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0204-049 (BLCK)Awl 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 'F M)9 C-23 YAC f' :! M 1 1112( Date s'% t �ti�'f'-' 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:. 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. Date: s � `2 2, 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 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 inspection purposes. d.. ✓ �e:� lrI Signature (Owner/Agent)'x�'>�« a.- Date ,�° t BUILDING PERMIT PERMIT02�-049 DATE ,. f '`«� VALUATION $-2M.00 LOT TRACT JOB SITE ADDRESS 48-20 '14 CuXdMMISTAS kAGu#A-606kA APIN _ OWNER CONTRACTOR/DESIGNER/ENGINEER 48-201 C LLE R,U.I+tS�7'.I AS 852 w0 ANITINW, S 0, 45. L ikQU1?+i'IA CA 92233 C0�!.ro"`.{�FLI .�a 0.4. 92236 ,398-3436 ::`i LO USE OF PERMIT Jv L.1r. WICULIlie'i'l,JKkIr4 m;t tt 4i 4 trr. WALL 130.00 LF JVV ELLHM C017r OF 4.:O.EdSUMC'D('.31'�'.� 2,0W.00 .L".�i�iO'9R6.0.�4.iP+.B• �7.J.ii,`A]:P.i,ES:.EC:A CONSTRUCTION ',EE 101-000418,000 $54.00 SUB. -W 1AF. WHM P=oN Im Pug en?.osc. 554..00 LESS PRE -PAM �$0.00. r't�1 LLPF 'ES WE POW RL f {FAPR U5 2002 CITYpiOFLAQ01447A 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 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 k� / s � BLOCKWAL' A ROVALS Final POOLS -SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Fi4<al Gas Piping PLUMBING APPROVALS Gas Test Electric Final Oaste 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 Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G. F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: Cont) X.#76"09 Ph: (760) 398-3436 85-220 Ave 50 Unit #5 Coachella CA. 92236 4v mk-``j a4 pe , �1'4-J;r 4�5 x H T I :cA 7 k i � 4 NAMES) EXHIBIT "1" ARCHITECTURAL IMPROVEMENT APPLICATION AND AGREEMENT DATE --',, I I l .. STREET ADDRESS LOCAL PHONE OTHER PHONE REQUESTED IMPROVEMENT Uj azo v dlaavd r-2. Approval is requested for the above improvement according to the plans attached. We have attached two (2) sets of plans outlining the work to be done along with la complete description of the materials and colors to be used. If we are using a contractor(s); we enclose copies of the Contractor's License. Attachments: (1) Two copies of the Architectural Improvement Application. (2)' Two sets of plans with materials and colors to be used. Note: ;.One,, ;set.;:.:i.s;., for the. msnagei pei�,t:�-, office; the other sIet to be returned to you as "Approved". (3) Contractor's name- and copy required if the improvement "Owner -Builder"). (4) Brochures (2) and/or color to be used. of contractor's license. (Not is under $300.00 or if samples -of manufactured products We have read the Architectural Committee Rules and Guidelines and have 'furnished copies to all contractors to be engaged by u,s': and we agree to 'comply with those Rules and Guidelines. We also understand that it is our respoinsibility•to insure that - our Contractor(s) comply with said Rules. We acknowledge that Building Permits fdr home improvements may be required by the City of La Quinta. The cost of permits, responsibility for obtaining them, and the subsequent inspections will be our # responsibility. In all cases we recognize the- requirement to , be' in compliance with applicable' building• codes including, but 4 not limited to, those adopted subsequent to the' original completion and acceptance of our dwelling. OVER Rev. 4-96 r k i � 4 NAMES) EXHIBIT "1" ARCHITECTURAL IMPROVEMENT APPLICATION AND AGREEMENT DATE --',, I I l .. STREET ADDRESS LOCAL PHONE OTHER PHONE REQUESTED IMPROVEMENT Uj azo v dlaavd r-2. Approval is requested for the above improvement according to the plans attached. We have attached two (2) sets of plans outlining the work to be done along with la complete description of the materials and colors to be used. If we are using a contractor(s); we enclose copies of the Contractor's License. Attachments: (1) Two copies of the Architectural Improvement Application. (2)' Two sets of plans with materials and colors to be used. Note: ;.One,, ;set.;:.:i.s;., for the. msnagei pei�,t:�-, office; the other sIet to be returned to you as "Approved". (3) Contractor's name- and copy required if the improvement "Owner -Builder"). (4) Brochures (2) and/or color to be used. of contractor's license. (Not is under $300.00 or if samples -of manufactured products We have read the Architectural Committee Rules and Guidelines and have 'furnished copies to all contractors to be engaged by u,s': and we agree to 'comply with those Rules and Guidelines. We also understand that it is our respoinsibility•to insure that - our