0210-137 (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.
Ni,,: License # Lic. Class : Exp. Date -
Date Signature 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 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:.
Cartier,. Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
�r) 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 provisions.
Date: Applicant
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 15is,
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.
Ire (Owner/Agent) Date
BUILDING PERMIT PERMIT#
D`QiiE VALUATIQN TRACT
� �.� �
y ; `F
JOB SITE '
ADDRESS 47„615 ARA MONTAIN A
APN
OWNER
CONTRACTOR /DESIGNER / EN (NEER
ROB MT A' -NM,,
0'M7,LM BUMMER
•4.7.615 VIA MORLWA
1,P, Qumu, CA 92253
r
USE OF PERMIT
427 Sfe A.L111.4:.Pttii+OOD PATIO COVER Pik:& APPhOVED n101'Na17, m O.P;,Txw
ps
FOTt.(.HIRAT.10 tP.00 OF
FIMMA' -IM C'OWT OF ODNST 2UMI:OIy
PTS 4 C II.�I I+?yl 101-000-439-318 $52.6$
CCYIN3 T V_UC T 1014 VF. Is, 101 -000-41 F3 -WO W.60
MON C} M'C10 1 FIP, • IMiD 101-000- 241-000 $.
r.
XIX 110 I1:Q3D PIS Cr. II..�`K
$134.22.
Y, FrUagr VMS DUE ANOW
$3134 22
NOV
.
CITY OF L.A f`• A4'i A
DEPT.
FIIdAt�CE
RECEIPT
DATE
BY-" Ky • �••
-?.o3
DA E FINA ED
INSPECTOR
i��?��v
til
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing .o „$ , yz
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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
Sr; Iver Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas rest
Appliances
Final
COMMEN S:
_ _ a ,�
�7 /�j�` /1!2
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)
4.
F -uinfa Association
Lake LaQ
«,
ARCHITECTURAL/ LANDSCAPE REQUEST RORM
-
Lot 277
• ,. • , r� � ,
# • G • FBF!
.10/02/02 Date Received: -
Date Submitted•ark
ROBERT A. MELKESIAN (Hereinafter "Applicant)
owner's Name(s): LA QUINTA
rt tl
Property Address: VIA MONTANA
578-0085771-9203 Other Phone:
x
i
Local Phone: r s• ?
t(� Mailing Address:
(If didcrnt from pzupesty adlresa)-
- If applicable: '- ROBERT .RICCIARDI• a.,.
q%� = Architect/ Contractoi Naive:
i}�' Tele hone: 3 41 _ 2 2 2 3 --- _ _ __-- -- - .:
The following described modifications are proposed and approval is requested tri accordance,w�th
the
Procedures outlined in the Association s Architectural/Landscape Guidelines (hereinafter "Guidelines° - •4
PATIO-COVER ON WEST SIDE s^t
`` "" Description of project (hercinaftei '[mpiovemcnt')
.
,TO PRVIDE.AND ENHANCE APPEARANCE.'
a
e
1Pleaee. provide a cumplote narrative deseiiption of rlic propuseu rnudificatu�n and inchlde dievzr►gs as approprietej
be.accom anted by:
? ' This Asohiteetural/,Landscape Request Form shall P =
• y.
* 1, All copies of plans and specifications, as enumerated in.the A}�pLcaticn Procedure,
`Article 1i1, withili t:he Guidelines,
£ 2. Complete Architectural im_crovement Agreement, where i�gslred.
3. Neighbors Cornments Section, where applicable. i:.IP;r�,bors should also sigxl rliP nlsns.l
r _ - t
THE APPLICANT UNLERSTANDS ND AGREES TO THE,FOLLOiV1NG:
.�1
1. The modifications will' be made in strict-compliance with the approved plans and specifecatioris
lication: Should any changes be required at an} time during the project, those ti
4 ; Submitted with this app
x i
changes must be aj�provzci in advance' by the Architectural Review Cori mittee and noted on this a
3 g
application, ;. =h
2-Owner shall hold the Association harmless from all liability related to'any damage to existing S,!
r'
residences. llliprC!YBrflellts themon, any cornmoq� rea propel t�`-
' -. dvi9e'Assa^iation`offiee �roInPtly upon completion of the work.
L� 3.. Applicant shall a r
• '� , • a i � a � Standards for V I.
4:' Applicant shall comply with the Architectural / Landscaputg l;utdeLrrzs and Design
Lake La Quints Associalior, and furnish' copies of these p.ovisions to the contractors) engaged
be owner for the improvement, Applicant further understands that it is Ow'ner's re:sponsibili[y to
ensure that`his/her, contractor(s) alcomplies ts,rth if required it d lise y the local governmental ent V.
5. Applicant shall'secure Proper building p
lens which have not .4
the City of La may notapp rove ani
Applicant understands that p a
yet been approved by the Association's Architectural Committee
i ' T
OWNER SIGNATURE
C. property t:
.. N@ig�bor Comments. ('rhe c3mments o` any owners of ` tic -me
ed�acrnt to LireHues of the applicants
improvement shell be required far awnings; ouilt-in barbecues arid waur features, con nd3CiP ° �� pale a such Af
W61115, mist cooling s��teme. petii, extensions, pods / spa's, room additions f cr_closures., k� •F.
otlie•r improvemeim the Arenitecnfral RevieK Committee deems aNprupriaLe)
_f th�'ab6ve
4C
,SF I/ We, the undersigned, have reviEwed and -signed the plans and epecifi^ati object
ect v,th t e foLow�ing e� -'
improvement and I f we either, (11; do not object to this improvement; or (2) _
t�
comments: a ` 1 Y 11
}.. A f!l
-- --= -- — Lot # Comments
,Nei hbor's Signature /Printed Name
w, . u' awe , v„(/� • (-r �l' , ,
jFse Association use only , %'! • . r, ' • _ ' kt '
L' v COMMITTEE REVIEWlett:` „
LJAPPRO�JED as sby
ubmitted. Project to be comp
❑APPROVED subject to the following conditions: - , C1 DENIED DENIED for the following reasons:.:.:=_:_—....----...:-- - _-: ---- - -----
❑ HELD OVER per_diifg receipt of the follo1NIVn , -d nnation from Applicant: J
Committee Member, y(fi — - —
'= APPLICANT NOTIFIED OF APPROVAL/ DISAPPROVAL Date:'
7r
' s •.. • '• . S `wk ter. .:'. ' - • ,
rJ, �,r , • A ` a` J fK,
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YO UNG ENGINEERING SERVICES
Engineering Architecture -Surveying- Building & Safety Services
Letter of Transmittal
To: City of U Quinta Date: 11/25/02
Project: 547-615 Via Montana
Attn: Ed Randall PC#: • 210-137(2" . check)
Tel No.: (760) 777-7012 Tract No.:
We are forwarding: X By Messenger By Mail Your Pickup
No. of Copies Description:
' 1 Set of new plans
1 Struct calcs/old struct calcs
r
at Comments: Plans ate acceptable.
. r
This Material. Sentfor:'
Your Files �..1. Per Your Request '
Your Review x Approval
Checking At the request of:
Other
By: Eric A. Frenzel
Phone #' 760-360-5770
77-804 Wildcat Drive, Suite C, Palm Desert, CA 92211 (760) 360-5770
Bronz Young