12-1451 (PAT)P.O. BOX 1504 VOICE (760) 777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 BUILDING & SAFETY DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
, Date: 12/19/12
Application Number: (1210 00 014 51 Owner:
Property Address: 79275 HORIZON PALMS CIR CATHERINE BELLINGHAUSEN
APN: 604-100-059-137 -19903 - 79275 HORIZON PALMS CIRCLE
Application description: PATIO COVER - RESIDENTIAL LA QUINTA, CA 92253
Property Zoning: LOW DENSITY RESIDENTIAL �
Application valuation: 3165 D
Contractor:
=or�_EngjneeApplicant: ArchiATLAS AWNING & SCREEN, INC.
754 S. WILLIAMS ROAD
CITY OF LA QUINTA PALM SPRINGS, CA 92264
1nr'NANCEOr-PT• (760) 327-8466
4'`Il22-�^ Lic. No.: 835140
-------------------------------------------------------------------------------------------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am lice ed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Busin d Prof ssionals Code, and my License is in full force and effect.
License Class: D03 `� License No.: 835140
ate:ontractor:
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031 .5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by
any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).:
l _ 1 1, 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
improvements are not intended or offered for sale. If, however, the building or improvement is sold within
one year of completion, the owner -builder will have the burden of proving that he or she did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractorls) licensed
pursuant to the Contractors' State License Law.).
(_ 1 I am exempt under Sec. , BAP.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address: 11 fK-
LQPERMIT
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.
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 and policy number are:
Carrier EVEREST NATL Policy Number 7600004167121
I certify that, in the performance of the work for which this permit is issued, 1 shall not employ any
person in any manner so as to become subject to the workers' compensation laws of California,
and agree that, if 1 show b om su ct to the workers' compensation provisions of Section
3700 of the Labor Co , I alli rtl it comply with those provisions.
ate: --� plicant:
I -F
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this application.
1 . Each person upon whose behalf this application is made, each peison at whose request and for
whose benefit work is performed under or pursuant to any permit issued as a result of this application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 anAcounty ordinances and state laws relating to bu' i s'ruction- and hereby authorize representatives
oft county to enter upo the above-mentioned o nspection purposes.
ate: gnature (Applicant or Agent):
LQPERMIT
Application Number . . . . . 12-00001451
Permit . . . PATIO COVER PERMIT
Additional desc .
Permit Fee . . . . 63.00 Plan Check Fee
40.95
Issue Date . . . . Valuation . . .
. 3165
Expiration Date 6/17/13
Qty Unit Charge Per
Extension
BASE FEE
45.00
2.00. 9.0000 THOU BLDG 2,001-25,000
18.00
----------------------------------------------------------------------------
Special Notes and Comments
REPLACE WOODEN SHADE COVER WITH.237.5
S.F. ALUMAWOOD LATTICE SHADE STRUCTURE,
ATTACH TO EAVE OF CONDO, POSTS MOUNTED
TO CONCRETE SLAB. 2010 CODES. AJ
-----------------------•------------------------------------"-----------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
STRONG MOTION (SMI) - RES
.50
Fee summary Charged Paid Credited
--------------------=-------------------
Due
------=----------
Permit Fee Total 63.00 1.00 .00
63.00
Plan Check Total 40.95 .00 .00
40.95
Other Fee Total 1.'50 .00 .00
1.50
Grand Total 105.45 .00 .00.
105.45
LQPERMIT
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LA QUINTA PALMS HOMEOWNERS ASSOCIATION NOV 13 2012
EXHIBIT "1" B'
ARCHITECTURAL IMPROVEMENT APPLICATION AND AGREEMENT
G -k--h P -T k V�
LU 1106 1 /A41' 1� /U Date: //l.S112_
Street Address: '/ �f � i`S' W e P- I'7 "� .,l � 11, , 1 A n,. _
Local Phone: % ( / Other Phone �
Requested Improvement U 42' a r P t, ZDJ -et., 10aJ r D Co n r-
-'
Approval is requested for the above improvement according to the plans attached. We have attached two
(2) sets of plans outlining the work to be done, along with a complete description of the materials and
colors to be used. If we are using a contractor(s), we enclosed copies of the Contractor's License. -
Attachments:
1. Two copies of the Architectural Improvement Application.
2. Two sets of plans with materials and colors to be used.
Note: One set is for the management office; the other set to be returned to you as
°Approved°.
3. Contractor's name and copy of contractor's license. (Not required if the improvement is under
$300.00 or if "Owner -Builder').