Contractor(s) comply with said Rules. We acknowledge that Building Permits fdr home improvements may be required by the City of La Quinta. The cost of permits, responsibility for obtaining them, and the subsequent inspections will be our # responsibility. In all cases we recognize the- requirement to , be' in compliance with applicable' building• codes including, but 4 not limited to, those adopted subsequent to the' original completion and acceptance of our dwelling. OVER Rev. 4-96 Page Two The Association has no responsibility whatever in achieving compliance with newer building codes which apply as a result of Homeowner prompted modifications. Further, we understand that approval will not be granted for any modification which directly or indirectly conflicts with the Declarations of Covenants, Conditions and Restrictions. We also understand we are responsible for the accurate determination of property lines and setbacks (as applicable). We also understand that we will be responsible for all costs of this improvement and for costs associated with any repair to common area occurring as a result of implementing this improvement. Examples include, but are not limited to, sprinkler and irrigation systems, buildings, roofs, exterior walls, lawns, plants and drainage. Further we 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 required maintenance standard or irrigation standard are our responsibility. Additionally, we understand that the job site must be left reasonably clean at the end of each day, that no debris nor dirt may be dumped in common area or left at job site. Any maintenance or replacement of permitted improvements, except for certain landscaping, which are beyond "initial" improvements, shall be the homeowner's responsibility. - We agree to indemnify for ourselves, as well as for our successors and assigns, and covenant and agree to hold Association harmless from all claims, demands or liability arising out of or encountered in connection with this Agreement, whether such claims, demands or liability are caused by Owners, Owners' agents or employees, or contractors or subcontractors employed on the project, their agents or employees, or caused by any products installed on the project by said contractor(s) or subcontractor(s). Such indemnification shall extend to claims, demands or liability for personal injuries and/or property damage occurring during installation, as well as after completion, including, but not limited to, all Owners' maintenance responsibilities provided herein, We further indemnify and hold the Association harmless from all liability related to any damage to existing improvements (wherever located within the Subdivision) resulting from the installation/construction of the Architectural Improvement If required by the Architectural Review Committee, we agree to record,:and pay for the recording, of this improvement at the County Recorder's office. We further acknowledge that the Architectural Committee may require a deposit be submitted before work is begun. Rev. 4-96 ARCHITECTURAL COMMITTEE CERTIFICATE (Exhibit "A" to the Architectural Improvement Application and Agreement) 1 } 1 The'•Architectural Improvement Application and Agr ement was reviewed by the Architectural Committee on��/7Z,,,and has been: Approved Conditionally Approved Rejected subject to the following conditions set forth below Returned for Further Information Required Modifications Comments t I Yes No Recording to be sent by owner to County Recorder's office for roof and/or exterior wall modifications. Deposit Required De' ooiit o f ire.d $ Date A '�' i ee Architectural Committee Architectural Committee rchitectural /Coafmittee Architectural Committee NOTE: THIS APPROVAL IS VALID FOR 90 DAYS FROM APPROVAL DATE 0 Rev. 4-96 I ' r 'Page Three i r ` -We further agree that this improvement will be completed in ,• -a, reasonable and diligent manner: We further agree that 1) if ,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 frames the Homeowners Association may elect to complete the work and/or repairs, and we will be responsible for the actual costs of such work. Payment to the Association is authorized by us in the form of an assessment or "monthly penalty payments as approved in the Guidelines. By signing this Agreement below; we agree to be bound by its terms and conditions and any conditions set forth by the Architectural Committee in the Architectural Committee Certificate, which is attached hereto as Exhibit "A" and made a part•.+hereof by this reference. Sig at res f all Own rs: (Signatu a) (Signature) r Rev. 4-96 . M