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0403-064 (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 �1 ci B 0C A / 0�J31 i2t Date Signature of Contractor i 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 3700 of the Labor Code, for the performance of the work for which this permit is issued. (I ) I have and will maintain workers' compensation insurance, as required by Se tion 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 STATE FUND Policy No. (This. section need not be completed if the permit valuat;on OIrs1for $100.00 or less). O I certify that in the performance of the work for,! this pe_ rmit is issued, I shall not employ an person in an �.e k' x b p y y p y3 manner so as.to; beIf come subject to the workers' compensation laws of California, and agree1hat if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code,..l shall forthWith.comply with those provisions. , t?_'W'nnIicant _' Le AC Vk, ,1d WaTing: �Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of.work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. p / Si nature (Owner/Agent) % ='"`" ""`� Date !I BUILDING -PERMIT PERMIT# DATE VALUATION LOT-� TRACT JOB SITEAPN ADDRESS '61459 V y� UMPp:2LAW, OWNER CONTRACTOR/DESIGNER/EN (NEER 'tR1'MA*F_R. MCT= , COMISTRUCTION i3ESIC$M SY—RIWAO IAT► 60.458 JUNIPER LANE 78401 3-1Cyk1.'WAY 111, 0VJT1 F-2 Iw, QLIlA1TTA i."A 92253 LA ir?viWA CA 92253 ,. C16(J)-ni-3593 MCU :5830 USE OF PERMIT x 9S w. o'. AMHUT,RINOOD LATTICE PATIO !COVER PORCH/W10 493,Oi+ Iff ERDM,f�.TED COSr OF C©NWfR JG-J1OY+t PLAN CHECK RX 101-000-439-.31S USA CONSTRUCTION FEE 101-000-418-000 $54.00 TfRONO MOTION FEE • MID 101.000.241.000 $150 MAR 0 5 2004 C9TY OF LA QUINTA FINANCE DEPT 3B40TAL C:01MRUC1101T AND A" 01-M- CR LESS PRY -PAID IPM 6 OTAL0 1�0m.L FEY -9 .L+rVE uANii`4�' ry3,� $99.60 $€00 i ( 99.6 0 RECEIPT DATE BY DATE FINALED INSPECTOR 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 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 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 Fbdures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: :20'0 1.`Trilogy at La Quinta Maintenance Association 3 February 26, 2004 WALTER J. & CATHERINE M MCKEE, TRUSTE 60458 JUNIPER LANE LA QUINTA, CA 92253 Property. Address: 60458 JUNIPER LANE Dear MR. & MRS. MCKEE: We pleased to inform you that your plans for the installation of a patio cover have been conditionally approved by the Design Review Committee with the following conditions: I . Cover and footings must comply with City of La Quinta set backs and property lines. 2. Cover must be pitched for drainage away from the home and should be free standing or attached in such a way that it does not compromise the integrity of the water permeability of the home. 3. Color must match the house trim, or be white. 4. Have your contractor refer to the Association's Design Guidelines. 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 Da n Dic ey Association Manage 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 `.