9910-092 (AR)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
/648352 $ g'r' �?bl3i9f2Q?t
ateJ 4 ' '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.
,(, 11 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 f� ENT
n 1 Policy No.
CLf.4:�"it"13J,N A�.4t�S �A. � 0
'A.6itl\.lt�J4L 1 4W
(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, provisions, � Y°
(Efate: L -14 - q`; An licant / " Zt 3`Z, `
PP z- —
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.
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,inspectio'n purposes. -"
/Signature (Owner/Agent) '_' ` sr ' �F ""— r Date./1F `f
PERMIT k
BUILDING PERMIT
11M)IO 02
DATE wivi �VALUATIO N
�lE�y�ii � LOT TRACT
JOB SITE ADDRESS 47-970 VL% NXV,
APN M111.30-0213
OWNER
CONTRACTOR // DESIGNER ENGINEER
pwryH1P, rJHEN
t5p4vE-T iJNSyat IC0 N CO yryTIA: Y
47.970 'SY"iA. NCE .
2016 (ALLE PALO: 1''A iARID
LA. QU3:NVA
`A 92.253
!'.r-lLM ,&PR(NG CA. 422(u2
l�rf1�32�•I f HL`t
USE OF PERMIT
ROOM Atw`I'i PATIO LNON-TRU ruRAL t2E ;iu L -L
d�iJisl's"i�
11111,0 3F
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10t41100-43 -318 543-60
ITFIF,
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li3a-000-420.000
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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 9 ?
Insulation Cie
Compressor
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath G%
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)
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
. CERTIFICATE OF COMPLIANCE
Date 10/13/99 APN # 643-130-025
No. 19469 Jurisdiction La Quinta
Owner NameArthur Cohen
No. 47-970 Street Via Nice
City La Quinta zip 92253
Tract # Lot # Square Footage
Type of Development Residential Addition
Comments
144 sq. ft. room and patio addition; misc non-structural remodel.
Permit # 9910-092
Log #
Study Area
144
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 144 or $ 0.00 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed project may now bcJssued, "'r
Fees Paid By N/A - Gary Counts/Garnet Cons. Co. Telephone :7.74-0736
Name on the check;
By Dr. Doris Wilson
Superintendent
Fee collected/exempted by . Juanita Green Exempt $0.00
< Check No. N/A
Signature
NOTICE: Pursuant C&Assernbly Bill 3081 (CHAP 549, STATS. 1998) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
collect them on the District('s)(s') behalf, whichever is eadier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building DeptJApplicant Copy - Applicant/Receipt Copy -Accounting
• October. 8,1.999
• s ; �- i,.
TG Greg Butler t FAX 777-7011"
' n Euilding kSafety Dep"ent ,
;. "City of La Quints
• y
4 e Staii-Sawa FAX. 777-1233. + {:
' Community'Development Department 4
City of La Quints
FROM, "Rich Lane PH; 346-8184 (work); 771-3640 (home, after 6'pm)
Chairman; Architectural. Committee .•' s
Lake La Quints Homeowners' Association
' ,
The Lake La QuintaAHomeowners' Association's Arohitectural .Committee met Thursday,
October 7,1999 and,took the following actions: '
. �. a , � � '.fir �• ! `y < - }
y The waste bedroom add-on project}5of Art-Cohen;"'47 970 Via Nice , Lot 25 t
Garnet Constructionconstruct: _ _-
__ .Company wi11 the add-�or� ( )
u 'Approved
f The lakeside rear yard flatwork`and landscape designproject of Diane 'Abelnour 47
665 Via Florence (Lot 224):
a . Approved
R The lakeside rear yard'flatwork and landscape design project of Robert Schliek, 47-
380 Via Cordova (Lot 209. Bergin Construction is the general'contractor.
Q, Approved Y :,
." -.. ,, ., + ► 3 - `, .` . it .. ,
The aluma wood patio cover by;Sunland Screen and Awning -for Eater Kay,' 47-875 p,
" Via Trieste (Lot 50) ;
'-Approved...
. t
,r
The retractable cloth"awning by'Accent Awning for Sheila Havas, 47 -655 -Via
Montigo (Lot 260) y
. ❑ Approved '
The'retractable cloth awning by Accent'Awning for Marie Nierma' ' 47-875 Via'
Montigo.(L'ot 247).