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0003-008 (RER)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 71695 OM iI20i ,Date Z , ! Signature of Contractor y s i 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 hot 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. SecZ )._ I have and will maintain workers' compensation insurance, as required by tion 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. C/1L•I(*(71tI+'tA t,�DI;�f iXf f;2 .r.66A (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 those provisions. \IDAte: i2 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 Ouinta, 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) Date1 BUILDING PERMIT PERMIT# iNt1i3-1)t6K DATE lV VALUATION 54.719.20 LOT TRACT JOB SITEADDRESS 79-145 QUAIL Ci�t)S. RiG, APN 772-012..412 OWNER CONTRACTOR/DESIGNER/ENGINEER A!/ilri C1:'17nQn1( It i. 114 ..IA*...J 431- I& 1)A1 -Ir rrAk1Q-MT(i' nriR( 1 411. a, ti4Jt .0 • 4i.J` i l V I 79-145 QUAIL CROSSING 72-8,15 AtRBOL€'sL'A AVENUE LA OUIN'I•A (:A 92253 PALM DESEWI' CA 92260 (760)776.9W_ % C AL# 5937 USE OF PERMIT R.rSiDENTiAl. kRINIODEL CONVE-Rr THIRD BAY vF GARAGE 11V 1.O CONtD 1 ZON17- 3 CRAFT `.i STGRAOF& Ruk.)NI BONUS ROOM 135.00 3F 'Si' I TET) COST' OF C.':);Z>�'�t�lt`)'rL':� 41,1191201 i' MN11-1 FEE, SSi7WA1A1V PLIkN CHECK FF.I? ] 01-0UCi-439-3111 S46.W rnNXrfrttr1'I(_1NF-Hc7 fnt_ry .,ttS-!1(Nt 5r�nn ;LfCK"IW:ICIAL ; LM i n i-000.421-000 1'IEC`l'>;(C( A1.kNt: 101-000420-0W S.ty.iti STRONG M.UCION FRF - IESI13 .101-000-2414000 S.it► -• t STIt3-'1OTAL(X)N`'1'RUC'!1QN iiNPP).A'N'ryiCz `K ? 5t54(Wi L SS PRE -PAID FEES $0.00 '1'mA1,1'Fxmrr rF:>" s OUE NOW $154.06 RECEIPT DATEBYu 1�` DATE FINALED 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 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 ' 0a)1 Final Final BLOCKWALL APPROVALS POOLS - SPAS 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 Connecticn Encapsulation Gas Piping Gas Test Appliances Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Poe Underground Coiduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Recepta:les G.F.I. Smoke Detectors Temp. Use of Paver Final Utility Notice (Pe --m) COMMENTS: EXHIBIT "1" ARCHITECTURAL APPROVAL APPLICATION LOT # NAME(S): STREET ADDRESS A oc '5- '!�y k L (1 00 SS/ LOCAL PHONE:22— � 3 OTHER PHONE REQUESTED IMPROVEMENT Approval is requested for the above improvement according to the plans attached. We have attached three (3) sets of plans outlining the work to be done along with a complete description of the materials to be used. In addition, copies of the Contractors License and proposed contractor(s) are attached. Upon approval of this application and prior to commencement of the improvement, the certificate of liability insurance will be provided, naming the Association as an additional insure We have read the Architectural Standards and have furnished copies to all contractors to be engaged by us. We agree to comply with those Standards. We also understand that it is our responsibility to insure that our Contractors(s) comply. We acknowledge that Building Permits for home improvements are required by the City of La Quinta including any modifications to bearing walls. The cost of permits, responsibility for obtaining them, and the subsequent inspections will be our responsibility. In all case, we recognize the requirement to be in compliance with applicable building codes including, but not limited to, those adopted subsequent to the original completion and acceptance of our dwelling. The Association has no responsibility whatever in achieving compliance with newer building codes which apply as a result of Homeowner prompted modifications. Further, we understand that approval may not be granted for any modification which directly or indirectly conflicts with the Declarations of Covenants, Conditions and Restrictions. We also understand we are responsible for the accurate determination of property lines and set -backs (as applicable). We also understand that we will be responsible for all costs of this improvement and for costs associated with any repair to the common area occurring as a result of implementing this improvement. Examples include, but ar not limited to, sprinkler and irrigation systems, utilities, buildings, lawns, plants and drainage. Further we recognize that any modifications to the common area irrigation and landscaping �e ee tmhe are subject to formal acceptance by the Association. Any required remedy to ac required maintenance standard or 1 - TO DECiARATIOU Additionally, we understand that the job site must irrigation standard are our responsibiL'ty. that debris nor dirt may be dumped on be left reasonably clean at the end of each day, is and the project. We acknowledge that 1) if there is no unobstructed removed.nor cess, swir m°n a such to spas must be hand du and 2) no walls are to ntenance or replacement of permitted vin equipment access. Any improvements, shall improvements, except for certain landscaping, which are beyond "initial" be the homeowner's responsibility. We agree to pay the Association an application fee of $250.00 to defer administration costs and expenses in the Committee's review of the plans and specifications. Application. �� addition application f the should be submitted along with this Architects Approvalpp Committee deems it advisable to hire the services of oengineer �� architect addition to the the submitted plans, we shall pay all reasonable costs $250.00 application fee). We further agree to secure in advance and thereafter at all times during the Performance of the work which is the subject of the ply and/or specifications Performance Bond in the amount Architectural Control Committee for a Oproval, maintain �h equivalent to the Association) of Twenty-five hundred Dollars (52,5 ) ( or to secure compliance with the declaration of Covenants, Restrictions Rules of the Painted Cove at La Quinta+ these Standards �d� and/or �e Architectural Control Committee. Said bond sf any Association Asssoc tin as the obligee or as an additional obligee. We shall pay the premiumY againstdrawn the Association for our failure to We further agree that the f these Architectural Standards and/or the Rules of oomply_with the above -said the Architectural Control Committee - We agree that this improvement will be completed a ��d as a result of implementation manner. We further agree that 1) if we do not correct any damage TOvement within the allowed of this improvement or, 2) if we fad to complete this imp timeframe, the Homeowners Association may elect to complete the work and/or repairs, and we will be responsible for the actual costs of such wbe ork. a°as ��Pethe nof our tefor this deposit, held by the Homeowners mthea�he thAssocio k � to and has been accepted by the purpose. We understand Homeowners Association, we may request a refund of our deposit. Signatures of all Owners. (S' ature) F,44r.►.' -. vy owF.wr To DECLARATION ARCHTTECTURAL CONTROL COMMITTEE CERTIFICATE This request was. reviewed by the Architectural Control Committee on �2' %�� and has been: Approved Rejected" Conditionally Approved with pp required modifications set forth below Returned for Further Information Required Modifications Comments Date: 4L `Z p U - �4rchitectural Control Committee COMPLETION INSPECTION Completed work inspected and approved: Deposit return authorized Comments: Date: Signed: * Less any reimbursement to the Association for costs incurred to bring homeowner into compliance with the governing documents.