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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
'421915 31196
Date ., Signature of Contractor
OWNER -BUILDER DECLARATION 1
I hereby affirm under penalty of perjury that IIam 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 jissgIeaq yyworkg�sf compensation insurance carrier & policy rio. are:
Cartier Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(') 1 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, ai/d. agree that if I s ould become
subject to the workers' compensation,F� royi6ions of Section,3 0 . of the Labor
Code, I shall forthwith comply with t�6Jse,provisio
Date: Applicant.C..
Warning: Failure to secure Workirs Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,0001`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 hi's
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' his City to enter upon
the above-mentioned property fc p in_§pe9gon p_ es�
Signature (Owner/Agent)
BUILDING PERMIT PERMIT# CONTROL#
(HAW034 3468
DATE 61 7196 VALUATION 53,43�%.IN} LOT TRACT
JOB SITE
ADDRESS 4*633•C.ALIX .&SPERANM.
APN
OWNER '
CONTRACTOR / DESIGNER / ENGINEER
''4JV SANMRS
CugSrRU(,1J0N
S1wE
'78-620 Wi`IZ1rBRUSH
Lal. QM_ N'iA CA
1.f'+ QW.N`i".z1 CA 9T253
(
(619)564.2.176 Mfd 1494
USE OF PERMIT
F=,A°S'1c�J
f'A',C10 COVER
1.iaft�r"H&1Vrf0 JC+.iiU SF
s,ro xt'E) C"C; O.li i"d)i�1S' i�BJts t'li) i
31, 7.i1i3
PLAN 0(13C,1': FFX 1014VO-439-318 Sft95
CO,N11tUTC"TfON FEE J W00 ?� 418-000 563.00
S'i'0140 XiO7IO14 FU-'1113SID .1.01-000-:.241-000 $.50
�C?NSTR.IJCTION JWD PLAN CHEC1
fi1104.45
LESS RRE-PAUFEES
1 Ii
$0.00
JUN " 1996 1: ''YTI t, �'FCtMIT F. , �»ftr N�►��
$104.45
gy
.
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Foalings
Ducts
Slab Grade
Return Air
Steel OF
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 P ROVALS
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
OX 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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Laguna De La Paz
P.O. Box 799
Rancho Mirage, CA 92270
(619) 564-8864
FAX (619) 564-8867
November 7, 1995-
Mr.
995
Mr. Jerry Herman
Community Development Director
City of La Quinta, CA'
SUBJECT: 'POST SETBACK VARIANCE FOR PATIO COVERS:
Dear Mr. Herman:
Detailed plans, including post set backs for pato covers, are
submitted by owners to our Architectural Review Committee for
approval.
Due to the small size of ma4ly yards here in Laguna De La Paz
the Architectural Review Committee will, on occasion, approve
3"setbacks for posts from the rear property lines, with a• ,
maximum of 1''overhang, if they are adjacent to the common area.
In addition, where practical, side yard setbacks of 3', for
posts with a 1' overhang, may be approved.by the Architectural
Review Committee.
The Board of Directors support the decision.s.of the Architectural
Review Committee and will approve rear yard setbacks of 3' when
adjacent to a common area.
All submittals are subject to City of La Quinta approval and
a variance fee.
Ron Perkins/Presi
Don Guarascio/Vic
Judy Munson/Secre
Lyman Brown/Treas
Tom Cook/Director
Sincer 4Tom
" BussjArchitectview Committee
Laguna D6 La Paz HOA ,
MAY -29-941-13=4,6 FROM= RYDER GREAT LAKES ID= 3135409945 PAGE 2
=' - ' .... .:. u. ..-ib r. v/1114 f•VUYq
Aug"
-
FACE 2/3
LAGma.1)3.. L)t PAL HOMEOOWNnS ASSvciATYON "u. , " . ' "). " y • ,
ARMC iiTECTURAL IMPROVEMENT APPLICATION
LOW � � DATE 14064
STREET
A !v
.LOCAL PHONE - OTHER PHONE
RJQUESTED IMPROV$MEP •
Approval is requested for the -above improvement vavcording to the
plans attached. VW lfa'ie attached two (Z) sets of plans outlining
the work to be dome _along with a Complete description of the
/ materials to bo used. Upon approval of this application and
_ priorrto_comIDenc�oa�t�ot=tom- em ,}tom
riix#ty-tu _ th4--be-pzOv3dtd,–: tZm<tng=`tiie�AiiipCS— p -as
,.: .
we have read the Architectural Comittee Rulea and/or Guidelines
and have furnished copies to all contractors to be engaged by ns.
