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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
M717 C-39:13 £51l�31l;(
Date * .yG_ Signature of Contractor ✓ ���"�
W r
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.
.,;TATE F+i.T3d) 04$^M24-"
(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 Lab
Code, I shall forthwith comply with those provisions. D
Date: jr Applicant
Warning;: Failure.,to..seoure-,Workerss'Compensation coverage is unlawful a
--shall subject an employer to criminal penalties and civil fines up to $100,000,
addition to the cost of compensation, damages as provided for in Section 37
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
for a permit subject to the conditions and restrictions set forth on hi
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 inspections purposes.
Signature (Owner/Agent)`"'"alf k Date
a
BUILDING PERMIT PER, #
DATE VALUATION LOT TRACT t
Mli°Z.i:'/2m
JOB SITE
APN
ADDRESS
yy�� }} �� gg �c y'[.yy //��
0-2245 �tSA.fIX �J�RRi RWA
•• .•
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1AGURA DE LA PAZ
WMIMN PACIFIC R00F190
48-226 CJ�LLt 1;?L0R3JTJ 1
3462 LA, CA 'AINAWNY
1,5.4, fT,NTA CA. 92253
PALM MiR S CA 922,62
(76001(5-n77 C.i'7X 4293
USE OF PERMIT
0 % i?,< WELD .Ci Y
'A' ms's i'Si;3iVLLS)
ENU1 A dED C(.>Vr OV' CONS',Y.RCrMCOT
Vii, l43t5.0<9
PIR, .R00F ME 1. F 01.000-A} 8.000 MIN
D
7UNA2001
QUINTA
FINANCE DEPT
SrMk `'0TAi, XG) PLAN CY C K
$10.00
IMS :JPRE-11417 k r%r&.r
$0.00
r•
RECEIPT
DAT +' 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 _
Roof Deck ���/ ci S�
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 Vis` 0 S
BLOCKWALL APPROVALS
Final
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas TestElectric
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
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
4 -ow Voflage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
MAY -30-2001 11:24 AM
By: WESTERN PACIFIC 1100r1NO ('(]fit'. i 700 32U 0912; Apt -5 -Of 2:27PMi
11o47ng t'orpnradwi
Since 1940
`+
Amit .S. ).1)111
Karlene Jurdau
LAGUNA DR I.A PA'/.. IIVA
C/O DRSERT MANAI:P.Ml:NT
P.O. iWL 7"
.iMncho Mirage, 4;A 923711
RE:1ticclronAttg P.ejt ct; l.al!►tna Pe I..n PaT ITtrtrtrttnncts 4rKocittlltm
Appileatltm or a polynretltene roam sad ne ryllc e,reling ttw-w ing System
Dear Ms. Jordan:
Thank you fnr the nlrltttttttuily to Inl mel tine nntllt ►, �F SlentS on Itr_ abmw xthranoed property. Flaying
done so we we pleased to snbmil our ra:vmn+cndatiotos anel litop Tel far the installation. of it polyarnttetne
rtror system. The nmeorltatenrlccl st-orr. of wtxlc and n"winlul costs aro as rollows:
CoXWERAL
llnlcz9 expoev.4 xuded to the: c:nutrnrv, the cpntr,^.rt,.r slmll lrt re•c1,nn.sibic for pe,tbrmir-p, the fo!lowiatr,
S,
DLrS,CRW 1'10N
A. Vic general ylntxfant (vilsttuctinu tanottttct sluall form a pert oftltcw
g)eciriculiuns with the sncne-, rot= and effort tat though nspcated heroin.
11c. 'nit; trtttraltor .hall rurnislt ;111 Intc+r, Tnutctlnls. tvpdrancnt, contrat:tor's lioentlM inatuatuce
cerillit:ationn, ctc:., to Pei lit, - all nlwralions tcdrtlrcYl lord arev.-med lbe centroc"w shall ymn-ide
labor and tm;nc:t i:nl vuMov ntlln fochtel^d to woytc of rite sant: stature to sive a eptrtlity, complete
job.
('. if uncxpected oanditic,cos rtre enc enntlert-4 ditrinr. the +rank, and the ataditions adversely alpnq the
cost or pmgtrss of tvul k. the cnntwlorwill urtfiry 1.Ite inviter littate4intely, and the mover will
neptttixlc 9 t:hnngc--nttl^r to tr,"��It`e ttrc Itr<o!tj+�-tcnl cUllt)ltlon.
