9904-192 (PAT)` LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
f= Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Profd` sionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
O Lr) 3 2dA C-61 30191
r— LLJ
r` Z �Date� r Signature of Contractor%�"f��j'*
O W
(DO. 1
J U C OWNER -BUILDER DECLARATION
W UJJ r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
U) • 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).
C0 O I am exempt under Section B&P.C. for this reason
O N Date Signature of Owner
0)a Q WORKER'S COMPENSATION DECLARATION
o Z cr.I hereby affirm under penalty of perjury one of the following declarations:
Lo H 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, U (/) I have and will maintain workers' compensation insurance, as required by
Q
Ly,
Section 3700 of the Labor Code, for the performance of the work for which this
a- Lo permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
oo O >7'A7 E 3"c.`IvrCf sic ti3'193 ^S
(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
1 subject to the workers' compensation provisions of Section 3700 of the Labor
C�ode, I sha11•forthwith comply with fthose provisions.
✓bate: A1'.%: t /'`.i'Applicant 6" 44 /41./f'' 10K
Warning: Failure to secure Workers' Compensation overage 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.
/nature (Owner/Agent) + %��' 'r xj � t Date 14/74 t0fl,,
PERMIT #
BUILDING PERMIT
!}9044.92
DATE VALUATION S2,W4 saes LOT TRACT
JOB SITE
ADDRESS 4"44 ilASCO .4'AIUZO
APN 646-082.091
OWNER
CONTRACTOR / DESIGNER / ENGINEER
PAT KE' S:ai•XR. & Al •hROSI°IAY
TONY M.Y.BARILN CONST. I'. CO,
48"1 PASEO'#"ARAZO
SOO SI'UKGEt'JN DRIVE
LA. QU NTA CA 92253
CC3STA. MESA. CA 92626
(71,4)979.5493 CRL# 41,40
USE OF PERMIT
TAA/+ -J AI.UMIlu"M4 C,E07I06 PATO COV RS 696 S.F. + 0 S.F.-.156
S.F.) .. 10BO UN38
b>0IiC.'l-ir`I Xr1C? 156.00 S'
2,074.'1
f"ERiMI1. F.6IT SUMMARY
Mrs RY
PLAN Cl11EC:K. FU 101-000439-30,( $35. to
CONSITft:(1(710N M. 101 4MI-4)fid!(» S50i()
w'"ITcONG MOTION FEE- #iI ID 10.1-03-2414k $SU
�Stfit3�`IRc A', CONS"i"RJC'" ION AND
�NDPLAN CHFf.
fitta,0�0t►
L "-•
LESS P10.1:-P1ID PETS
APR 21 1999
6i'ClikS.041t+;.(Vf,)VL
$89.60
I Lia ,,� :
RECEIPT
DATEBY
y
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
a BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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 Pibg. 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)
`f0fW7'oR
*
Tony :.:b
C s Co. PLOT PLAN
566 Sturgeon Dr.
Costa Mesa, CA 92626
I k/115/7()4 4 PHON4�&0p77/— L13Y
1'41
.n;L .4
TXACTIPARCEL MAP LOT
ASSESSOR*5 PARCEL NO.
REAR PROPERTY LINE
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FRONT PROPERTY LINE
STREET
284-263 REV 4/98
I
E'oa���7�oR
Tony M. Yberta ,
consa co. PLOT PLAN
Costa
S rgconMesa.
C 9 loo n ?//q
r.
Costa Mesa CA 92626 � / /-- �
NAME'.1, /'1 7/ O5HA PHON� D 77/— 1 /3,7
SITUS ADDRESS 8'� �y P/�S�o /tzo /A CYCf I �Il; n Z Piz
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TRACT/PARCEL, MAP LOT
! ASSESSOR'S PARCEL NO.
!!!!+ REAR PROPERTY LINE
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STREET _
284_263 REV 4/98
Rev. 4-96
.may/
i
. EXHIBIT "1"
ARCHITECTURAL IMPROVEMENT APPLICATION AND AGREEMENT
DATE t,\J
NAME (S)
(Priny��D
STREET ADDRESS ZIA
e r7 �rz�
LOCAL PHONE I o� OTHER PHONE
OTZ>
REQUESTED IMPROVEMENT / V
- ///� _..�_/� _. //�InA �j'/�� 2/.'.�__.�
0j r-
Approval is requested for the above impr`ovemen't,accordng•-to"
the plans attached., We have. attached two .(.2) sets of. -plans
outlining the .work to .be done along with a complete description
of the materials and' colors to be 'used. ...If we are ' using a
contractor(s), we enclose copies of the Contractor's Licensee.
Attachments:
(1) Two copies of the Architectural Improvement Application -
(2) Two sets of plans with materials and colors to be used.
(2)
Note: One set is for -the management. office; the .other
set to be returned.to you as "Approved".
(3) Contractor's name and copy of contractor'.s license. (Not
required if the improvement is under $300.03 or- if,".
"Owner -Builder").
'
(4) Brochures (2) and/or color samples of manufactured products
to be used.
We have read the Architectural Committee Rules and Guidelines
and have furnished copies to all contractors to be engaged by
us and we agree to comply with those.. Rules and Guidelines.
We also understand that it is our responsibility to insure that
our Contractor(s) comply with said Rules. We acknowledge that,
Building Permits for home improvements may be required by the
City of La Quinta. The 'cost of permits,' responsibility for
obtaining them, and the subsequent inspections will be our
responsibility. In all cases we recognize the requ.irement 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.
Rev. 4-96
ARCHITECTURAL COMMITTEE CERTIFICATE
(Exhibit "A" to the Architectural
Improvement Application and Agreement)
'-!'.'>> k .;`.��_ "t r• .:.':t. __ t• „s•1 ., it +.
The A.rchitectural!-Improvement •Application and"*Agreement was
reviewed by the Architectural *Committee on /Ti and has.
been. ,
Approved y Conditional1 A roved Rejected
PP Y PP J
subject to the following
conditions set forth below
Returned for Further Information '.
Required. M6difi�c'at Lons
I z /tv v
1/ Recording to.be sentbyowner to County-Recorder's
office for roof and/or exterior wall modifications.
Deposit,Required Deposit Amount Requir=d $
Date A c ie ural/mmitt_e..
A* -chi tPr+:ur, ' Commi.ttpP Architectural �Comr.ittee
Ark itectural Co. ittee Architectural Committee
NOTE: THIS APPROVAL IS VALID FOR 90 DAYS FROM APPROVAL DATE