Ve agree to comply with those Rules. We also understand that it
In our reaponsibility, to ensure that our Contractor(s)•conply.
we acknowledge that Building Permits for home improvements are
required by the City of La Quinta including any modifications to
bearing walls. The cost of permits, responsibility for obtaining
them, and the subsequent inspections will be our responsibility.
In all cases, we recognize the requitement to be in compliance
with* applicable building codes including, but not limited to,
those adopted subsequent -to the original completions and
acceptance of our dwelling. The Association has no
responsibility what so ever in achieving compliance with newer
building code9 which apply as a result, of Homeowner prompted
modifications. Tuxtiier, we understand that approval will not be
grante4 for any modifications which directly or lndirectly
conflicts with jL9_Zaclaratlons of Covenants, Conditions, and
Restrictions. w4 -also understand we are responsible for the
accurate determination of Property limes and iet-backs .(as
applicable).
AS•Revised January 1996
�",.,.r.. - __
MAY -?9 .SE;;a1 3 :4 a FROM = RYDER GREAT LAKES
Page TWO
ID= 313S40964S PACE 3
10.8153404601 PAGE 3/3
• ,t
We also understand that we will be responsible for all costs of
this improvement and for costs associated with any repair to the
common area occurring as a result of implementing this
improvement. ExaMples include, but are not limited to, sprinkler
and irrigation systems, utilities, buildings, lawns, plants, and
drainage, Further ve recognize that any modifications to the
common area irrigation and landscaping scheme are subject to
formal acceptance by the Association. Any required remedy to
achieve the requ i rghd ,.meintenance standard or irrigation standard
is our responsibility. Additionally, we timftrstand that the job
site must be left reasonably clean at the and of each day and ,
that no debris nor dirt may be dumped on the project. we
acknowledge that walls that have to be rmoved or-
*- A% -4-- - --- -- . ..... 1-�
rmi cion ana must oQ re laces txhe salmw,its =taall removed. Any
maintenance or rep acement o permittemprovementa, except for
certain landscaping, which are beyond "initial" improvements
shall be the homeowner's responsibility.
We a to pay the Association an aypplicatipp fee of
s(if required) to War administration costs and expenxes
In s comwitteo'.s revi*w of the plans and specifications..
We furtbtr agree that this lmpravesaent will be completed in a
reasonable and diligent max (but no longer than six (6)
months). We further agree that 1) it we do not correct any
damage caused as a result of implementation of this- Improvement -
or, 2) if we fail to complete this improvement within the allowed
time frame, the Homeowners Association may elect to complete the
work and/or repair, and we will be responsible for the actual
costs of such work. Wo authorize the use of our deposit, if, any,
held by the 9omeowners Association to be used as partial payment
for this purpos Ota"Vnderstand that when the Mork Is complete
and has been accepted by the Homeowners Association, we may
requestlu . r'"d of our deposit if cue has boon given.
1 C1Mmers:
tura
AS Revised January 1996
LAGUNA DE LA PAZ HOMEOWNERS ASSOCIATION
ARCHITECTURAL COMMITTEE CERTIFICATE
. r
Thi 1 on was reviewed by the Architectural Committee
on d has been:
Approved 'Rejected Conditionally Approved with
required modifications
set forth below
Returned for Further Information
equired Modifications/1,4
P
Comments. _1>/A/L h / -AzL "i ,- .0 / M
Si
COMPLETION INSPECTION
Completed work inspected and approved:
Deposit return authorized (if applicable)*:_
Comments:
Signed:
z
* Less any reimburse. rd%Der- .4
m ¢tYpo , ° ,c"
bring homeowner intoJ;Gnek,ConcY e,'��M*tom!`
SOS '
As Revised January
'CAgt9
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Com4�e�eRe�on. t
ew ConstN
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