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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
Profess onals Code, and my License is in full force and effect.
License# Lic. Class Exp. -pate
6782_' C-61 X703 �.. , _ 10131/19!
Date Signature of Contractor-
OWNER -BUILDER DECLNATION✓
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.
(,.have and will maintain workers' compensation insurance, as required by
S ction 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.
SC is E r,1110 t,-rd'-t?I`rft"7,19
(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
Ce
to the workers' compensation provisio sof Section 3700 of the Labor
ode, I shall forthwith comply with. provisions.
Date: " l A 2'_ Applicant f
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.
I .,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
th /ab
ove-mentionedned property for inspectior"`purpo,ses.
Signature (Owner/Agent)_'-Date
BUILDING PERMIT PERMIT/t
!f 4*5_226
DATE 0511711" VALUATION S2 .00 LOT TRACT
JOB SITE rte' APN
ADDRESS 48-548 V1lLk AKUSTAD
OWNER CONTRACTOR/DESIGNER/ENGINEER
HERB KOScx(� F NTLA4 PLA WING COINIPAN'Y
48 -Mg VIA A.NI:1STAIJ 754 Wfl-LIA(VIS ROAD
i,,f1 QUINTA CA 92253 PALM SPRINGS CA 92261
(760)327-8466 cel # IM
USE OF PERMIT
GEWE LAL, t1i1il.Ui.PlO
[80 S.F. AT,;( MAS TOOD IIATIO COVER
PORCHMATIO
180.06 Sir
jE a a'10".AIT D C aST OF C.GIN.1kMUCT11ON''
PERMIT FEE' SUMA"RY
ftAN CHEiCK I; FX 101-f>0 )439-318 $35.10
(Y'YWIM! IM 0 t FEF 1014,W-41 "00 $54,on
71tC1N i NIMION 1i EL - RVK) 101.000.241-000 5.50
RECEIPT
.StYB-1XJr1'A1 C0N1,;T :� r('.TI®N' ANn PLAN CHECK
LESS PRE -PAID FEES
BY I Vr -_�, I DATE FINALED I INSPECTOR
2J94.00
$89.0
$11.00
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 k,11
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 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
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)
COMMENTS:
Owner:
5"6 VIA A J
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSi'RUCTION
SUBJECT TO INSTALLATION AS PER
AND ALL APPLICABL CODES
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L IMO COLUMNS MINIMUM REQUIRED,
ALUU. RM'TER_4' k d A`w
SEE SCfnUI[ EOR 91E
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OEM
x r ALU. COLUMN.a
1 r Atw. SIDE-
IFfn1AlF 1 x D.f,UTS-ATEFOtATEWOOD
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k 1 OF. SIDE PLAIE
OPi. 3 I/r CONC. SEARSNF1YSIAXE
OR ABISC0
NICII7R 1111111 CONCRETE
Eoollnc nP. OR 10011%
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WDIOU1 ANCIXIRS.
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SIDE VIEW
i 10 OOUCW FR - LARCH i2 MAX WOOD HEADER WAY BE SUBSTfRM FOR r T r ALUM. rX r ALUM. BOX SEMI OR I
4ADER USSEE COLUIM T EAO
SPACING FROM r x Er D42 ALUM. IIER. rx rx 12 GA. STEEL 'C• BEM, L1WER
tX3 l/f OR rxr RAFTERS. ALTER'A SHALL CONSIST OF 1U- ' OPT. ALTERNATE 'Er (IB' ROOF PANEL)
SEE SMULE FOR SIZE 7/
��� ROOF PANELS, PLACED PARALLEL TO •OPj. ALTERNATE '� ��k01 '9'
�� ALTERNATE 2-YX6 1/r STRUCTURE ATTACHING W 2 10 (18 ROOF PNIEL
READER N PEACE OF I I ) !/
HEADER WITH POST SMS TO RAFTERS. 49 24' MAX.
AND SIDEPLAFES ALT 'ff SHALL CONSIST OF 113- ROOF LARICE OVERIWIG 16' FOR O'HAENG-6
PANEL PLACED PERPENDICULAR TO I I/7' x 1/2' OR IS* FOR MIN. O'HIING
X r POST STRUCTURE AND ATTACHED W/Z #10 SMS r X 4'_
.43 TO BLOCKING.
\ WERNNE 2-t x 6 1/2' HEADERS. LAFRCE: .018 X 1 1/2 X I 1/7' 0 3 I/1"
OR 7 O.C. OR 1 X 4 0 6 OIT B' O.C.
.p N p NOTES: vtE � I �p� %5 8•- MAX.
IBE1fi12R#Y lArm USIflc 00RNC55 W/9 0 IO I. f1IIS STRUCTURE MAY EIOF OE ENCLOSED WIRI ' COLUMN HT.
