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0106-149 (BLDG)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 # u Lic. Class Exp. Date 061 DO . 24• � �f'51C V X. Date / 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: 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). 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 c_ertificate.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 ` Policy No. ,„(This section need not be completed if the permit valuation is for $100.00 or less). O I certify that in the'performand&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;he wofkers' compensation provisions of Section 3700fof the Labor Code, l s all fo hwith comply with th ose provisions. f , Dater Applicant ��� "` �° -�`�" �Warnifig"FalTUure to sec a Workers' Compe sation 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 inspectioses n pur, oy Signature'^(Owner/Agent)kr�i)ate ~ �D BUILDING PERMIT PERMIT# DATE l r VALUATION LOT- TRACT JOB SITE ADDRESS ' APN 43-14-7 t<'^"IX RAiTAS' OWNER CONTRACTOR/DESIGNER/ENGINEER C3OTei ,b 8A .A:CNA - f°OR'll N. ! nlAkkh CO.NW1. CO. CA 92252 CO AINMA CA 92526 ' (7CB1.R 4240 USE OF PERMIT ZZ SIT LATTICE PWf 10 CCFVFIZ ICHO #5038 i POPICY11PATIO M.00 SF .,y:. r Ct. n OF COM 3C',.�'. 0AN 3,657,50 �p �rvr cy n y j �ESTU"'MD A7KE ffilh�.iKn.�M33 .?1.,AA t`lIECK. PRE ate, 101-=-439-31 0 $40,93 COESf`%r,4ltv'1 ION F'`EE 101-OOLI.418-000 03.00 $.,b STP,0140Jiv4t T101-1 FEE M -41D2. .�1,�2>�ClR3a3a�iut�10 JUN 1 5 2001 CITY"GF CA OUINTA FINANCE DEPT MR -10f CCMMUC°.�t':fON AND ,P1AkT CXWMK $104AS J,FZ3 Pk2.Y✓'-PAM FJ70 tai .00 °ItOT',AIL r 'rte' Z)q D11TS NOW 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 Cbmbustion 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 Wali Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath 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 Parts 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 " Extsrior+Receptacies 7E.—F T. Smoke Detectors Temp -,Use of Power Final Utility Notice (Perm) COMMENTS: ' SKETCH/AREA TABLE ADDENDUM Flle No. 7aa_aAa_tea2 Pto Address, 48147 CARIESEPANA6 ST. ou LAOUiNTIm, _ State CA Coup_ AIVERSIDE --ZJoCode 02253.2217 Borrower SUTTON - BAOAWA ro AR OW 11 o �' / '/���•� CANS;tucTCN Tony M, Ybwm 5-6 57��406 PP / coir co. 566 SNrSoon Dr. 2�{�<..;� ,'� "'d. �' Co9TaMem CA 92616.3145 17 wowrig., �. n:'•' i' .ri";i. e l: •t 171 SFR. � •`•�. . is <':�:: _ 2 .. •. :� '' t•.�j' •.t ••��-fit 1 x" ��:'r . F �" 9�(��� .l.h�. •1{',�{h,9,- � � 22 sl s. GARAGE & SAFETY DEPT. BUILDING 10 APPROVED, FOR CONSTRUCTiC3�1.. SCALE: 1 Inch a 20.001001 1 FROM :: SAGAWA-SUTTON PHONE NO..: 760 564.1062 ARCHITECTURAL COMMITTEE CERTIFICATE (Exhibit "A" to the Architectural Improvement Application grid Agreement•) Jun. 05 2001 05:16PM P2 The Architectural Improvement Application and gr ment was reviewed by the Architectural Committee on l3 and has been: Approved conditionally Approved Rejected .subject to the following conditions set forth below Returned for Further Information Required Modifications Comments Yes Ho Recording to be sent by owner ro County Recorder's office for roof and/or exterior wall.modifications. Depo it Required D A o t i d$ 3� Date Arce1 81 ` it A' ATGhitectural Committee Arch i ct�ral Committee xchitectural Committee Att.hitectural Committee ROTE: THIS APPROVAL IS VALID FOR 90 DAYS FROM APPROVAL DATE FROM : SACAWA-SUTTON PHOIE NO. 760 564 1062 Jun. 05 2001 05:15PM P1 r _ � 2 *` EXHIBIT P'l" ARCHITECTURAL IMPROVEMENT APPLICATION AND AGREEMENT DATE_/ NAME(S) STREET ADDRESS�Ca4-/-4& 12EI.fAfY_ LOCAL PHON _ 2 ,16 OTHER PHONEr%G8� REQUESTED IMPROVEMENT • C�f{� .�� f S',�,�,,,� �7`���%' Gov T�i �"' 44/)-1-4e o &,,/ Apr/ 11 Approval is requested for the above" improvement according 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 License. Attachments: (;).two copies of the Architectural Improve'me'nt Applicatio». (2) Two sets of plans with materials and colors to be used. 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. (riot required if the improvement is under $300.00 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 er.gaged.by us and" we agree to, comply with those Rules and- Guidelin' es, Ve also 'understand that it is our responsibility to insure that our Coatractor(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 permit's, responsibility for obtaining the m,and the subsequent inspections will be our responsibility. In all cases 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. Rev. 4--96