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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
23;5'1 X r9y�<��
Date » r 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
(letion 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 Policy No.
(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.
t Date: I IApplicant �-7 ��•� f`
,..:,a�-�., t -....-:.........»_._ s+
_Warn ng: 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.
t":?w1. Each person upon whose behalf this application is made & each person at'-5-
whose
hose 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.
!I Signature (Owner/Agent)"' ✓ Date rr-,�•f
BUILDING PERMIT PERMIT#
a
DATE VALUATION LOT 1 TRACT
Qfi�l �"�C1.t'iF: !k^ E3�i':13i1
'�
'09iSITE APN
ADbRESS
46 ,21 C_&1JX EMMANZA
OWNER
CONTRACTOR / DESIGNER / EN INEER
LAGUNA LIP, 1.A PAZ H0A
►a.14 PA(;11 .iu.;' ,.R00FR\fG
PO W73. 799
' 34621, LA CAW M AY
R"{ANCHO MR A.M CA 92271
PK -Ad .SPIRINGS CA, 92262
(760)416,5877 CMIA, 4293
USE OF PERMIT
Rr..-9.1 0fo - RTC ;C`60 BMR4630 Q PO MiRA.T nANE *MAM a; ACRYLIC.'
C t7A,P0.4G ROOMING SYSTEM
r
Id,CR00F 710514 Do L3
HISIMMID COST 0F COPSYRUM011
R&ROOF FFM; 101.000-4l 8-000 $31.40
aY
SOB-T01'AL C.'OM) I'MC 109 AND P1AN
q 1 � p+�;.�
/1 Adlsui?' X..^l Dd'Ylof.�S
�.6�KV�1
!/l1\.l
D
�A��'ro.t,n �'A,L1:�'.E.t.` .4�'2EEO Zi�,.@Lr .LtlS.s'Yv
x$0,00
SEP 10 2001
CITY OF LA QUINTA =
FINANCE DEPT.
RECEIPT
DATE yt
DATE/
BY
DATE FINALED
INSPECTOR
1
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
. MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Roof Deck
Combustion Air
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
6-(
BLOCKWALL A' PROVALS
Final
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 Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
-
JUL-1T-2001 03:32 PM
&ant By: WEVERN PACIFIC AOCFINa CcFP.; 760 320 9912;
?A I
Stnce I WY
�l
C�r 'Ma 10, 2001
WESTERN PACIFIC
iLaaber Jordi
1hQ1JNA 119 LA PAZ HOA
CJO D=81�,5? 11tAl�PAG>eQ►f Y�
P.& Bos 7"
Rsact a M]rwrc. CA 92270
Route Coiporsdon
Lia X235717
RL. L+pM DOLS l -es HOMM., = A,ea=Lxdas .
hoot Srrees• M�°'cc ..:.:-�;
may -10-01 10:37AM;
-23S717
P'�'Lj (, -
Page v -j
:ear Me. Joidaa:
Twk youdd
Nr thaapport>md4� eo = a prnpaol �r tae tvof tl n tttatt>beetica cm tba tttbwe d .
TINS peogtmn.promotca a" ��� :oof �• In 0& ani td*wIft
or
"'n=00m awn dam lowers ft ovwW cosi par tea
senricatt�b life. 8ebw as our .._ .. _ �_�kY�c for an aw=al iaapN*n and oUt ao OOM C"PM
8Etro1!'IMz�A7iOT18:
L Raaove ad Foote deibcs $ bu roof eceaa
7- Irsp= W-M*4ft as pipes sr .: ,.enu as necasaa:p•
3. Imporx base =gin ac wd ' :xa Rep* aM holm. Wn ar spllU ualag a lluroo•ao = rYaM^
4. 1=9w the =nm and base .,:u2d all AAgbm �, r am baim trams or q*w wing a dum-cause noOtm
S. Inspect vma c oveaag * z�x -;uir c�c m�zteacr with a tbroecouae s/aMIL
6. Inipacs and threessozse apc m!-s�p Joia>a � montaay.
7. ThM0,00urm oD Anim arid. '•
L Rep* all vbd* exhs, s,• r_. ee Act elect claw "i"S = ttne� syBk
f. bmp= and ce-seal as'=MMr' jd1 Urn in U dawft
to,
C?odc B r X08 VM h._ . ,Tic;a). F9x = saw M.M sl s wa 0f S7100 pa *OIL
1 L Cbodc for ntisdr$ bot a.► . cepa cad a�II' noct,aaef a cast d i9.0>0 es.
3462 La Cwrp=a `.
vvw .
m Springs, LA 92262 • (760) 416 -SM • Fax (760) :33(1-8.912
OoCcaw - E-mail: wp wectPACToef-eom.
