04-5866 (ELEC)r
I
BUILDING & SAFETY DEPARTMENT
P.O. Box .1504. (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number
Property Address . . . . . .
APN:
Application description . .
Property Zoning . . . . .
Application valuation .
04-00005866 Date 8/06/04
80355 VIA PONTITO
772-450-040-76 -298.942-
ELECTRICAL
LOW DENSITY RESIDENTIAL
0
Owner
Contractor
SEDONA HOMES, INC.
SUNROSE
CORPORATION
49-950 JEFFERSON ST. #130-134
499.50.JEFFERSON,
#130-134
INDIO, CA
INDIO
CA 92201'
INDIO CA 92201..
(760)
772-8224
(760) 777-7522
WCC:.
STATE FUND
WC:
16404622003
09/22/04
CSLB:
533.670.
06/30/06
CCC:
B .
Permit . . . . . . ELEC-MISCELLANEOUS
Additional-desc
,
Permit Fee* 30.00
Plan
Check Fee
.00
Issue-_ Date- ._ .. _....,_:
Valuation:
0
Qty Unit Charge Per
Extension
BASE
FEE
15.00
1.00 15 -.000.0 -EA ELEC
,TEMPORARY
POWER POLE
15.00
Special Notes and Comments
TEMP POWER POLE
Fee summary Charged
Paid
Credited.
Due
Permit Fee Total 30.00
.00
.00
30.00
Plan Check Total .00.
.00
.00
.00
`Grand Total 30.00
.00
.00
30.00
2004
CITY OF LA t,IUINTA
FINANCE DE PT.
— -
P.O. BOX 1504
78-495 CALLS TAM PICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
VOICE: -(760) 777-7012
FAX (7.60) 777-7011
INSPECTIONS (760) 777-7153
Date:
Architect or Engineer's Address:
nn ,
Lica No.:
BUILDING -PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that lam licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
e, and my License is in full force and effect.
icense.Class cense No.
",--Date_ trractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter. -improve, demolish, or repair any structure, prior to its Issuance, also requires the applicant for -the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale, If, however, the building or improvement is
sold within one year -of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U. I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ I have_and_will.maintain a certificate.of, consent -to selfinsurefor workers' compensation; as provided,for by'Section 3700 oftfie Labor Code fog the I: rfce
&jria_
of the work for which this permit is issued.
I have and will maintain workers' compensati n insurance, as required by Section 3.700 of the Labor Code, for the performance of the work for which this permit is
issued. My workers' compensation i nce carrier and policy number are:
rtier. olicy Number
I certify that, In the performance of the work for which this permit is Issued, I shall not employ any person 1n 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_ plicent
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING.AGENCY
hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT
Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La 0uinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authoriie.repr sentatives of this county to enter upon the above-mentioned property for inspection purposes.
Date Signature (Applicant or Agent):
1
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Application Number:
Property Address:
APN:
Application Description:
Property Zoning:
Application Valuation:
BRES2017-0066
80355 VIA PONTITO
D �� VOICE (760) 777-7125
FAX (760) 777-7011
DESIGN & DEVELOPMENT DEPARTMENT INSPECTIONS (760) 777-7153
BUILDING PERMIT
Date: 5/24/2017
Owner:
GENEVIEVE ROBIMSON
777110041
GOODRICH / DEMO AND REPLACE COV PATIO COLUMN AND ADD FIREPLA , 92253
$40,000.00
Applicant:
FEDDERLY & ASSOCIATES
78206 VARNER ROAD STE D #248
PALM DESERT, CA 92211
LICENSED CONTRACTOR'S 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 Professions Code,
ae and my License is in full force and effect.
License Class: B License No.: 762889
/ Date: Contractor: be&
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's State
License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair
any structure, prior to its issuance, also requires the applicant for the permit to file a
signed statement that he or she is licensed pursuant to the provisions of the
Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division
3 of the Business and Professions Code) or that he or she is exempt therefrom and the
basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a
permit subjects the applicant to a civil penalty of not more than five hundred dollars
($500).:
(_) 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 and Professions Code: The Contractors' State License Law does not
apply to an owner of property who builds or improves thereon, and who does the work
himself or herself through his or her own employees, provided that the improvements
are not intended or offered for sale. If, however, the building or improvement is sold
within one year of completion, the owner -builder will have the burden of proving that
he or she did not build or improve for the purpose of sale.).
(_) I, as owner of the property, am exclusively contracting with licensed contractors
to construct the project. (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves
thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
(_) I am exempt under Sec. . B.&P.C. for this reason
Date:
Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for
the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Na
Lender's Add
Contractor:
FEDDERLY & ASSOCIATES
78206 VARNER ROAD STE D #248
PALM DESERT, CA 92211
(760)773-5205
Llc. No.: 762889
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one o` the following declarations:
_ I have and will maintain a certificat ? 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.
