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9601-106 (PAT)LICENSED CONTRACTOR DECLARATION I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with NU)' W Sectiocn 7009 of Division 3 of the Business and Professionals Code, and my � O � License is m full force and effect. �7ii B 12i31l�i5 r W License # Uc. Class Exp. Date Date r7 el S i g n atu re of Cc ntracto r CD H rn OWNER -BUILDER DECLARATION J W ' I hereby affirm that I am exempt from the Contractor's License Law for the W following reason: ~ Z ( ) 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 f Eontractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section B&P.C. for this reason M Date Signature of Owner LO N_ O rn / WORKER'S COMPENSATION DECLARATION -. d Q I hereby affirm under penalty of perjury one of the following declarations: 0 Z O I have and will maintain a certificate of consent to self -insure for workers' LO H O compensation, as provided for by. Section 3700 of the Labor Code, for the X W W performance of the work for which this permit is issued. O J. J ( ) I have and will maintain workers' compensation insurance, as required by m Q U Section 3700 of the Labor Code, for the performance of the work for which this O U permit is issued. My workers' compensation insurance carrier & policy no. are: rn Carrier .,. Policy No. v Z (This section need not be completed if the permit valuatioPi'is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued, 1 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 e © Code, I shall forthwith comply with those provisions. ;Date: 1 .� a rApplicant /10 A__w '� C_ Warning: Failure to secure Workers' Compenss h coverage is unlaw_fu 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 V4 whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application agrees to, & shall, indemnify & hold harmless the City of Indian Wells, 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. SignaMre (Owner1Agent).__. `,1' '^ Atri Dais -i7 ALCM BUILDING PERMIT PERMIT 960 106 DATE 1/22/96 VALUATION ;�93]"� LOT TRACT JOB SITE ADDRESS 48712'1 CALUEFLOWSTAVS APN OWNER CONTRACTOR " 1.-A kkY GjUM'(7, TOM BIUSS.AuER ?8365 ElWY I.! 1, #1.49 S"IE LA QUdNTA CA 92253 LA QUINTA LA 92253 (61 p)WI.6927 CE►1,1,` 2799 DES16NERIENGINEER USE OF PERMITSX('I OVEN L.AXT.I.CF-PAX10 FEE DESCRIPTION FEES i�uic�zili�r� ff3 '7t�.GG Si• ESi+"MIATI D a OST OF CILSNS'aMVIC' ;.100 9:xi.1jt11 RL AN 0-TEC1' FE -6 10.1 -WO -439-319 $If)Mi ,,;01'4,TI"12t7G710N FEE 101 -000A113 -NO $25.00 L.i313._ICi%LFEE, 101-000-42" 00 $15.00 STO NG,1V10TIUN'FEM-.RE:SID 100-000-241-000 3.50 S B rC TAL CONSMUC'"! [ON AND FUNNI CHECK $56.75 LESS F IRr-PAjD FEES $0.0 TOTAL PERMIT Fri -Es 'd�+�T°i+', .NOW S56.75 RECEIPT DATE BY DATE FINALED INSPECTOR 7J INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPRO ALS MECHANICAL APPROVALS Set BiS ks Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air y Roof Deck Exhaust Fans O.K. to Wrap 1 F.A.U. Framing Compressor Insulation Vents Fireplace P.L. t Grills Fireplace T.O. Fans & Controls Party Wali Insulation Condensate Lines Party Wali Firewall Exterior Lath ; Drywall -Int. Lath ' Final Final POOLS - SPAS BLOCKWALL A99ROVALS Steel ' Set Backs Electric Bond Footings Main Drain • s 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 w Gas Piping Gas Test Appliances Final COMMENTS: Final10 V 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 s Final Utility Notice (Perm) Page One LOT# LAGUNA DE LA PAZ HOMEOWNERS ASSOCIATION ARCHITECTURAL IMPROVEMENT APPLICATION //tv /'�v / NAME (s) STREET ADDRESS LOCAL PHONE OTHER PHONE REQUESTED IMPROVEMENT i� OOH !/�yTI �► �9'�`G2 40, /01 0 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 a complete description of the materials to be used. Upon approval of this application and prior to -commencement of the improvement, the certificate of liability insurance will be provided, naming the Association as an additional insured. We have read the Architectural Committee Rules and/or Guidelines and have furnished copies to all contractors to be engaged by us. We agree to comply with. those Rules. We also understand that it is our responsibility_ to ensure that our Contractor(s) compl We acknowledge that Building Permits for home improvement are required by the City of La Quinta including any modific,to bearing walls. The cost of permits, responsibility f fling �2r them, and the subsequent inspections will be our aes In all cases, we recognize the. requirement t :"compliance with applicable building codes including, oty limited to,, those adopted subsequent -to the i.al completion and acceptance of our dwelling.�� ssociation has no.,, responsibility what so ever innlekrih9 compliance with newer building codes which apply modifications. Further, we un granted for any modification conflicts with the Declaration Restrictions. We also understz accurate determination of Pro applicable). As'Revised January 1996 a resu4t.:of Homeowner prompted stand%that approval will not be:. wch directly or indirectly o Covenants,, Conditions,' an we are responsible -for t e ty lines and .., `set=backs (as '0� as o� LAGUNA DE LA PAZ HOMEOWNERS ASSOCIATION ARCHITECTURAL COMMITTEE CERTIFICATE Thi a p is ion was reviewed by the Architectural Committee on nd has been: Approv d Rejected Conditionally Approved -with required modifications set forth below. Returned for Further Information Required Modifications Comments Sig - Date: l� Arch'it ctu 1 Co itte COMPLETION INSPECTION Completed work inspected and approved: Deposit return authorized (if applicable)*: Comments: Signed: * Less any reimbursement tt bring homeowner into compl As Revised January 1996 0@. Date: the As 101-ation for costs incurt-ed to ncethe governing documep§. 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