0304-189 (PAT)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
11_ � C61 '3�JC D'2. ;i 0/03
Date '{ f ' <172 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
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 1,XEV.P'(' Policy No.
(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 forthwith comply with thosepr visions.
,Date: ^ �%AppIicant�/
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
the above-mentioned property for inspection purposes.
`Signature (Owner/Agent) i' le: -4. Date
13ULDIN" PERMIT PERMTk
DATEVALUATION LOT TRACT
Ilk An . �i� t3 1pU
JOB ADDRESS 'W'm f.�ate�.ia�e.A'�Q�1;7.G r APN w
OWNERCONTRACTOR / DESIGNER /EN 1NEER
1).AYM CAV—ANT) .:VACi'77A V+Tcl°Y h9L39W-21w.P&A
48-125 QUWER�, CO -UR
LA AQT,lf�j'1°A CA M,19,:4.3 t�1�70 Citi 922.01
060342-M7 c r r CSl,' 4889
USE OF PERMIT
PA3'1'C
111MM ply
;�:�!r!3:,37NL?�'�'!�'I� �''�41�> �'��.1`a�"'�T�"'::�t1.i'�' .33:`1.431➢
���:�plti'1�//n�����pp/�tiyl Marl jf✓�q'fq,Y+tir��n L���:��yy 1,j(J�••�t�1ry1''�1 y�'��'.�f��c�� ..
f3�•1Ji lJ,l'1 Ei l�r°nC.'I-r�il`°.''•Sti .' rit�:l��l 1`,7.1+.,(�00-24.1"LZ00 'Sill
APR 1-6 7003
I CITY OF LA OtjINTA I
FINANCE DEPT..
Waa-`iY)TAG comlauc `rIT"w'AAM ymm, cam. c
LEOS PE, -FATD WE
L}f,13? ^I 1`�' '1�k1,�S
RECEIPT IDATE'� • ' �r' ' , I BY E I,DATE F NALED� . I INSPE
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. tl
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
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)
J , Ann Ua l�/�+�� CSS
/ Coachella Vallee Screen & Awning
i 1- �S ,'UI jiI P�'J The New Company with 16 Years Experience
Screens •Awnings • Doors.- Windows; -
C -'.I %Alumo-Wood_• Potio Covers
f83480 451h Ave., Unit 7 + Phone (760) 342-7272. ' c'
„Post Office Box 1434 Pager (760) 779-2651
t Indio, California 92202 _ License No. 735369
04/09/2003 14:43
s
7605680324
AVAIL PROP MGT
PAGE 01
03/310083 13749 16ASS85374 AVAIL PREP MGT PAGE al
Parc ,A Quiteta Homeowntrs Association
LAY — tRACT
_._ DAT7 R CEIVED:
DA'Z E SUBMITTED: J i1 (hereinafter 'Applkant')
OWNER'S rArtE(51: —aLIL oil r j 912 Y .T
PROPERLY AADRESS:Y—� ,
LOCAL PHONE: L64 .Y '-Z� DISTANT PHONE:
MAILING ADDRESS'
(If dltteter►t from propecry address)
The following dcscrlbe4 elodifieation is proposed end approval is rcquest11d t� t >tu etruca th+aTja;WZ Ir.
re «tt M
accordance with the preeedure o0diee6 fn Ott A$sociation's CC&Rd. 'flee APP
documents as outlined in tie r-C&Rs and ArdtirecterroI Guidalines and Deman Sm"Ords.
30� �I�1
(Pkete pmvid� a tanplut Mrni.e amnlp�oe of uu ptepesed meC;hc4llao and tneNd11 ara�Injt V •DPr09'imU
The Applicant 111110 understands that, it approvel is gamed, the Aw cast will be teapon$111C for ln4t is n ed to
f said
Alodiricatlon And any and all dambg0 which roar occur to Wry COinmon ale@ propeny, indudiog but
sprinkler syate ns, utit:�ies, DutldUtg.,.lawAs, and plaris. The Applicatlt Gather tmdttstWt, that &)I budding
modifications require approval of %be City of Le Quinta sad building partnite tray be requited" The cost of 1111
approvals and permits will be boar by the Applicoat. 'I1te Applicant funher agrees dut, 1f approved, the
owdiricatlons wrW be made In Witt complienee with the p;aas or descrlpllon submleed with Ibis epplicacon. Should
w,, changes in OK. Pland or deseilption be required as my rime duriag the projtcL, thou :hanees must: be noted by
Ike Committee on thin spp)iestion. Applicant father apees to hold the Association harmless from ell IWAlky related
to any damage w existing buildings or it0provemmu,'Wherever looted within the complex, resultnl& pons the
iasta!lationrcoes7nrction of thib improvement or rttodltteA Jon. Applicant aba11 advise Absociatioe offce prorrtpdy
trpott Completion of the work..77
"
`..�..
OWNER'S SIGNATURE(S) r/ —
;rat Ailfidauan CAM Airy! C
A nit F tlF)tEW REnIriHEII ONO D Yes MEETING DATE:
1. TIIE-A"ROVED STANDARD
2. APPROVED as submitted
O 3, APPROVED subject go, the foaowlttg conditions, --
❑ 4. DEMED tot the following reesans:
O S. HELD OVER pending receipt of the foltowiag Information from Applicart: J
8 flllA1111 CQNB1hdA=H SP0111RED ,*No O Yf11EETING DATE:
Aultrori2ed Sit3naturelOatc: Ufa-tt�_ --•
C. NOTIFICATION OF COMP=ON REQUIRED: Date received:
WORK COb1PLE'fED PER SUBMi'RPL: h Yes O No (augch sober)
VEWFIED 13Y: _ Date: —
(Print. Name.)
Approved via telephone from Jeff Wood, ARC Chairman, �:-8-03.
AVAIL PROPERTY MGT_ C�
P.O. Box 1032 k
Palm Desert, CA 92261
F. , 0 n9/.
AC11 ox
infirm dab:rn r:n Rn .rd►(