM : L I SSBERGER ENT.
FAX 0. 7605641525 Apr. 16 2002 03:23PM P1
meat
January 9. 2002
John & Michelle Lissberger
77-385 Lome Vista
" La Quirtda, CA. 92253
Fax # 561525
1E : Lot #31 & 32
Dtar Mr. & MrS. Lissberger,
On behalf of the Arebkectural Committee and the Board of Directors for Mountain
Estates this Ietter is to WOvide you with the approval. to your archAectural vazi�ce
request.
The approvals S=ted for the following 1) Aa exterior Replace at the Cmebo and
2) A,powdea/morn* room of the existing kitchen per the submitted pia s dated
12/26101,
Thank you in advice for your patience and cooperation during the r+evim process.
Sincerely, v
Carol Caiboun, Property Manages
For the Bom d of Dhmctors and the
Ardutechmd Review Counnittee
Enclave Mountain EMCs H.O.p—
Professional Community Management I?esert Resprt Management
PM0fkIeBcx4772 PWml0SW,CA92261-4772
73450A1e M&O, Suite 5 -Palau DeWO, Calitbrn a- (760) 346-1261 'FAX(760)346-991S