0001-098 (PAT)LICENSED CONTRACTOR DECLARATION
!`0 I h�q,eby affirm under penalty of perjury that I am licensed under provisions of
N Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
O 5 ch License # Lic. Class Exp., Date
I W 493348 B J 1/301'20f6 Z r- Date J- 1 > ignature of ContraCor'f t `-�
co01'�
J I.-� OWNER -BUILDER DECLARATION
LU C -)
r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
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). /
N () I am exempt under Section B&P.C. 'for this reason
O N Date 1.-_L_%---41?,—_-r-Signature of Owner,,,
0)d WORKER'S COMPENSATION DECLARATION
O ZI hereby affirm under penalty of perjury one of the following declarations:
LO p () 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 LaborCode, for the
O _ Q performance of the work for which this permit is issued.
C0 Q 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
ti 0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carver Policy No.
CIS 5 '131% , 113M 1711AN inO
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 California, and agree that if I should become
3 subject to the workers' compensation provisions of Secti n 3700 of the Labor
C96e, I shall forthwith comply with those provislo s. n �
Date: • �� ��'7•Applicant f % 7•
V T-
� 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
06 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 property Pr inspection purposes.
4Signature (Owner/Agent) �� l%'' �Date/-/;
BUILDING PERMIT
PERMIT #
0001-4"s
DATE VALUATION �httP�ii�.i•{� LOT
TRACT
JOB sit
APN -
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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TMART ' J .C.:BSI
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79345 B[€lMtt O OD
44082 SM4 LURE UP,
LA. QUIN t"A G.A. 92253
PALM, DESERY C:'A 92260
(760).140-2285 CBM?
USE OF PERMIT
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804 S.F. TKLt,3S PAT.K) COVER
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FERMI' F FAUS
tit IF NOW
!ii211?3.)7
tf
RECEIPT
DATE
BY
IJa(AkSD c� _
INSPECTOR
s
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_ —
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 APPROVALSGas
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
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)
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TO� THU 12:43 FAX 760 346 9918 D R M
041
May 20, 1999
Mr. and Mrs. Martin Jacobs
79365 Briarwood
La Quinta, CA 92253
Dear Mr. and Mrs. Jacobs,
The Architectural Committee for the Estancias at Rancho La Quinta has reviewed and
approved your submittal of plans for a patio trellis addition. The trellis will be placed on
the master bedroom and living room patios. The plans were dated April 30, 1999.
Thank you for your plan submittal and patience in our review of them
Sincerely,
Mindy Gutierrez, Property Manager
The Estancias at Rancho La Quinta
Professional Community Management / Desert Resort Management
Post Office Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 0 Palm Desert, California • (760) 346-1161 • FAX (760) 346-9918
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