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LICENSED CONTRACTOR DECLARATION
I h reby affirm under penalty of perjury that I am licensed under provisions of
6na{iter 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
344248 C-61 4606'97
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.
53'/11; .f^UNI) (fti3l7r#S
(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 Drooertv for inspection Durooses.
Signature (Owner/Agent)
Date 4
PERMIT # CONTROL #
BUILDING PERMIT
97(W1103 5030
DATE
4122/97 VALUATION 5 7,K4) LOT. TRACT
JOB SITE
ADDRESS 78 a8ali A1310HA WNV
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
i10N PI`1u C)HILIi'
TONYM. YIS.ARRA. CONST CO. .
78-855 AUKt7Jk 6'V.A,Y
:1.1'l ilst: L"COhe t)KI E~
LA 01.11.C,A CA. 92253
CO SMA MRSA CA 9262.ri
MY 4240
USE OF PERMIT
W11 N11I.A.T E 0 CONT 011' CONST 81.UICT ION
H. AN r'F 11CK, fq�,X 101•-000-439.318 �7ti, ►i►
f'r?N<}`I'f%flfr'1'Ft.)Td4.17P. f()f-(i''()f)4111st-M)
ITC.1 IG qac: 01.1N, JIM, - R11811.)�i -241
R11811.) _ 101--010
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ISOIVIVYVAI, CON5%`.1t►_1(;i'jCa�1 �N0PLAN('H C
X17909
1997. LESS
$0.00
APR. 2
r"LK
RECEIPT
DATE
BY
DA FINA D
INSPECTOR
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
Final
Final
BLOCKWALL APPROVAL
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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:
APR -21-S7 10:36 GM WATSON COMPANY INC 619 3457370 P.01
STALLIGUT 1ED"UNIES
1HUA EOWNIEUS ASSOCIATION
ct- ColBren Properties
P.C.>Box 1033
La Quinta, CA 93253
Ph: 619-345-3440
Fax: 619-345-7370
April 18, 1997
Monte Dillie
78-855 Aurora Way
La Quinta
CA 92253
Re: Architectural Gonan1ittee
Proposal for Rear Courtyard Pergola
78-8$5 Aurora Way, La Quinta.
Dear Mr. Dillie;
On April 17, 1997 the Architectural Committee of the Starlight Dunes Homeowners Association
met at the rr,onthiy tnuetintg to review
mentioned property, your proposal to install a pergolain the rear of the above
Based upon the plans, specifications and dimensions of the pergola which was presented to the
Architectural Committee, we wish to infarrn you that your proposal has been approved by this
Conunittee as of April 17, 1937,
Cordially,
Mr. Ham Watson, Chairman
Starlight Dunes Architeciural Committee
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284-263 REV 4/90
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