0310-020 (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
2_500 C33 '` ,S_ ; 7131 /0�
Date ' F. Signature of Contractor 'f �
I s� 5 s.' -
OWNER -BUILDER DECL\AR.i4TION
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:
j, () 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.
j (.) 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:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
i ( ) 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;»an�d agree that if I Sh uld.become
subject to the workers' compensation provision's of Section090 of'the Labor
Code, I shall forthwith comply with those pAvisidns( ;` w
,..Date 1^1'1004, Applicant
Warning: Failure to secure. Workers Eoinp nsation 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, damage's 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.
a
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 inspecrtion pur oses.
le f
",,,Signature (OwneiF/Agent) j % Date
BUILDING PERMIT PERMIT#
DATE VALUATION - LOT fEtslo, 4 TRACT
10134113
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
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USE OF PERMIT
RATIO
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RECEIPT
DATE
AT I ALED
INSPE
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
BLOCKWAI I APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 VoRage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FA
CIE
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE IV 6y.
J cvYl
gyp `►-w��
�) -? 5 - 75 c3
CIE
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE IV 6y.
10/02/2003 THU 16;43 FAX 760 777 6119 Trilogy at La Quinta 4002402
]n; 5_'.1_ft[t3 1-1: j
Trilogy at La Quinta Maintenance Association
October "l. 2003
ANDREW & IRENE RYPINSKI
00535 JUNIPER LANE
C.A Q INTA, CA 92253
Property AJJress: 60535 JUNIPER LANE
Deiu MR. & MRS. RYPINSKI:
We are pleased to inform you that yotu plans for installation of a rear yard, lighting, fountain, planting,
and irrigation have, teen approved by the Architectural Committee with the following conditions: 1) all
plants, except Mexican Fan Palm, arc on approved list. Amhiteet suggests changing to I lybrid Fan Palms,
and 2),patio, cover is to be white.
This approval docs not constitute consent by the Association for the applicant to encroach, trespass, or
build art an.y properly other than that of the applicant. Tbic approval is tclated solely to the items
t i=rved for approval by the CC&K's in accordance w'itll the Architcotund GuideUes. The aliproval does
not e><tettd to the quality of work done by your architect, or contractor, or to any strucrti al engineenrig,
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 nut relieve you from obtaining airy necessary building permits
from the governmental agencies involved. 7.713ank. you .for your patience in this .tuatter and for complying
with the Association's policies and standards.
Sincerely,
For ilio 1 rchitectural Conutlit.tcc
*. 3 NC
Daon�Ictey
A.w- xiation Mttnae r
Euclosw:e:5
Pr*stiOnathl Mvzgred try t4c0on Properly Management, Inc.
198 Technology Drive. Suite iou lrvitu., CA 91016
949.450-020 40-400-1164 944.450-0303 far
' W1vw.t2cltprt-�iuifnF Curtr