(have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the perfornance of the work for which this permit
is issued. My workers' compensation insurance carrier and policy number are:
Carrier: SECURITY NATIONAL INSURANCE COMPANY Policy Number: 762889
I certify that in the performance of the work for which this permit is issued, I
shall not employ any person in any manner sows to become subject to the workers'
compensation laws of California, and agree th et, if I should become subject to the
workers' compensation provisions of Section =700 of the Labor Code, I shall forthwith
comply with those provisions.
Date: 7 Applicant:
WARNING: FAILURE TO SECURE WORKERS' CCIMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMILIAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSAND DOLLARS ($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.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT: Application is hereby made to the Building Official for a permit subject to
the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this appl'cation 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 application , the own-er, and the applicant, each agrees to, and
shall defend, indemnify'and hold harmless the City of La Quinta, its officers, agents, and
employees for any act or omission related to tie work being performed under or
following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and hereby authorize representatives of this c'ty to enter upon the
above-mentione property for inspection purposes.
Date: 15/24 / 7 Signature (Applicant or Agent): 1
(vv 4T-10 Feb& w sk Asxxp ks
Application Number:
BRES2017-0066 Owner:
Property Address:
80355 VIA PONTITO GENEVIEVE ROBINSON
APN:
777110041
Application Description:
GOODRICH / DEMO AND REPLACE COV PATIO COLUMN AND ADD FIREPLA , 92253
Property Zoning:
Application Valuation:
$40,000.00
Applicant:
FEDDERLY & ASSOCIATES
78206 VARNER ROAD STE D #248
PALM DESERT, CA 92211
Date: 5/24/2017
Contractor:
FEDDERLY & ASSOCIATES
78206 VARNER ROAD STE D #248
PALM DESERT, CA 92211
(760)773-5205
LIC. No.: 762889
---------------------------------------------------------------------------------------------
Detail: DEMO (1) COLUMN FROM EXISTING PATIO AND REPLACE W/ A 5.5 INCH X 13.5 24F V8 STRUCTURAL GLU-LAM BEAM, ADD (FIREPLACE ON VERANDA
PER2016 CBC
FINANCIAL •R •
DESCRIPTION
ACCOUNT QTY AMOUNT
BSAS SB1473 FEE
101-0000-20306 0 $2.00
Total Paid for BUILDING STANDARDS ADMINISTRATION BSA: $2.00
DESCRIPTION
ACCOUNT
:QTY
AMOUNT
FIREPLACE
101-0000-42400
0
$152.00
DESCRIPTION
ACCOUNT
JQTY
AMOUNT
FIREPLACE PC
101-0000-42600
0
$228.00
Total Paid for FIREPLACE: $380.00
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF
101-0000-42400
0
$22.80
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, EA ADDITIONAL 500 SF PC
101-0000-42600
0
$18.24
DESCRIPTION
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 100 SF
101-0000-42400
0
$51.68
DESCRIPTION.
ACCOUNT
QTY
AMOUNT
REMODEL, FIRST 500 SF PC
101-0000-42600
0
$141.36
Total Paid for REMDDEL: $234.08
DESCRIPTION
ACCOUNT
QTY
AMOUNT
SMI -RESIDENTIAL
101-0000-20308
0
$5.20
Total Paid for STRONG MOTION INSTRUMENTATION SMI: $5.20
DESCRIPTION
ACCOUNT
QTY
AMOUNT
TECHNOLOGY ENHANCEMENT FEE
502-0000-43611
0
$5.00
Total Paid for TECHNOLOGY ENHANCEMENT FEE: $5.00
Bin #
-SA
Qty of La Quinta
Building 8T Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
-
Permit #
710()66
Project Address:
Owner's Name: GllAtA
A. P. Number: l\Wq—L4
Address:'.a
Legal Description:
City, ST, Zip: ZpaAiEsq�LL!L_0\A 43 -Ma
Contractor:
Address: W" cl
Tele hone: I.Sq- owt
Project Description:C-0
0 Vk A k>kf
60
City, ST, Zip:
111 0 t emw\l N W.
Telephone:
.15,-S
hf-)oAlt brft* eq-
State Lic. #:
City Lic. #.-.
!A
Ilk Ir
Arch., Engr., Designer: -V-��Wy
RR 19 20
12 20 7
Address:
rITV 7
City, ST, Zip: )ty�nx 9 0-
OF LA Q1JII 1
COMMUNITY DEVELOF
Telephone:
.........
Construction Type: Occupancy:
61
State Lic. #: aiab9
Project type (circle one): New Add'nCAlt7
e), Repair Demo
Name of Contact Person: 01
Sq. Ft.:
# Stories:
#Units:
Telephone # of Contact Person: -7�O
Estimated Value of Project: 06)6)
rF-0r=RLM.tpJM APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req1d
Rec1d
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount'
Structural Cafes.
Reviewed, ready for corrections
Plan Check Deposit
Truss Cafes.
