9612-328 (SFD)rico a
N U)
W
I\ d ur)
w�
0�
T
CD
J c)
W Lu
H 0_
W
Z
CY)
LID
N
ON
U °)
o 2 Z
rFZ0
0 J J
mUU
O
0 H
;I- _Z
ob
ob 5
d
Q
J
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
714118 i3 1t113119,
/Date / 9 5�,� Signature of Contractor,4,'Z`' r'•" '" """"`
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). k
( ) 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.
Qv� 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.
'Lis"sv� 1`11:.ttdS. CCS. 201«1."eLiC�F,�O.t
(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
e, I shall forthwith comply with:those provisions.
d .
Date: A `d` ��' 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
/th,',bove-mentioned property for inspection purposes.
gnature (Owner/Agent) ,4_ "" ' Datey
BUILDING PERMIT PERMIT9612-1 Z# CONT4OL5# 8
`
DATE ,�tKj� VALUATION �i49t1.�i71f"� LOT' 7 TRACTJOB
SITE
ADDRESS 70-175 C„�\1�111r 0 ltv:iADA
APN 604-4511-009
OWNER
CONTRACTOR/DESIGNER/ENGINEER
.nr, "., ; p
j,R,ek.c.€1s'.1tx� Y+��.�,�.�r.
nrrt n t tir r �� rw
r.�:,..�1.+~t;.tf"s..€?t"r:c,ati.�,'� "irt•tls
13 3. 5 S0. "1?YK FF 1', 5.17. H2N)
1335 So. "DO R.T'€2.ET'T, s .. 4200
SAN RMCA 92400
;;�iN 1;1:FtN�1it1ANO (.A 92.408
1,4019)391-6007 C131ytt 2170
USE OF PERMIT
RANCHO ty+�E 1l if.I.Es - F�t,t�%i 40st3[Z
11Zht.:`1' SF
t�i:�ItCHJ1°A."1'iE� JCi.tet) :i�r
(_�.AR A_0f3('4 ARIy(.)X ' 590.00 St.
AUSTMAITED COST OP, CO'NSTRUC 110114
160.97110
,r:C)NS*t'R(k,ei3()N f'FE' 101-00()•418-1)00 S 35;.{if1
PI -AN (IffPCK Fl.,1d 101 _000 -143? -318 $710 53
A113.i.`11 011C:A1 FEES 101-M-121-000 $135.50
E:0iC ,,fR1L'Ai: IZ EL.8 101-0w_.120-4011 5135.78
1►1.[)1Vfl3fNC�'1'1 Fti 101-•OW-419-t)()i1 5161.25
3t-(it)NOMCI71ON(RFS) 101Loi-000 5fr.tt>
G12A:r1NG 101.000-423-040 34u.txt
iNFRASTUL'Ft,RE 225-0W-"3-3412 $1.591 t2
ART IN 1'[It? IC;' F F.Ft0Z3 f tisS! 701-000.255-W,
PAI D
N AND RAN CHECK
55,7"17.71
$0.00
r'
` CITY OF LA QUWITA, Pntsir-r �� cv.s OUR NOW
55,747.71
RLICEIRT
DATE .
BY
DATE FINA LED
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 Af 4 7
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 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
terai
Pool Cover
'Segger 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)
TRACT 24517
LOT 7S
ADDRESS:
We, the undersigned purchasers of the above referenced
property do hereby request that the patio structure, as
it is normally constructed by the builder Century Homes,
be deleted due to other plans which we have.made for a
patio cover.
We understand and agree that it will be our responsibility
as a homeowner to provide for shading of the windows over
which the patio cover is drawn.0ur pool and patio plans do,
however,make the builder and city approved plans unworkable
for our home.
J
,5/-3/97.
APPROVE Y LANNING & DEVELOPMXr7jp;
MENT
BY 0,E �
EXHIBIT Z'
CASE NO. RAE ALIM 'y�sZ1
%E , fes ��i c�✓� r ew&'
1-14 C y'