0401-390 (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
67086 D MO A �.. SJ3 11105
Date t-4 e r - (nSignature 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.fpr 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:
CarrierS- Policy No: - -
1'.t�,'F� MD
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those�ppro�visions.
A Date: ' W' " Applicant-
Warning:
pplicant
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.
r1. 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 dayswill subject permit to cancellation.
I certify that I have read this application an 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 purposes.
4
Signature (Owner/Agen�ft) �' y-L`�," • Date 0
BUILDING PERMIT
DATE VALUATION LOT
Y,M1tK
$3,40040
PERMIT #
0,01-31N . TRACT
JOB SITE APN
ADDRESS W•WX2 a "ONIPER LAM _ «
OWNER CONTRACTOR / DESIGNER / ENGINEER
�'Tl'.'�fi3?.9 &LINDA AJFELSON C01V5`T.t UC"I1UfF UMTC4N SYSTEMS 19C
60-602.SU211PE3 LAWE '??AOI 1W- 1..1f:W.> Y 111, gi1TYEF-2
LA Q:[J'tKrA Cis. 92253 Ste, QM TA. C k 32253
(760)771.3593 CH116 5830
USE OF PERMIT
FA:.t�:C1
256 Ill J ,I..i4NLf;.'6 OOO PRF1O CC"`✓EIZ
PORC,11JT ATIO
256.00 5F
EfiM MATED, C09r OF C0111S '.1Ri3•M'OIV 3,404X0
PIM CHECK FU 101.000-4 9.318 141 96
CONSt`RUCT101f FEE 101-000-418-.000 $63,00
STRONO MOTION VER • RESID 101-000441-000 $.so
SiTPo'•°90T AL GOil 'MUMMY, AND PLAa'1+d" O'1�',1UK $104.45
IXW PRE PAM FEW $p.00
. `}i `Sd3�r d".�,�'�` t i• .. ' t .8157 no. d9?LMrAS
D
AN 2 8 2004
RECEIP I DATE �, ! f pPFE FI Lhp ED „� INS OR
CITY o n r�
idmwrA.. .j, C171(J
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)
N
CDS Fax# 760-771-492
:�rierium�,x
13U111)ti\(:1'lt()UUCI'S, t\'C. ALUMAWOOD NEWPORT AND LAGUNA ORDER FORM
ROMOLAND, CA ORDER DAT �IV %L`�`�''CK UP
800-350-5209 Fax - 800-530-9222 —T
CUSTOMER C . D . S . , Inc.
CITY La uirita
FAX (7 6)0 771-4q3
PROJECTION LENGTH 3 LIVE LOAD 10 . 90
MPH ATTACHED
RESIDENTIAL
ATTACHMENT WALL _ EAVES ❑ MOBILE HOME Ig( SLAB
13 (3 FREE -STAND PATIO COVER [3 COMMERCIAL CITY 13 FOOTING
COMMERCIAL
LAGUNA /Lattice
X STD SPACE 3" O.C. WITH 1-1/2" TUBES
❑ STD SPACE 4" O.C. WITH 2" TUBES
1, caps=beveled
COLORS
❑ WHITE
DESERT SAND
❑ SONORA BEIGE
13 ADOBE
❑ MOJAVE TAN
❑ FLAT
h MITERED
❑ CORBEL
NEWPORT/Solid
❑ WHITE STEEL C -BEAMS ❑ 20' ❑ 24' 1330'
X DESERT SAND' STEEL CLOVER LEAF ❑ 10' ❑ 12' ❑ 14'
❑ SONORA BEIGE
❑ ADOBE POST HEIGHTS: 8' 10'
13 MOJAVE TAN
❑ RF EXTRA PARTS
❑ ALASKAN GUTTER 801/006 ONLY
SUPER 6 FLAT PAN RC
❑ WHITE 13-018 ❑.024 8032
❑ DESERT SAND 0.018 8024 11032
❑ SONORA BEIGE 13.018 13.024 13.032
❑ ADOBE 13.018 13.024 13.032
❑ MOJAVE TAN 0.018 0.024 C1032
ALL COVERS ORDERED AS PACKAGE MUST CONFORM TO ENGINEERING PRINTS.
LAYOUT PLOT PLAN (SHOW GENERAL LAYOUT OF HOUSE AND COVER LOCATIONS).
Please draw in mmnn.ti....A .—_ .
Visit our web site at
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Total Sq. Ft. oZJr�
August 2002
01/26/2004 12:54 9094841891 ACTION PROPERTY MGMT PAGE 02
Trilogy at La Quinta Maintenance Association
January 26, 2004
STEVEN & LINDA C. NIELSEN
60602 JUNIPER LANE
LA QUINTA, CA 92253
Property Address: 60602 JUNIPER LANE
Dear MR. & MRS. NIELSEN:
We are pleased to inform you that your application for installation of a patio cover has been'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. If any portion of the common area is damaged during
construction, repair of same will be done by the Maintenance Association's contracted landscaper and fees
for the work will be deducted from your security deposit. Thank you for your patience in this matter and
for complying with the Association's policies and standards.
Sincerely,
For the Architectural Committee
Dayton .Dickey, CCM
Association Manager
Enclosures
Professionally Managed by Action Property Management, Inc.
29B Technology Drive, Suite 100, Irvine, CA 92618
949-450-0202 800-400-2284 949-450-0303 fax
www.action-online.com