Called Contact Person
Plan Check Balance
Title 24 Cafes.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"' Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review, ready for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
I
fit
A
IMENT
THE HIDEAWAY
PROPERTY OWNERS ASSOCIATION
May 23, 2017
Mr. and Mrs. Robert Goodrich
PO Box 2151
South Zanesville, OH 43702
Re: Lot V76 at 80355 Via Pontito
Remodel: Paint Modification
Dear Mr. and Mrs. Goodrich:
This correspondence shall serve as notification that the Hideaway Design Review Committee
(DRG) reviewed and approved your request to modify the paint/stucco color at your home based
on the field sample provided.
This work may begin at your convenience. Please contact Brook Marshall at 760-219-8057 or
by email at DRCFacilitator@gmail.com or Sharron Badham at the Association office with any
questions regarding this review.
Sincerely,
THE HIDEAWAYUE;SIGNREHEW COMMITTEE
By: mmwkWIL
Title: tl j"+' ` Date:
cc: Fedderly & Assoc.
DRC File
Pursuant to Cat Civil Code, any rejection by the DRC may be appealed to the .Board of Directors for the Association- If you wish to pursue an
appeal, please contact the Association 's properly manager directly.
80955 Avenue 52, La Quinta, CA 92253 • 760-393-5210
THE HIDEAWAY
PROPERTY OWNERS ASSOCIATION
May 23, 2017
Mr. and Mrs. Robert `Goodrich
PO Box 2151
South Zanesville, OH 43702
Re: Lot V76 at 80355 Via Pontito
Remodel: Architectural Modification at. Rear Patio
Dear Mr. and Mrs. Goodrich:
This correspondence shall serve as notification that the Hideaway Design Review Committee
.(DRC) :reviewed your request to remove the ,existing (middle) column at the rear patio and
square the arch. detail. .In addition, a .new fireplace ,is being proposed :at the opening on the side
of the patio. The remodel was approved as proposed at the May 16,. 2017 meeting.
Please contact Brook Marshall at 760-219-8057 or by email at D.RCFacilitator@gmail.com or
Sharron Badham, at the Association office with any questions regarding this review.
Sincerely,
THE .HIDEAWAYDESIGN REVIEW COMMITTEE
By:r��G"" -
Title: �t�I iu'V Date:
cc: Feddeily & Assoc.
DRC File
Pursuant to Cal. Civil Code; .arty rejection by the DRC may be appealed to the Board of Directors for the Association. .?'you wish to pursue on
appeal. please contact the Association's property manager. directly.
80955.Avenue 52, La Quinta, CA 92253 • MM93-5210
Tityoe 4 4 aftlam
BUILDING & SAFETY DEPARTMENT
P.O. Box 1504 (760).777-7012
78-495 CALLE TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
BUILDING PERMIT
Application Number . . . . . 04-00005866 Date 8/06/04
Property Address . . . . . . 80355 VIA PONTITO
APN: 772-450-040-76 -298942-
Application description . . . ELECTRICAL
Property Zoning . . . . . . . LOW DENSITY RESIDENT=At
Application valuation . . . . 0
Owner
SEDONA HOMES, INC.
49-950 JEFFERSON ST. #130-134
INDIO, CA
INDIO CA 92201
(760) 777-7522
Contractor
----------------------=-
SUNROSE CORPOP.ATION
49950 JEFFERSON, #130-134
INDIO CA 92201
(760) 772-8224
WCC: STATE FUND
WC: 16404622003 09/22/04
CSLB: 53360 06/30/06
CCC: B
-----------------------------------------------------------------------=----
Permit ELEC-MISCELLANEOUS
Additional desc
Permit Fee 30.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . 0
Qty Unit Charge Per Extension
BASE FEE 15.00
1.00 15.0000 EA ELEC TEMPORARY POWER POLE 15.00
------------------------------------------------7---------------------------
Special Notes and Comments
TEMP POWER POLE
Fee summary Charged
----------------- ----------
Permit Fee Total 30.00
Plan Check Total .00
Grand Total 30.00
Paid Credited Due
---------- ---------- ----------
.00 .00 30.00
.00 .00 .00
.00 ..00 30.00
u "F LA QUIN'TA
P.O. Box 1504 •
VOICE (760) 777-7012
78-495 CALLS TAMPICO FAX (760) 777-7011
LA QUINTA, CALIFORNIA 92253 INSPECTIONS (760) 777-7153
BUILDING & SAFETY DEPARTMENT
Application Number:
Applicant:
Applicant's Mailing Address:
Date:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No..
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S 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
C de, and my Licens�$I(� full force and effect.
cense Class �u cense No.
vwrvtK-bUIWEK DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U 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 and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale, If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to
the Contractors' State License Law.).
U I am exempt under Sec. , BA P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
_ 1 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' compensati n insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is ued. My wor-k--e� ompensa 'on i nce carrier and policy number are:
�rrier ,�� olicy Number
I c rtify that, in the performance o He -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. ,
WARNING: FAILURE TO SECURE WORKER' COMPENSATIO41 COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this 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 application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work being performed under or following issuance of this permit.
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 county ordinances and state laws relating to building
construction, and h�hoinzesentatives of this county to enter upon the above-mentioned property for inspection purposes.
Date v Applicant or Agent ,
LJV I ♦ I V LtW • •v e.... -
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