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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 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
-59S-11
3 0 B .. ,.� Ufa 3012(
at - s 4 d,Q 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:
(r)^ 1 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:
Cartier Policy No.
9TATF FUND
(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
Coje;'I shall forthw�,�ith comply with those pJovi jpns.
`gate: L�61,91
a—Applicants
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
,taabve-mentioned property forinspection purposes.
�q 1
signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT •J'IlIJw7.fi TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
DARRYL BIUMTETMA
RXX A7WMME,, 8401.
5`%v .ggdRAMIRy
.39.i459 Wg3.)OY. T.N. .10 ,
L,%t;i031+3TA CA, 92253
1140MANDPIs US CA 92276
(`'160)343.1211 C:13TW 4600
USE OF PERMIT
.5r�1,JAA
F1
1kt'T1C1f1 PX.fl0 COVER lChImp ...• .
1 UJ
2001
:PORC3'Ifl ATIO CrT" 0!'!
1. 001TA
Ir 01 MUMON
=WKNI'M COS CON
PLAN CHECK ME 1014100439-:318 S;M .A.0
C,MMTt•~T104 MEE5sCF1-c"i+ 1�3-i4I84A X; p.4.60
MONO MOT:01101 FRI, MID 101-000.241.000
4AUD-°.f i.d L NYU:kM`rt TJOYMW,AM) PJ AN (53 ..
$89.60
: ES0 F '94"AID PI9,139
$0,00
TOIAL MM IT TME. 9 RUH HOW
A)
RECEIPT
DATEBY
�
DAT I ALED
INSPECTOR
G o
3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs/
Underground Ducts
Forms & Footings
(P�a
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
Framing
_ _ _
`p���Q� �,�L
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall'
Exterior Lath
Drywall - Int. Lath
_
Final �®
BLOCKWALL APPROVAf_S
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
FROM : Darryl Branstetter
PON
PHONE NO. : 7607771885
FAIRW'A'YS ASSOCIATION
Apr. 27 2001 01:46PM P1
'�P)'-. 27 212-101 Z2 2Fq,j F1
April 27, 2001,
Darryl and Janet Branstetter
55-802 Brae Burn
La Quinta, CA 92253
Re: Architectural Change application
Dear Mr. and Mrs. Branstetter:
The ArchltecturaVL.andxape Committee of -the PGA WEST Fairways Association
.. reviewed the pians for Trellis at your Hering$ home at 55-802 Brae Burn. The
Committee is please to announce that it has approved your plans as submitted.
IF you have any questons, please give me a.caif at (760) 776-510D ext. 24..,
f, ,
Sincerely,
FOR THE ARCHUECTURAL/f.ANDSCAPE 50MMTTTEE
PGA WEST Fairways Association
� t
Grace Davis
Assistant Association Manager
1971! � l"A1.M DES1VRr, CAL1•�'t7'RN1A922sa ..Tv�. l'1G01 ?�6-81u0 , •aa.,. <�e��•, �-,a_s���
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