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9603-094 (BLDG)LICENSED CONTRACTOR DECLARATION co ,.l 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 C\1 W Professionals Code, and my License is in full force and effect. , O Z) M License # Lic. Class Exp. Date O 424048 8 6/30196 r-- CC j ZO r- Date d �f 4 Signature of Contractor U °� OWNER -BUILDER DECLARATION } I hereby affirm under penalty of perjury that I am exempt from the Contractor's ~ D_ License Law for the following reason: Z_ ( ) 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). M () I am exempt under Section B&P.C. for this reason u7 O N Date Signature of Owner rn Q WORKER'S COMPENSATION DECLARATION C) Z I hereby affirm under penalty of perjury one of the following declarations: tM Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers' X W �: compensation, as provided for by Section 3700 of the Labor Code, for the O � Q performance of the work for which this permit is issued. m Q C) ( ) I have and will maintain workers' compensation insurance, as required by QSection 3700 of the Labor Code, for the performance of the work for which this dLOpermit is jsue�rM,"y wQrkGs compensation insurance carrier & policy no. are: ,It Z Carrier Policy No. co =) �O J(This section need not be completed if the permit valuation is for $100.00 or less). ( ) I certify that in theperformance 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 thosgjprovisions Dater 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 the above-mentioned property for inspection purposes. Si nature (Owner/A ent)�.fit' Datela BUILDING PERMIT PERMIT# CONTROL# G ���.a 4► 3000 DATE 3119/9,6 VALUATION �ki00l)) LOT TRACT JOB SITE ADDRESS 48-609.ib,A:SLO TARAZO APN (►a6-UZ1�-�iI�S OWNER CONTRACTOR/DESIGNER/ENGINEER 4,8609 PASPO °1'3\itAZb 711365 RW ti 1 I.1,16.148 1.A, QUINT. A CA 9225*3 LA. QtJINI. A. CA 921253 Til-ta>31 (019)564»692:' . CBL :P 2789 USE OF PERMIT c'iN,hlRA , t3(aii,.IANG ADD WINDOW 11EMODEL 705) LS L.NT1MATF, ) cus- r of a)IVS` JIAJ C,.F10N f111i,i►() C0N&rRUC7(6.N Ff1 1.01 -MO -4,19-000 $19.00 VL. kbf CHECK FEE 10.1-000439-318 $12.35 • CI r � Q( Cr Q SUD-TOTAL CONSTR,UC7110-P!)kND PLAN Ci1C:CK $31.35 USSS PRE -PAID F'815 $tl_t}t) B"C)TAi,, PCIMMIT FEES WICNOW $31.35 RECEIPT DATE BY 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 Final Final BLOCKWALL PROV S 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 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 Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: r, Ctl civtJ °� t .w I/Va0 (.N% S ,Ao e LAGUNA DE LA .PAZ HOMEOWNERS ASSOCIATION .ARCHITECTURAL IMPROVEMENT APPLICATION 1;OTW-31 -DATE—hiqjtic-,/4 A Ni - M E s') f--- ri 't'j, 17-0 a L STREET ADDREYSPI45�&6) -7 -6 LOCAL PHONE -IL-q �3 �--OTHER PHO14E REQUESTED'IMPRO% fioc2A T /V 5T .5 5 proval is requested for the -above-improvement ao1r. ' cc ding to the lans' attached.,' We have attached two (2) sets of plans. o'ut1ining e Ong, , W1. 03� t 'w( e i - approval of this application and r Lai o be used.' Upon 1 fie@ mmencement of the improvement, the certificate of. -t insurance will be provided, naming the Asso-ciation as. Wen additional insured. We have read the Aichitectur'al C6mmittee Rulos and/orGuidelines W and have furnished copies to all contractors to be engaged by us, We agree to comfly with those Rules. We also Qndersta.)d that it is, our responsibility, to ensure that our. Contractor(s) comply. Pte acknowledge that Building Permits for home improvements are nc re-�.,ired by the ri+-y of La Quinta i:- 1,adi--rc; any. modif icat-ions to bearing walls.' The cost of permits, respqrSibility for 'Obtaining .