AALOTWILE SPLICE REOD !COLUMN OHS GPEN LATTICE. - ���'
R o cI 2. FOR GENERAL NOTES SEE OWC 05003 SIR. I
OF 16 AND 2 OF 16.
3. FOR ALTERNA� [AVE ATTACIIMEW OF RAFTERS
SEE DETAIL ' OF OWC. NO. 35003 SISI. J OF 16.• ✓ i� t 0
4. FOR SAY SINCE AND ABCSCO ANCHOR DETAIL
fDROI I I PR CFET
ll SEE DWG. NO. 35003 SISI. I I OF 16.
5. MAX. HEADER OVERIWIG = 40% OF COLUMN
SPACING FOR UP TO 16' PROJECRON AND 337, OF l�Qd yn.
COLUMN SPACING FOR 17'-70' PROJECRGPI.) 1/
ON. E EP Of �►,
6. DESICU PER U.B.C. 1991 EOIRON. r CON �C$(�► f1 , ��J
SUB- SEE NOME d LAGUNA-TYPE OPEN
• 7. FOR RAFTER IIANCCR, HEADER 10 SIDEPLATE OR +IS ON IWC. 15003, '�`�" 3 � l
COLUMN CONN., RAFTER TO HEADER k COLUMN TO St15 Z OF 16) p`0a
SPLICE LDtaT10N5 FDR OPEN LAFIICE AWNINGS FOOTING OR SLAB AIIACII. SEE DWG. NO. J5017, SIRS. 6, 7, AND 8 OF 8. p� LATTICE STRUCTURE
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a� •Y. •�, } BUILDING PRODUCTS INC. p"`01• I'• IfI.O-I�tl
No. 1. J
357
EXP ALF IC.B.O. ES. EVAEUAl10N REPORT N0. 2621P
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ARCHITEC.TURAL.COMMITTEE CERTIFICATE
(Exhibit "All to the Archit'9ctoral
Improvement Application and Agreement)
The Architectural Improvement Applicati.6n and Agreement was
reviewed by the Architectural Committee on and has
been:
Approved A Conditionally Approved Rejected
subject to the following
conditions set forth beloW:
Returned for Further Information
Required Modifications
Comments
Yes No
Recording to be sent by owner, to County Recorder's
office for roof and/or exteria*T: wall modifications.
Deposit Required. Deposit
Ah UYquired $
4
Dade Tr-cUAect.:.6ra�1 Committee
kroitectural Commi ee Architectural Committee
IC
rc ctural Commitlee Architectural Committee
NOTE: THIS APPROVAL IS VALID F . OR 90 DAYS 'FROM APPROVAL DATE
Rev'. 4-96
ARCHITECTURAL
NAME(S)
STREET
LOCAL
EXHIBIT ''1"
IMPROVEMENT APPLICATION AND AGREEMENT
DATE AM
A V /C.4 /A
y ? S y s (Print
ADDRESS /1
PHON7o�.5 G y_/� 3 �� _OTHER
PHONE ,310C—�
V�- sE 73�'
REQiJESTRT)
IMPROVEMENT
IA %%/c tf
ries
c o vz-R
4?
Approval is requested for the above improvement according to
the plane: attached. We have attached twu (2)
outlinin sets of plans
g 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;
(1) Two copies of the Architectural Improvement Application.
(2) Two sets of plans with materials and Colors to be used.
.Note; One setis for the management office; the other
set to be returned to you as .!Approved".
(3) Contractor's name and copy of contr:actor's license, (Not
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 engaged by
us and we'agree to comply with those Mules and Guidelinea.
We also understand that it is our responsibility to insure that
our Contractor(s) comply with said Rules," We acknowledge that
Building Permits for home improvements mpy be required by the
City of La Quints; The cost of perm.i,t' responsibility for
obtaining them, and the subsequent inspections will be our
responsibility. In all cases we recogni4e 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
Page .Three
We further agree that this improvement. :will be completed in
a reasonable and diligent manner. We - fut-ther agree that 1) if
we do not correct any damage caused as a result of implementation
of this improvement or, 2) if we f8il to complete this
improvement within the allowed time Irame the Homeowners
Association may elect * to complete - the work and ' /or repairs, and
responsible will be resonsible for the actual costs of such -work. Payment
to the Association is authorized by u.,0 in the -form of an
assessment -or monthly penalty payments'.; as approved in the
Guidelines.
By signing this Agreement below, we agr.ge to be bound by its
terms and conditions and any conditionsset forth by the
Architectural - Committee in the Ar;ehitectural Committee
Certificate, which is attached hereto aq I Exhibit "A" and made
a part hereof 'by this reference.
Signatures of all Owners:
/ 7
V
(
(Signatut'e) SignatTre)
Rev . 4-96