9604-103 (PAT)Y 7
LICENSED CONTRACTOR DECLARATIONµ
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 # Lic. Class. Exp. Dat/e.� "
C+ipi > B .3/�V91;
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:
( )
-1-,'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 isfissUedPMy;workdrshcompensation insurance carrier & policy no. are:
Carrier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
() 1 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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with thos��e,,prov.isions.•!:%
")(Date: "' •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 p
furposes. /
f `rr ( ,
Signature (Owner/Agent) �'t''' r' �r��r�`:'��'� Date V4) t
PERMIT # CONTROL #
BUILDING PERMIT
81604-1113 314
DATE, ap,(!)♦<j VALUATION '��;>E�3,xQ LOT TRACT' -
JOB SITE78-770 SL*�'�i �..�.f�RS MIX
ADDRESS
769-6' 769-i►'5�f?4
OWNER ,
CONTRACTOR/DESIGNER/ENGINEER
R,01,11ALD D B :IAM �
{�fL1&1N11 ,'()N.1S W'MON
716770 IiP1''Ol:.A,` S HILL 1: R
:39060 ;KtLIMANJARC•) C'I'.
LA,QUIN`1'A CA 92243
PAL>'14. DESERT CA 922.11
fa'I9i5fd••Fi037
(67.9)1,14-7998 CBI;.# 3799
USE OF PERMIT
CIOVk.:RM_ P r1Cy
r txa+t�.tarr.-�,.t,.rtir •s 4.0 ar'
OSB. I VJ.AI f`i) MST OF CO S TR1.`C i ION .
�j.�7wT•f3�7
P11100111'0V SUMMARY
1'irAN CNFfi)C.Fd's8 tOt-000-439-:318
CONS`)'RUC'ftONFls`E 101-()(-}(}-41t?'m $81100
1' '40 tM0110N I -VE - RESM . 1111 -W, -'6%4I -NO $,s-4
isi:.EiC" C KlGA7', FEE $14.(11)
SIJIO� CU"I' U, C9►j NSiICJ.•rI011 013 P1 LAN (,-`,H K
S1.19.19
TIESSB-PA10% FEES
.
�
�C
,t%?r p RAff ipr"s` O4YNOW
$149,19
APR 2 2 1996 E
RECEIPT
DATEBY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i
Underground Ducts
Forms & Footings G •
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck [,L�_
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 PI . 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
LovVo&Ve.Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Desert Fairways Homeowners Association
Architectural Committee
April 13, 1996
Cam Anderson
Avail Property Management ;
P.O. Box 1032
Palm Desert, CA 92261
SUBJECT: Architectural Committee Review of
REQUEST FOR.ARCHITECTURAL VARIANCE APPRQVAL
• Dear Cam:
The Architectural Committee reviewed' the Request for Architectural
Variance Approval from Mr. and Mrs. Hawks, 78-770 Spyglass Hill, for the
' installation of a stucco, covered patio addition t6their house (rear yard) to"
match the house and roof.
The Architectural Committee unanimously approved the site plan as "
submitted to Cam Anderson on April, 11, 1996.
The following committee members approved: Anne Eisler;.- Norm Moore, Bill
Murray, Deana Wentworth and Bob Larsen. '
Desert Fairways Homeowners Association
Architectural Committee
770 S �.
L__ i i Y U r 1.H�04
i„lU 1 1V'1'4 k
Contractor %�) /�, • �o� S Address '31
Owndr� (�,� kS Job Address
AA Q aG/ * /fi
This form shall be posted on the job with the Building Inspection )Card at all times i
conspicuous place. It is the responsibility of the General Contractor or the Owner/Bui]
to monitor the sub -contractors that are on this list are the same persona performing
work . Any changes of this list must be approved by the City of La Quinta Department
Building and Safety prior to work being performed by a changed sub -contractor. Failurt
comply will result in a stoppage of work and/or the voidance of building permit.
TRADE
SUB -CONTRACTOR NAME.
CONTRACTOR'S
LICENSE NO.
WORKMAN COMP.
NO. ON FILE
CITY BUSINES!
LICENSE NO.
GRADE/
EXCAVATE
PIPELINES
CEMENT/
FOUNDATIONS
CEMENT/WALKS'
6 DRIVES
1 SD
('0 JJ rr
ASPHALT
FRAMING
�Al'o e O
j.S
nn
l_ � Spy
r, ` � � i. i C
� - G
r
STEEL/
STRUCTURAL
MASONRY
PLUMBING
LATHING
LSI r� f.
DRYWALL
PLASTERING
1 -
HVAC HVAC
ELECTRICAL
%%
/ I
ROOFING
SHEET METAL
FLOORS
-
GLASS/
GLAZING
'INSULATION
SEWAGE DISP
PAINTING/
DECORATING
TILE
CABINETS/
INSTALLATION
ORNAMENTAL
METAL
FENCES/
BLOCK WALLS
LANDSCAPING
OTHERS