�th6m, and th4 subsequent inspections be our resp--nsibilit Y. we recognize the—req-uirement to be in compliance in all cases, j- *�h' applicable building codes. " but not limited to, Wi including, Pthosip- adopted subsequent to the original completion- - and acceptance of our dwelli.ng. The. Association has no -re 'Ppnsibili-tY what 'so ever in ac'hieving' compliance -.-21,th newer building codes which apply as a result of Homeowner prompted modifications. Further, 'we understand that 'approva.1 will not be granted for any m.Ddifications which directly or indirectly conflicts with the Declarati.ons of Covenants, Condi--ions, and Restrictions: We also, understand we are responsible for the accurate. - ,determination of Property. lines, and i6t-backs (as applicable).. h I :i3 ?r, S A q Ad 3C! At;JO, 1 ,A T;fV4:IVORgt9I JAR'JT03rIH:)RA aTACI 1'--eii c." t� �� :�� �c� �' 223AC1(3A 01IJ iia - - _— — ---3,[oHq A3fir0 _,::�\_�L_3t:OHq JAX I � �� ��� Q� _`\_�v �:. _ .a _� �\ c: �l♦ TV a,%I3•JORq,KI (31 23U43R LA 21 v \N,-\ Ada agnif9biuD 70\bn6 LJR 99JJiMMOD t82Uf'3911do7A 9dJ bb9Y 9vad 9:V -au yd bspsprz9 9d PIojoszjnoo Us of a9xgoo b9dain7u3 av:sd bns Is jsr[j bc:uipY96nu 9W .astuR 9eorfj ifl1w Y y;o o3 9:)7ps sw .•liq,roo zuo Ibrij 9 -mans UJ ylIJLdta.zogesY Yuo at .Tc, ejns�19vozq�It 9Iocf xo3 ajimxsq prlibi LEI j4{ij spbdt'doaxo6 9;1 4f �rtUfjS"11�ii`O,1 '`i1G �h"I.n? 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Ejniu^ sl to yl!'-, uift yd bsY1'.c9: 91L,lisjdo 101 yjLtld.. 4301 '81ti1eq to taoo SAT .aLtb.. errvi-, A .yittcdipnogajz zuo 9G .iliw 27ctJoDq-AI Jn3up5adva 9r[j b -'s rf +3rtbtt ,Elco ni sd 03 Ini'1:3ILu• AZ :irij 99JApoo92 9w of b9j t,,i L jon yuci p, -.!%u aubo3 pntbLiud 91dbo cIq,, I;nb noLjytq�Ioo ts��:piYo y,.� of jneupsadua bslgobs o :j t a'ad noijsi703z4 9rfpnIIIgWb 7Jo 33 K, 1., 7 n 14Jiw F,an4![lvrias n.1 It)v:3 0 16rfw , Ji, rttd.L ,s r•).',I-)-sq b ab •{:cis rioic{w 29boo p,�LbLlud )d 4,J11 111W '-fediYu'i .2noij6ai31bo tii3�3�, ►�i Yo y;faeYtb riai w erYotj:s�riibc , yrts Yo3 bg-1 -xp 6-tE �2.iattto:07 �a� ,rr��c7 io atrotjsTff-79Q jiit rtitw ajoifirioa L)AI -lot C.r b061219bnu oal6 y0 ..:n') ! 1o1Y1.1 ,; q ? �) 2?i76d-jai b,�rb 1i.It1 6aL,11-;pj bYuaas . ; ibattgge► 1 t Page ,Two ' vr ''e also understand this , im rov that we will be r. e ,- , P ement ,and for �p�t•s.ib e ion' a1.1! common area costs associated �,, CG5ts of improvement•, the occurring, as a' result 1th any repaip' tc� Examples include, ,°f implement,.r this and irrigati'on.. s . but are SYS not :limited to, :sprinkler ng drainage, Further. utilities, buildings, lawns common we recognize•• that p.l-ants, and are .irr•i•g,at,ion" and any modifications formal.' acceptance b landscapingy to the achieve Y the As scheme are su:;, j ect ,`•o the required -maintenance 1st ston.andard }Any required remedy : to iS Our'responsibilit tandarc site must be Y• Additionally or red left reasonably'�' we understand that. the. job that.. no -debris nor clean at the end of acknowled dirt each rI-ay and , edge walls thataY be dumped on the project. t'E removed have to be removed or t� ermit di in artially ermissiont and,• e u�pment access mus mai-ntenance must be replaced the same t have rior or� replacement of as wall removed. Any certain landscaping, which permitted improvements, except for shall be the homeowner's tresponsi•bire '1 ty beyond znitial" improvements Wee to }pay the Association if required) to defer administration c Sts and expenses in an application' fee of' t CoMmittee'.s review of the plans and s.ecifi