0203-173 (GRES)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
791618 i D C-8
Date eZ i Z -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
ection 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 MU-NIC,rfPAL M -U k'Ux Policy No. 'MIX -1 IDIOM
(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 forthpvith comply with those provisions.
bate: � , / ' ( -Applicant i a 6 i lydriin t f r 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
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 td
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 for inspection purposes.
Signature (Owner/Agent) f s A.A+t m ,t �� 1 i' d Date
BUILDING PERMIT PERMIT#
DATE Qy�fY VALUATION T�
�1 i1,7�taAo LOT 21 TRACT 26J,G4
C
JOB SITE
ADDRESS %9'.+65 OM� LAPN 769-770-i0"7
OWNER CONTRACTOR/DESIGNER/EN (NEER
TJA1;tNA', IT Y1 XPAD ilaE.i �'�,':-MR COld'C.IU tE Ct2N8'I'#v.0 MYN
79.465 DMOQK'41'TtLfes ?8:xb5:a T`lIII, ' rl Z83
LAQITRZfA CA 92-25.3 1.t,t1M, P CIA 92253
(760)564-3411 Ci_l4 2532
USE OF PERMIT
GARAOr OR CATS 0Kr
"AL.
0ARA . CA32PO11T
904,00 BY
EMMATED G ST OF
Plt YMT 11, Via". SUMMA IZ
C01,13'1;i2T.i 'TIO'N FEE
10 1 -006 418-U0 a
sk h0.ilf3
PLAN CHECK FES
101-000419-118
�l�lti."fib
MEC11ANICA1,F1'sl;'
101.000-121000
S40,50
?�1', ,CTRIC`,Al FEE
133.08
Rf'f, MBINO FU
301.000-41,9.000
SUM
STRON10;MOTION ME, RE IL?
10 1 -000-241 -OGO
$1.77
GR-DII40.IEEE
3.01-000-423-000
S1.5100
D
AM PLAN 01~MMa
T. Pry-P.Am n:ea
59.13
$0:00
M 1 CU01 U O �?.1�3.3Ytl11'1�;.�:t1:,EDOE, ROW
ary0F LAQUIMA
FINANCED E rr
RECEIPT DATE ABY DATE FINALED INSPE O
�?
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
2 7 —Dy
Combustion Air
Roof Deck
,, 01.E d e__
Exhaust Fans
O.K. to Wrap
2-1,7— -6,0
F.A.U.
Framing
— 01::_
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
-7— 3 — J
Drywall - Int. Lath
— — —
Final
Final
fl— —
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
I 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
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)
D4tsert
Resort
l� nagement
August 30, 2001
Mr. and Mrs Bjame Nylund
79-465 Brookville
La Quinta, CA 92253
Dear Mr. and Mrs. Nylund:
The Estancias at Rancho La Quinta Architectural Committee has reviewed your submittal of
plans for a garage addition for. your home at 79-465 Brookville. It was the decision of the
Committee that your plans are approved subject to *the following conditions:
1. That the garage addition structure, finish, and color are to match existing home.
'2. That a check in the amount of $2500.00 be written to Estancias at Rancho La Quinta.
(Construction Deposit). Please return in enclosed envelope, noting on check that it is
a construction deposit.
3. Give a completion date.
4. Additional hardscape and landscape must be submitted for approval.
When the work is finished, please notify me. We will perform a final inspection to verify
installation according to the approved plan, and then your deposit can be processed for a refund.
Sincerely,
GaryJLe,y, Property Mger
Master Association for Rancho La Quinta
Cc : Blake Haddock
Professional Community Management / Desert Resort Management
Post OfficeBox 4772 • Palm Desert, CA 922614772
73-550 Alessandro, Suite 5 • Palm Dessert, California - (760) 346-1161 • FAX (760) 346-9918