P. 05
l
JUL-17-2001 00:82 PM
Sant By: WESTERN PACIFIC AOOFINci :.1P.;
L,
It
7a0 310 0912; usy•10.01 10:38iW;
LAVM D@ L P'ru BOA
AprA 3. 2M
pW2
1Z Kapott i+mr beam ab 1i�t►ts .. ...: roc�ry �ataomr.
13, idea dte the tool asap aro lam say bdw M the ma d 53.00 pa d1a
11. Aper al=maa= 0=613 m ,` ..- :13 u pra "thanliras uiriswlois d1011*100.
13r E�vride tAgP4optsQ tA,naR:
-A in ;ypodioo pmch so tfit wch bmldtis Tltti mpd
v�1 mneeast dtttna� ted
a�pQtient dls:,iaaol COetdi>�t ttsc tttt
WAs=Arrrn
Page 3/u
M ,zpdes n+adc by waMea+ -' =S will, be waenemd IN period d m. (1) W >3oaa tb• dtoe cd =npWdhnIt
mm be ward Und wtnle A mo. _ „aN is =zmiaky dbcdVR ;t Is DOt a dl Soak 1CikS rtiU d+ �P awry
� oar wow a� Wcsoca F--. , :ll ::� to itroee 5aeio tx a aaa aCS6o.00 per Davr.
Tae WW peafcr paftmj .,
corf Acr AMOUNT, -
AMWAL MAUMCNANC--
1VA deposit aeon AVin8
r=im
If vm we in SOME&=w
(RiCL WC Will. to Hall Ap
Ar7m malftneeft
Agri 10 e4 w=q*d
LAGU14ADl91 J?AZLAVM.
t
Mar
if 1 cm tins► W=T Tj=x
...ki-:bxfag kbX moubalo aAd sauvislM oa An naatd bye is;
;c .: r uai[ z 3�S amts) e��ea Y1 aaib bid r�+m11e/ !b 2001
I: :nd the baiacd doer upm completion. istroim to be paid within 10 dies of
herder. piogc ewe the apmmmt below, ad mm bath =ON to thio
1 ..3n o00 oojd i0 you. Zaaalcyau�ryaa mop's�i00~ � this amcdcx
WESTmx PACD><CB00mc*' Ct7ii.
Cam ul mtr LJoe M r =717
]loo's L Wlide
- i' - Op�tnlr Masatpsr �s
::.. ,..: �stlslt�oc� piece �d dee to aonloA me dias� � (7611y1t6�Tf.
P. 06
JUL-17-2001 03:30 PM
Sant By: WESTERN ?ACIFIC AOOFINQ CCnP.; 78C 320 8012; Jun -19-01 9:38AM; Page W4
Lastaas De Lw Pts HOA
Jnee 19,2=1
fella 3l00 Kum beet, ytddint a
b. The tOp cac smell ba snptied at a ate Of 1.30 plloatt DcT
total ,-slam-hi dmes br bate Doom of 30-32 Toad Dry bdk
r- Daring the s roll top CM sppllCstta n fte *11 rwoks v►itt be «ieesaeos fate the wet
coo Dost rm:=W m a mlc of 30 canis =100 attune &et. Tat# cast caber to be
LIGST C"Y. '
d. AU them is to be coated. COMM AMU extoifd UP ofd Ow til Monod vtmt pitta sad
tact uaWd .: mia=m of 2 lnChet above the them, aesdat z nett sMc owme, odf-
WrminadcA .129d= ;.f aatadted "WO
z7oa gxcj+cation maou vmumx&=uwroqAnuwnm Uades+Ktmr L*anlatp
womficumm NW 1:B0 ComCtikmw- T s syaam wbaa aC011ed over sat Dothan fLm-
misd CLim A of B Tutt -up rvaf sym m has a UL 7K A daaWIosiiM WhCm APPiiOd
over an eft C n.,cd mat "m the comm teting mmaim RX ICDO d at 4630
The last cosi fbr aU labor.-reriaL m,rfvlmrm. ittart mm@l taloa,, sic-. lir
CONTRACT AMOUNT
�48-61Z Calk S.aper=zn Medd 7 S7437.00
WARRANTY
ATOM 1161 rear MX=Lfk : cel M gyateat wwfarAy wln be faolodby React Teel OWV
C.rpora3 = and Wetlare . AVIr RL .-,Ai Carport d= npoa commiedW of tic Mf aW full OOY.Yn =
1, tscd+�ed.
