9906-210 (PAT)I£
LICENSE[�COIyTRACTOR DECLARATION
I hereby affirm_unde.L•ptnalty of p�rjur that I am licensed under provisions of
Chapter 9 (commencing with Section 00) of division 3 of the Business and
�Professionals Code, and my License Is to full force and effect.
License # Lic. Class Exp. Date
101 /el :511407 13 C-6 10-03 iIWWN
at,{ Signature of Contractor��'�
14 ✓
r OWNER -BUILDER DECLARATION
I h r `_ffir under penalty of perjury that I am exempt from the Contractor's
L,tebL uG� or 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 coyisfruct the project (Sec. 7044, Business & Professionals
Code').
( ) I am exempt under Section , B&P.C. for this reason E
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:
CarrierPolicy No.
COL.I)EN HAGI t` NWC1303700u
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) I certify that in the performance 9f 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
subjp6 to the workers' compensation provisions of Section 3700 of the Labor
C • de, I h¢��II fo hwith comply with hose provisiorisa
Date: , Applicant ��r��
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 proper'/ for inspection purposes. "
Signature (Owner/Agent) �'Jlh-�`t✓ .t."a� Date�� 1
r -
BUILDING PERMIT
DATE "VALUATION ,�}�g�s,� LOT
PERMIT #
TRACT
JOB SITE
ADDRESS 49-IITQUINIERACOURT APN 644-301"27
OWNER CONTRACTOR/DESIGNER/ENGINEER
4909.5 C7fJf.AIEMA CI' 833.A S'NIAIN SrLl 437
LA.QiJINTA CA 42253 FA1, LBROOK CA, 92029
(700)631-1401 00110 5198
USE OF PERMIT
YA'1 its
512S. P. A% tMI NT.Al LATTICE, PATIO COVER (1060 #5038)
PGl'X 1,iYAr#.0
512,110 8:F
1"CIMIT FEE SUMMARY
.PLAN CHECK 1+.FL 10.1 -OW -434-:3113 �',i $5&.fit
CONS11t1K." 101.4171"1". 101 -CM -41 8-W. $90,00
r
s
y
�v
S0.8—TOTAL ICON t"it(.FC 10N AND PLAN C<'s;81t"1t1.•1<.
RECEIPT I DATE
IF
TOTAL PERMIT P.i'!.(K NOW
DATE FINALED J INSPECTOR
6.309.60
$14919
$0m
S 144).13
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
uli. r T* so So
Final
Final gjPOOLS
- 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
Neater 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)
JUV-2az.1999 WED 02:41 PM THE VILLAGE AT THE PALMS FAX NO. 7603$91463 P. 022102
FARC LA QUINTA HOMEOWNERS ASSOCIATION
AVAIL PROPERTY MANAGEMPNT
P.O. BOX 1032.
PALM ]DESERT. CA • 92261
(760) 568-2717
t •
.lune 11, 1999
Temic Miller.
49-095 Quirnera Count
La Qui nta, CA 92253
RE: ARC Variance Request
Isar Terrie,
Your request for the rear yard patio. cover has been received and reviewed by Uie
the ARC. it has been approved as. submitted.
All neecssary permits must be received from the city prior to the work siarituig and
all debits roust be Clem-ied at the end of the day. `
Thank you for your coopera#ion.
Si�Zoerely, ,
Cara Anderson
Project NMartager
• •
06/23/99 13.:42 TX/RX NO. 1866 P. 002