PAT (0306-364),• LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
(V W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Classes^-, Exp. Date
Lu
oZ r- Date 9T 1 1--, Signature of Contractor r` r
�0rl-
J U OWN ER -BU I LDERTECLARATION
W W I hereby affirm under penalty of perjury that°i•am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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).
C'') () I am exempt under Section , B&P.C. for this reason
In
N Date Signature of Owner
ON
d Q WORKER'S COMPENSATION DECLARATION
D � 1 hereby affirm under penalty of perjury one of the following declarations:
O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W �: compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
M Q U (i1) I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
tl rn permit is issued. My workers' compensation insurance carrier & policy no. are:
oD Z Carrier ,
�,. Policy No. 2 a.!riR4-G(1a
�d
J (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 Califorpia, and agree that if I should become
3 subject to the workers' competisation prow isions of Sp6 on 3700 of the Labor
Code, I shall forthwith comply with those provisions. %
Date: / 1 Applicant A Z t �� ^•`'f
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to cri6nal 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_Fall-City, and State laws relating to the building
construction, and hereby authorize representatives �of...this City to enter upon
the above-mentioned property forinspeotion purposes.
Signature (Owner/Agent) i �"`f Date ( A)
BUILDING PERMIT PERMIT'#
r
DATE f1iV..t,?,1lUC VALUATION S3 191020 LOT TRACT
JOB SITE
ADDRESSr
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
JEHE3A 'r.".Fi
F Lt ," e.` it CoNsn.wcrm
-R .0 Xti"�3 W' VVAY
.W' RQAE*
74693 ,34,YFF-:i V;T.P.�E1�I47
y78
l...i1. (�tJ 1 iXI- 2 CA 97-15 1
U,
ai TJ0,0,M �aAf.9<,276
�)«yC
1130}B1i•►'s@t: ce"110
3106
USE OF PERMIT
1W S. F. ALLI.MA W%10D PATI0 CC]V &R, PESO .APPt OV9,0 P
P01tC 1f/P.oNTT0 29J.09 11
Y511 WA7" C'•C3.+;T 0Y CC3W?:t'i2UC1110.Iti
:3J4i3.�Q
PERMIT FEE 9XIM 14A1W
PLAN C'.HEC Y., MIK 101.OW-439.318 V 1, , P
C(1N; fRtIMIJR F;T dr 101-000-4 i 0-040 $63 (9i
STRO'NO MOTION P sE - R011n 1031 1.00 SX,
- 'Y ' 0ON:ilku T3'.:�ld'ru 1) mw r`u:�..n'
S1 04,0
o o LEOS PRE, -PAG IST15
SO.CK,
JUN 2 3 2003 WA.L 1 Q?3 UT. N3". MY , O W
CITY OF LA QUINTA
FINANCE DEPT.
$104As
RECEIPT
DATE
BY
D E F}NJr_
SPEC
+
✓
AK
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
Exhaust Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
i
Final
Final
BLOCKWALL APPROVALS
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
STARLICHT DUNES
HOM£OWNERS ASSOCIATION
PRQPC,RTy AddRESs: Zpff
ModificATioN MUC-SyEd:,• I —
(RERAINYINCt of I-loUSE dots Noy aeooiRf. dRAWINCIS SubMITtEd OR PERMITS)
To: ARCHITECTURAL / LANDSCAPE REVIEW COMMITTEE
You nae 110Reby Advixd TWAT Tk Above: wok is pteopmd ADId APPWVAI is REpukmd. ATtACi1Ed AAE dmvAr qs
TO scAlE (Mimmum 1 /8" a V) Of TkE wQRk t0 61 doNE And Tyl%m Of MwemAIS TO bE Uwd ARE iNdicATtd ON *6
drAwinGs. We uNda waNd r6 -r BUlldiNc, PeRmiis to& soME modifIcAywP6 ARE REpuiftd by -Fk OTy of LA
QuiwTA ANd "T Tl1f cows of iW j>muTS ANd Tlia RespoN61I)AITV Of Ob1A1NINCi PFRMiTS ANd SUBSEQUENT
im4peetioN will br bowm by Tk Applicow,
WC Acluvowladcia rkAT All Appaovad ckkNNgs im Tk OMcONAI desi4N will bE AT Ourt ocp&6c:; Tka Awy c6mAQi w
oR matocAT1U4 of tx&Ng spRlNklea rMemS, UNdoptoUNd WditiES, buildiNq sTRtjCtuW Arad @6 10OR W44ZAPiNQ
TC oyI ER dAMAgf To AsyocimioN ppopcM ResultiNq fmm Yk comsTRUCTim ANd/oR iNOAlIATION . T6EM
pERMitTEd tMpRoltfA4ENT; s1+All bE AT QU9 (��P r�
WE ACkNaA+tfidgE A sECURl1y DEpasiT 96 96 —NoNE Of THE TOTAL �9E 4c.? IS
Rfoulmfd TO COV0 ANy dAMA(;i T4 Tk commaN AREA OR CLEAN -Up NEC6SSARy 104 TITS CoMp(ErioN of rl�c ppo]ecT.
09POSiT AMOVW will be drYEwind by 1-kF AI.0 iN aclxrlON TO Tkc EXTENT Of Tkg'Jlclple. ncr deposit Must be
submircel pWOR TO COMMMIMENT Of woRk. Alma iw4*cYION Of TILE COMpleTEd PaOjECT by 1'I4k ALC, Yi1E
dEpow Vvi(l 6- AefUNdtd If All coMponei~Ts aRE n=roaed To oRirjNAl oR bc,, CONdiTiON.
"NOTE. coNpRv0oWiim9AL1ATi0N Of a9gu+szed ANd AppRJved ModificATioas mLm bEgiN witkk 45 dAys of
R(CfipT Of WRITTEN APpROVAI ANd wd Modiftcviom MUSE bL compirrEd w4iv 90 &)n of wwneN AppROVAI.
PRIOR TO COMMEN MENT Of p*000 Ed ModlfiCAT1414, pIEASE wbMiT WM4 11114 AppIICATiON CONtRAC1CRS INSURANCE,
EloNd ANd Copy of llam&E if Oyk(t Tkwv HoMEOWnER iNSTAIIAriom. FAiIURe TO COMply W ti MESE 04 ANy Of Tkf
AbOVE SPFCifiCATIONS Will RESWIT IN THE NUtlifiCATION of TIriS documov And wb%toutmT AppmNaA ilILramf.
OWNER SIGNATU'
MmtiNy Adt:!RESS• .�
KONF P
Seal To: EVFNwC,S U. T D
Paa"AIIrAd PROflERry MMMT,
68910 Addlim RoAd
Cot EdRal OTY. CA. 92234.
Arm: ALC CommIrree
••rwq•r�rv►�••.G•vM.rewe•r�e►..e s.vs•r+••ieb►••.. ••. e. ry i�wr•e•f�lr eq.�e�r.ea.r.r rq►•tb•►ef•w
Twt Abm RFoutst•los berm Rtvimd by k ALC And k4hs bm: (:�ppaovtd ( ) demiEd ( ) prNdlNo
DATE Rsvimd: A_
APPROVEd By:
(MU51 lave two (2)
ZO 39Vd OlI-lOddI LZZ8LbE0.9L TS:60 E00Z/60/90