PAYMENT 'TR1t1M3t
10% dapasit neon approval : rbc cow: -m=s. P ogss psyamm to be Mek twioe a month tocol ooarpi d"L
BRIE= nue IV= mrd poW w4hia 10 do" of aeoerpt Of the iavowe.
TLe pnm quoted has bora ::. cmu W n:dm standardr vm 2W= muhW* **red: quality
iusudWon, sorvace retiab• . 04 ia. =sot Derfatnanoe 'I>w iftiCs may bC >,9om to cbaz>13 days
film Me 48at of fhb ptapc:-..
If you are is accae+damoc .rig.. me Camd cm batitL tje mmane the agrommod bdow and return both
oopies to t6b aoce. We w:.:. in wco.. jZA these and temm jos copy m ym Thooityva Sbr Yowl
aWwimt in expediting -, cocim -.,yaw I ' llom siW&
Cotstracsmc qua reyulmd L. .M to be .: .=gW sad ra dated by ttie Contrac$Ws Stats lAC= a Rased.
Any q eortoer ing _ =Us= mom' t* znftsted m the OAOL% , C 0trsmW c State Lioante Botox
P.O.3= 2600n. Saamema CalUbmia 95M.
P. 03
Sant 8y: WESTERN PACIFIC AOCFING CCAP.; 780 320 8912;
LAW" De L Psa HOA
Ja U, =I
P006,
Jun -19.01 9:39AM; Page 4!4
. Owner admowt dem hart be bas Deed and waived a bwbk mm of Uw
spacrncu J udadzm ail u=m and sttmdard ¢s+balm cW w at is pw Osmed a"d tut be ho and
end icoMa hWbk =My of ovary other doaa mo met areae la• deed dm t% dtis assm sdaa Lae
hasty admow boo met Ow p=altT at Dom' thK Lew mositer the *9 ownas mad onvooc sutbmi ad
to s4m this oocaact as as septa of tae heel 4 .
ACCs?"i'A?fM- 'ria about pricaw 4Xciic does aed oeedkism ars seddacsory atd are bon *y
accastai. You an aotiwr+ito do tAa ww* as meclAealwM be as waibted shone. Yae,
the bmyw =iq c mood tbb traaaactioa at my tbm priw ft aaiddig" d the !hind >yrralsess day dt M
dw. dame:o(d Ab u% mmc docw. hoc res :riacboi ibotsa at CmmgoAoo form emiamsddro d'tds rbtk
Owocr hes the r4Fbt to M9 ---mc O mu. bond at amm's aspeste.
LAGIIM VIC LA PAZ El..;A
A7 I 6*od Am=—
r-
W13TW PACHW MOOt M9 CD".
Casttrone tors Yore a �T17
weraat%tMZMJWDVC:::SAAT. ;�ZWTo mar' I rXMat MACrWiT MMT2MDAyfOr
A XZrrAlfM TMA ACUL MAXUM= A,r 3as2
LA CAAQAIVA WAY. PALM .:I1 �l:s _ . F228. rte Qitl1�� a�.�w!i! r7l07�S !h ?!aJ A lR!!t�1f�L• 1!L
R>�f:17Vit O:MTlt. 4/�tLY� ::: 1► w: tMI7tti!".
MANAGMADCMAMM
A01k
Vmm
lbm.
P. 04
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