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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� �" A ,, 7i ,/ 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 �../ {KX1�Lt�fi1iAiO �Gg �'1 �EPI.&FN.L1 AEI-PPM1IJ.f'.KtlC 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