9908-075 (PAT)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
PQpter 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
f /
/e—,q/L ' P Signature of Contractor— -�
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 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).
( ) 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.
( ) 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).
( 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'. ompensation laws of California, and agree that if I should become
subjee to the workers' compensation provisions'of Section 3700 of the Labor
C�de I sh "II forthwith comply with thase provisions.
ate: �! i Applicant -^- -
Warning. Failure to secure Work rs',C mpensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree•to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the ap6'e-mentioned property,_for inspection purposes.
ignature (Owner/Agentp, ��^--•1•� .-__ Date <- 1 `�9
ti. j
BUILDING PERMIT
DATE Ox{ 1311" VALUATION 51g62.j)* LOT
PERMIT #
9%447
TRACT
JOB SITE
ADDRESS ��►•�:1��i��I����{a APN
OWNERCONTRACTOR
r r y �v r CONTRACTOR/DESIGNER
�/)ENGINEER
Fumes -ESLI
Jp / TLtiY pY7GAt,�.SS HILLct 92253
y p �dri3tii�51 ..P/kIAN 3y1_nr tCtO:RONADO 6
tog COL.$ 5572
USE OF PERMIT
N. kTfu
PORCIPPATIO
fi4u.tlte 3,i~
iqS'• �tl SY�11 it 6", i..�`lA:stX %� 1��.Ps i II il� II',kON
PERMIT VER, SONI-MA RY
PLAN CtiJECK Y Ei'i 110i-I31)i7.4:49-319 S c39S
C'f)N,i` ,1st"'t"j(ly3'1 F?4? 101411+110-4194M $4Afl*
ZONC MOTION MT.' - W ,'!D 10t-M,241-WO.Sts
UB-TCYT'A?,1 i"O?dSwi'�tUR- TY:N A TS P?',AN CHECK.
Li. Ste; PR ?-'IUD TIEV's
TOTAL 11%1UNIFF li'MS DUE NM
RECEIPT I DATE I BY / I DATE FINALED I INSPECTOR
571 AS
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
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 I I
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:
/
G
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Nottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
41
LAYlINT:A FAiRi�VAYS^'HdMEWNERS'"ASSc�CIATI(UN
i AV.AiL PROP JzT'Y l,?MA.NAUEMENT� � . i � ,, ;'��
P.U. 'BOX 103'
PALM DESERt CA 92261
568-271• I
/ r ,► r- , r
�. , -•,-�_ JiiJ.y 1.3, 1099
t r IW'
Mr •� Tubs Earl Leslie
50.440 Spyglass Hill DrivC
Lal ui.rita; C;a. 'x)225 �
RE: Architectur. cil Request r
r ,
01
Dear Mr & Mrs :Leslie: �
>
Your request for a rear ya d patio cover was reviewed and a�►proveca by be
i
} ALC
With the follotiving notations; 1
F , .
f 'ill be attached 'to
„c} x 17' roof "A711l. be suppai-te "
.
1 llatase aricl covered, with stucco to IT
l.at.ch fulisb on house• Roof will,be
+ereCl jvlt.11 tail )aper aa -id hot rriop tar. Will 1-1at be visible fro -M
flat and. Col
s ` ,
street/golf course'ar neig]-ibarifig 11010cs." ;
s �;�• ed prior to work st+:rtng L All
' .. All necessary city perin:its will bF:.ohtaln p i
r �n.ecl. lrom,xront Cif bousr and the street. at' c s
l�onsturct.i.an de
will • }��e. l.e� '
the enol of ede,11 Work.
clay.-_--"''�— =.•a
` Sincerely, `h
t
.fir: � • 't'1 1 _�(�1,/t/.. 1�}.•C..�i•'-?"••� � i
Cann Andersori'
Project Max).a:ger
1
• T 1
TO d b�zE+_:�S+(3'�' Z14`_•iW J,J:Id-1IH'0'.,H
1. , � . } - . 4 � • a , � T N. `.'- - - . •moi / +.� ... .,, . � .