p . cations, . We further 'agree that this improvement will be completed reasonable and diligent _manner p eted in a• months). We further' that (but no longer than six (6) damage caused as a result of implementat on if we o° notr'correct any or, 2) if we fail, to complete this improvement within therallownt time frame, the Homeowners Association iia work and/or re air ed p and we will be responsible for theactual. costs of such work, 4;e authorize the use of our held by the Homeowners Ass deposit, if any, for this Association to be used as partial Purpose., i�'e understand that When p+aYr.:er,t, and has been accepted by the Homeowners the work is conplete request .a' refund 6f'our deposit .if As:,ocat.i.on, �e may one has been given, Signature (nof all Owners:, ( Signature) (Signature_�'`� L As Revised January' 1996 1/- .�.. i -,r x .., .�. �; .�'..wr :._ ,. � �,�. •s�r.;�t"�-._;a-"'mow..,, �:�ti�.m-x„¢-.v-_�'`��- �--'�.�=1M�1 .,-�'�s� Yf .*•� �j owT 9psq dfanoge9s .d Lliw 9w JsdJ bnsJajgbnu Dais 911 ils 103 si mi airt.� 30 4Jaoo BOIS nommoa ©� -1isq3I yns dJiw b9Jaiaoaas baf Baa pni�zuoaon.m3vo-1 m0 vp-1gmt grif jp JLu2e'x m6X3 ,Jn9 2idJ pniJnsm9igmi a noiJ6plIll b06 �9i�(riisgz ,oJ bgJ.imtX.Jon g7s Jud ,96c�Lanizm9Jay 6rtibYb bn6 ,2JnsLq ,2nw&L ,apnib.Iiud ,asijiL2Juow 3tbom Yna JsriJ ss2n9oa9� olJs iz 1 Uaels Qnommoo 3riJ c�J anOIJsai 'ni 6oabnbl. bns n d eanbfggoas tsm7oi o� Ja9�GrJa sx6 9msrioa p.noiJr�iaoaa sriJ `� sY ec{3 svgigoo of ybgme7 b9-1tupsx yn�a son z97 7uo at ! 67bbn6Ja noiJ6pisIi '�o b sbnbJLLsnoiJ bbt� sm- 6j1 dparcoq dot 9dJ JbdJ bnsJa196nu 9a .Y Id6noas9-s Jj9L sd Jaum jbij fir*s Y&h ria ss 3o brig gq J6 9d ysm ilib -1on 2izdgb On b9iwoct�Io� gra .10stoiq 9dJ no bsgMub gd Y of bevomel 9p �1Lbs�7s -10 69VOm9'Y 9d of gust{ Js�� 8 Jifri izaimls 7oi-s 9vsd Jaunt aeeaos Jngm sc; 9 1 g-1 zo ean6n9Jnism } yRQ .69vom9-1 L bW ab 9rrtsz .dJ b9a 3o Jn9n9os q m bn6 no nisJYsa 101 Jg9oxe ,ejngm9vOlgmi Fj9�Jim7sq ni soabnsI d01 r zjnsmsvo-1gm1 "L6iJ1ni" b Yoy9d d aaOga9-1 day-19f[wogmod .dJ .d Ltsda g 9W to 993 CtoJ6aiLugg ns nolJsiaoaaA 9dJ y6q of ._...� a9ansgxe bns aJ200 noiJsYJatnBjbs9c-1i j3o we1V9�-1auaeJJsmmoo J rni .anO!j saijia9ga bns 2 q b ni 6gJstgmoo, ed l.i1w Ja9m9vo-1gmi . aidJ J6dJ 991L eldsno f91 k {a) Xra nsdJ Isenot an Jud) -19nn6m JngpiLib Yns Joe-1-1oa Jon ob ew 3i t J6dJ .9-196 -19dJ-1u3 9W •t2dbmab Jnemgvo-1gmi aitiJ 30 noLJsJn9mslgmi 30 JLua9z s aB b.auso e9 ,10 isms,, 9miJ f bgwott6 grit nidJiw JnanDvo-1gm1 21dJ 9J9.igmoa of ti63 sw 3i 961 e3eigmoa of 10919 yam noiJsiooa2A a-19nwos 99.1 -1o\bns :4-low LGuj06 sdJ lot gtdianog29-1 gd itiw 9w bns ti3 d bled ,ynb 32 ,Jiaoggb -1ub 30' Dzu .dJ 9TixOrtJU6 sS+1 wo9m riJUa 30 zbled 2irtJ ~xo3 j�-�smYbq L6iJx6q as b9au ed daft jo brz Jai9bnu SW -9200- uq a it bas gjg1qmoo at �(7ow gd3 tt d E,sJg9oag n99d .dam ew ,n0j.Jb.,.00saR axgnwo9moH 9dJ Y .nsvip n9ed v6d 900 3i fiaogsb xuo 30 bnu39'S 6 329up91 :alenwo 126 3o s-1uJsnpi2 *PP- j\q'1uJ6 deer ` isunsL beat •;; 2A LAGUNA DE LA PAZ HOMEOWNERS ASSOCIATION ARCHITECTURAL COMMITTEE CERTIFIC'ATE Th ion was reviewed by the ArchiZ'ect-ural Committeeo n %4nd has been: Approved Rejected_ Conditionally Approled with 77 required mod-Lf-ications s e,t ,forth be low Returned for Further Information Required Modifications Comments Signed - Date: ecturAA C COMPLETION INSPECTION Completed work inspected and approved:, ,Deposit return authorized (if applicable)*: Comments: Signed Less any re'imbursemen't to 'I[.he Association for costs. inic-orred to bring homeowner into compliance with the governing docvgnents. As. Revised January 1996.