0311-250 (PAT)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 # Lic. Class Exp. Date
260484 B C53 7 IXv
DateSignature of Contractor—6
f OWNER -BUILDER DECKARATION
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 STATEFUND Policy No. 229-Mrps °ADS
(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 thhatlif-lr should become
subject to the workers' compensationn provlslonsfof-Se! of -section of the Labor
Code,.! shall forthwith comply with those proyigio s.
Date t' 3 ' Applicant � _/N __�
Warning: Failure to secure Worke s+ -Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up toil 00,000, 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.
i 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 albCity;..and State laws relating to the building
construction, and hereby authorize representativeslof this City to enter upon
the above-mentioned pro�erty for inspe� ion(purpose's
B
Signature (Owner/Agent)' �� i( 'r� � � ""'� Date 1
iii•."�::. °`. ,... _ _. _. ..
...BUILDING PERMIT PERMIT#
DATE VALUATION LOT 03 11 -250 TRACT
11/25/0114 S2,793,00 _
JOB SITE
APN
ADDRESS ''•; CM -643 ,1i101�'.I'�"ER LA=,
OWNER
CONTRACTOR/DESIGNER/EN (NEER
F0.-643 YUNTtk EM IJ -,
74691 3 ff& V/YLL1R0PD
L& OLr12E CA CA. 5223.5
'MOUSANDPALW C'.A. 92276
("1613)275-6017 C -'.S111 d 3106
USE OF PERMIT
P=0
210 S.F. AL[; Al AWOOLD LAT?Wt [? PATIO COVER.
Y10RCN/PAT30 310.00 OF
.l�f�`:1`1 �A'�T-10; C0oErT' C33? C� NSIT�,�.�'�' ON
25'793.00
i�AA�q9•� pp��j�yy yyty��� �yp�
AOUIRY
PLAN CRECCY FEF 101.000-4639.318 $35.10
CONSTRIJC:TI 14 1 101-00.1-1118.000 $5 4.00
S'?R0110 MOTTO'H FEE - WID 101.000.241.000 S,SO
\
OV 2 6 2003 .
k
CIT! !I -A QUINTA
FIA' n.'CE C3EPT.
SUB -rOTALCOWT,I- UC'1710 iLAW'O%PWXf
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
1W
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 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 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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
We4,d,k1 d Mcor� S1-e�hehson
Coo(P9 3
L cA. C� u,,ti r� C,4
��as3
Ila�h-Lz
�CLti D COI�W'
wLer-
CITY OF LA QUINTA
vUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE • //-Zr-031 BY<?�
:SPECTION FEE OF $30
-, CHARGED IF THE APPROVED
3 AND JOB CARE ARE NOT ON
SITE FOR A SCHEDULED
.;;SPECTION.
.NO EXCEPTIONSI
' orf. m,.� � ���
Trilogy at La Quinta Maintenance Association
October 7, 2003
WENDELL W. & MARY V. STEPHENSON
Property Address: 60643 JUNIPER LANE
Dear MR. & MRS: STEPHENSON:
We are pleased to inform you that your plans for installation of a rear yard, spa, patio cover, lighting, and
irrigation have been conditionally approved by the Design Review Committee per your drawings.
This approval does not constitute consent by the Association for the applicant to encroach, trespass, or
build on any property other than that of the applicant. This approval is related solely to the items
reserved for approval by the CC&R's in accordance with the Architectural Guidelines. The approval does
not extend to the quality of work done by your architect, or contractor, or to any structural engineering,
soils engineering, or site grading and drainage design. You are urged to obtain the services of a state
licensed professional for consultation as needed.
Please be advised that this approval does not relieve you from obtaining any necessary building permits
from the governmental agencies involved. Thank you for your patience in this matter and for complying
with the Association's policies and standards.
Sincerely,
For the Architectural Committee
*Assciati.n
key
Manager
Enclosures
Professionally Managed by action Property Management, Inc.
29B Technology Drive, Suite 100, Irvine, C4 92618
949-450-0202 800-400-2284 949-450-0303 fax
www.action-online.com