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
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.l.h�. •1{',�{h,9,-
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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