4. Brochures (2) and/or color samples of manufactured products to be used.
We have read the Architectural Committee Rules and Guidelines and havefurnished copies to all
contractors to be engaged by us and we agree tj comply withthose Rules and Guidelines. We also
understand that It Is our responsibility to insure that our Contractor(s) comply with said Rules. We
acknowledge that Building Permits for home improvements may be required by the City of La Quinta. The
cost of permits, responsibility for obtaining them, and the subsequent inspections will be our
responsibility. In all cases we recognize the requirement to be in compliance with applicable building
odes including, but not limited to, those adopted.subsequent to the original completion and acceptance
of our dwelling. - T1116- ssoaaBon has no responsibility whatever in achieving compliance with newer building codes which
apply as a result of Homeowner prompted modifications. Further, we understand that approval will not be
granted for any modification which directly or indirectly conflicts with the Declarations of Covenants,
Conditions and Restrictions. We also understand that we are responsible for the accurate determination
of property lines and setbacks (as applicable).
Page Two
We also understand that w e will be responsible for all costs of this improvement and for costs associated
with any repair to common area occurring as a result of implementing this improvement. Examples
include, but are not limited to, sprinkler and irrigation systems, buildings, roofs, exterior walls, lawns,
plants and drainage. Further we recognize that any modifications to the common area irrigation and
landscaping scheme, are subject to formal acceptance by the Association. Any required remedy to
achieve the required maintenance standard or irrigation standard are our responsibility. Additionally, we
understand that the job site must be left reasonably clean at the end of each day, that no debris nor dirt
may be dumped in common area or left at job site. Any maintenance or replacement of permitted
improvements, except for certain landscaping, which are beyond "initial" improvements, shall be the
homeowners responsibility.
We agree to indemnify for ourselves, as well as for our successors and assigns, and covenant and agree
to hold Association harmless from all claims, demands or liability arising but of or encountered in
connection with this Agreement, whether such claims, demands or liability are caused by owners, owners
_ agents or employees, or contractors or subcontractors employed on the project, their agents or
employees, or caused by any products installed on the project by said contractor(s) or subcontractor(s).
Such indemnification shall extend to claims, demands or liability for personal injuries and/or property
damage occurring during installation, as well as after completion, including, but not limited to, all owners
maintenance responsibilities provided herein:
We further indemnify and hold the Association harmless from all liability related to any damage to existing
improvements (wherever located within the Subdivision) resulting from the installation/construction of the
Architectural Improvement.
If required by the Architectural Review Committee, we agree to record, and pay for the recording, of this
improvement at the County Recorders office.
We further acknowledge that the Architectural Committee may require a deposit be submitted before work
is begun.
We further agree that this improvement will be completed in a reasonable and diligent manner. We further
agree that 1) if we do not correct any damage caused as a result of this improvement or, 2) if we fail to
complete this improvement within the allowed time frame, the Homeowners Association may elect to
complete the work and/or repairs, and we will be responsible for the actual costs of such work. Payment
to the Association is authorized by us in the form of an assessment or monthly penalty payments as
approved in the Guidelines.
By signing this Agreement below, we agree to be bound by its terms and conditions and any conditions
set forth by the Architectural Committee in the Architectural Committee Certificate, which is attached
hereto.as.Exhibit "A" and made a part hereof by.this reference.
Signatur of all Owners:
( ature) (Signature)
Bin #
City of La Qui l to
Building &r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (619) 777-7012
Building Permit Application and Tracking Sheet
Pennit #G
Project Address: 7 75- /)0KM6A)
Owner's Name:
e—,,
A. P. Number: 1(20
Address: 7qd,-7r1-k1yzoq arm5. dzg�3
Legal Description: L -d+ 137 m8 1831bVik 11q,03
Contractor:
Address:*7 &AVI— I�A—
City, ST, Zip:
Telephone: (
Project Description:
City, ST, Zip: q- Ct�6
Tel
— (IW—)Cid
State Lic. 4 : .
City Lic. #:
Arch., Engr., Designer: e4 /t-- P.F-
ot 0 PJ rA-� rin n6-skc, &7A3Y&L,
Address: 3441 (WIL(Al PIA
-u -
City, ST, Zip:
M ii: .......
Telephone: 4314 7130 -
Stat eL i c. #:
Construction Type: Occupancy:
Project type (circle one ) Add'n Alter Repair Demo
Name of Contact Person:
Sq. Ft.:c,?J 7 5-1
# Stories: /—
L#��Uits--
Telephone # of Contact Person:
Estimated Value of Project-__
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec'd
TRACKING
PERNIrr FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calts.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Grant Deed
Plans resubmitted
Mechanical
School Fees
2°" Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Planning Approval
Plans picked up
S.M.I.
Pub. Wks. Appr
Plans resubmitted
Grading
H.O.A. Approval
" Review, ready for corrections/issue
Developer Impact Fee
Called Contact Person
A.I.P.P.
Date of permit issue
Total Permit Fees