0001-221 (BLCK)LICENSED CONTRACTOR DECLARATION
I herebv 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., Date
655i+.16' �3 J3�r2firi
VDate f' nature 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:
( ) 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 3706 of the Labor_ Code, for the
performance of the work for which this permit is issued.
(v 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:
Gamer 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' compensation laws of California, and agree that if I should become
su •t'ect to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply with th 5`bprovisions.
ate: _ Applicant -04w- 1-
9e d1 z
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, indemnity
& 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 f0 inspection purposes.
Svgnature (Owner/Agent) + .� ✓Akl,�Date--,r=7L/
BUILDING PERMIT PERMIT#
fNfil'34311
DATE ():MOW VALUATION S10,*6i� LOT TRACT
JOB SITE
ADDRESS 78-7a5SUN BROGK LAIN
APN -
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
ltC�l1 IAr'�rT;C'1�\`(� 111 Yf"'
J♦ 1 !l! ..AA 144, f,1 �.i �.
,dA��ia'�F*A?�tlYflaalfi-rnfT'S'fT;�
l' IA.I l\ ,.�.i\t 4�JlYll,ilJi YC 111..
N-755 SUN.EIROOK LANE
3068E. SUNSL7 ROAD, SUITE 14
LAQUINTA
LAS VFGAS h1V 89120
f7S121R)�!c i)tilti
CYR.# W5
USE. OF PERMIT
31
�� +.ik;ivl;4'171k1 tSU.t)..l.�.t(`ili
422" 7 LF-1� 6'(11) OAJ[WhN iitaiUL - Pfkv T O U. S T t1'v 2k -ijFlt A%F i2O4 u
Pki AX.1,%E Uki,ADINO PLAN'S UNt.Y)
4,=.00 LF
is S'�'f l'b A%-r`p.+i�rn crr 'c., y�♦'AT�+ �rss rrrwrxrXa�
�.-wS A'AYI1\!.8`..l/4VY.YE 0!• CLNN,YE LO. I"L.M A%.4AN
vi c 4rrc N1 r
A 0.J,4ti l �Y,V! ON
�1��11i11+i.� �ii'.i:.'�►il�`ill47rili�.'
Oc:�NS'13tUS.."i'kUN i^'kr� )Ut-t)U!)-X8.123-1iOt) �hc:u.5�i
E,a
i-sir+r
7
•
f-,ZL1
'it JP_ .11-n-Al-(:(1N"MUCrtnN ANDAl,ANt:'1AP(-x
Vo -A)
L ESS TO R 1-e 44Vf 11'S
u
TO FAL 1%RM11' Fli,EN 011lea NOW
RECEIPT
DATE
BY�' U
;a.f. LIJl� TI
DATE FINALED
INSPECTOR
r-
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Ait
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 Plbg. 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:
l.Qh 10 -44-44S�a'�-
34-31
r a p
t0F +a -y �--tQ'� �, "`�
s. �I�. CAf -� r� ._Yh f 3-zz-kW
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)
X
A
A
#
City of La Quinta
Building at Safety Division'
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address:
Owner's Name:
A. P. Number:
kC
Address:
Leeal Description:
Contractor
Address:
City. ST. Zip:
F Telephone:
Project Description:.
City, ST, Zip:
t
(764 "V -S /Z JE cy, L/16 S7-
7—
Telephone:
Telephone:
State Lic. #
City LJc5:
Arch., Engr., Designer:
Address:
City, ST, Zip:
Telephone:
State Lic. #:
Name of Contact Person:
-z,
Construction Type: Occupancy:
Project type (circle one): New Add'n Alter Repair Demo
Sq. Ft.: # Stories: # Units:
Telephone # of Contact Person:
1�6'� L� 0O
stimatcd Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
N
Submittal
Req'd
Rec'd
. TRACKING Af
PERMIT FEES
Plan Sets
Plan Check submitted
43
Item
Amount
Structural Cales.
Reviewed, ready for corrections
Plan Check Deposit
Truss CaIcs.
Called Contact Person
Plan Check Balance
Energy CaIcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2*4 Review, ready for correctionslissue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, rcadv for correctionstissue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
y7-�� &� �� ���
C'��
From:CSA ARCHITECTS 805 962 5095 12/01/2003 12:13 #004 P.002
ARCH ITECTS
December 1, 2003
City of, La Quints
La Quints, CA
Re: Plans fob 78755 Sunbrook,Lane, La Quinta, CA 92253 !�
To whom it may concern:
Please be informed that CSA Architects hereby consents to the release of copies of
architectural plans on file for the property located at 78755 Sunbrook Lane, La Quinta, CA,
to Ms. Patty Brown, the current owner of the property. The project at time of construction
was known as Desert Pride and was built by. Inco Homes.
Sincerely, '
CSA Archite s,, I+
Carl Schneider; A.I.A., NCARB
vJ�
330 E. Canon Perdido, Suite A, Santa Barbara, CA 93101 • (805) 962-4575 • FAX (805) 962-3095
\ e-mail; ase @m-aroh.00rn http.//www.caa-arch.com
From:CSA ARCHITECTS 805 962 5'795 12/01/2003 12:13 #004 P.001
ARCHITECTS
DATE: -
ATTENTION:
FAX NO.:
RE:
MESSAGE:
FAX COYER SHEET
December 1', 2003
Patty Brown
760-202-3399
Release Authorization
Following is the release authorization you requested for the City of°Le Quints,
J
SENT FROM: Rachel Hough, Office Manager
NUMBER OF PAGES SENT INCLUDING COVER: 2
330 Bast Canon Perdido, Suite A, Santa Barbara, CA 93101 • (805) 962.4575 -FAX (805) 962-5095
e-mail: rhough&sa-archoom www.cea-uch.com