A. The Cantingol 11+911 Cc:c ttl.ry, Urv, Aad rernit, Ulhim,; tet tont: the fwcntiws Only for tilt` p11rp09e of
exnnpleling tltc t+Y,rk In hr; lr..rrru•rttccf unJt-.j- Ihia cxngrv•t with the Owner. 'I'lte Coutructur SWI
toot uuthcmi^.e lot prrmit tm►y other Irsrutn to lose sni•1 rrentlres fbr any Imrpmse wbuuenever.
western Ncifle Is to be given 311 t+-aerrnablc sel••tort and atnp.)ng nmas.
Page 3
c :A t)??r,.! c00) 410-_ 8'77 - Fax (760) S7.0-8912
34Ci2 L:1 ('3n+lr;tn:c ��st�� .. (`;olnr . tn•ins:.. - ( 1
.t ww.ttrc :tl+ o,:rr.+r,}'.%ort. • r. Ittail• tt•Itrc !>sccilwcsll)acrt�of.cotu
04/05/.Ill 14:25 TX/RX N0.8879 P'. 003'
MAY -30-2001
11:24 AM P.02
t By:
WESTERN rACIFIC
noor.1Nil C()lil'.; 700 020 Wife,; Apr -5-0/ 2:27PM; Page 4/7
L Suet( De i..n PR'c HOA
April Si '2001
Paw. 2
l
F.
Conlraclnr's swop ol" work -shrill itul hu:lutlit tltc hlrnlflit:nffutr dcrccllolt, nhetetucnt.
rnr�-grnlntitt►1 or trnumnl nr acfteslnc nl slinllnl It,, •:ntltm.: snfinttln(MS. if C'ontmetor citiminler>;
ac►y Arch ptotlnt•IS OF m:110i,llr; ill (Ile C.otlrnt t.tl r•rt fitt►ctttyl illy 11-01k Of if Such NIZV. -dmfs
111h10�rlalt arc Ctti' ^utile rrd try• rmy 011ier flat( lr: r llm triitih mmk ill the jobTife nitd Contractor
d_tennlnet a it! !rwli m-picri-win present if 1lnr1►rt1 to Ifa •_nipinvecn, coni rector s1let I have the right
tp dis :nniitau! tt.a work :tirl n.'mtnr ii.5 rmldn.)�tY� thim tfte! jntrite nntil :wuch prndue tv or
Irr:ticrials.:Ittrf ally Irv.:rltic chane ciftl lhefe% llls. nit anti abste& erleatmItAted or
reurm-ctl, or it in dt9cnctit)rI flint nn luirarl crtiras ( n- dir cage nifty regalm), and Cont.ructor artful
fr. Ove no erlr• tisinit cif finte ki t.'V11 1lejC 119 1+'011i (trlrlrf-tk!r and r0illptetrsntloll for dcluys
irticauntered ns it re -toll Of m1c.11 sltt-ntion nail rort,mvilnn.
SU1itFAC@; I?RdFARA'I11A14
A.
. Retuuvul of (lie revoling afAl;r4rlike eftftll 1w.. by hrlltrallug fir power vacatmning. T)te existing ravel
SUMCC will Ir vacuu1110d, Swe.11 and +ltatumt`cl for lxnlaer 911tjltce M-ftrlrulion.
Ill,
Remove. IhC CASllnF fol+' 'i'-!0 and tt'Lillt(r. with taller fairs ns neOCS9Ary.
C.
Crind all 7.-1air mc-taf to lire pair. for thr nprilictttion tit the ti►nnt. (9ce attached ddAil)
171-
Retrinve existing itinnn,g nromid carirtitem, to enpUf=^. (lie metal flange. See atimcbed dendl)
E.
lilstall new ronm Stop tnrild nrxmnct if1C peo11111:ler er file 1111ildlings VVILCIL' ncC(swry.
'i
(Ilia stttldtcll IfltAQ)
F.
Iteultwe two coltrccS of life at the 1•T.tlit-lop tl)ollnf; Inivigifiou and set D:rl.Cio. lilt 0 water-bfOClc to
scllclrsu: Ow Iwo sysltans unt! rnsutic ;i fv 11rt liehl Srnl. (ICC nit+arhed detail)
AJ1117LICA'FION OF. I'()I,VURF.T1[AN.F, irOAR7 AND COATING
A.
Rcmuvc wu, conitiininflnis 11,111 a Ill livie- -re wilh the ntlhcxitrn ors(►r:►yod w'elhmte ronin to tfte
stihstmie. Serf -ho. sltnll Ir: rice of 1001te Mfticlea.
D.
R.txtf deck shall be printed %A111 Nr.00nir ptint!!r 111 the rate of .33 to .50 gallons Per 100 egttare
.tett.
thiacrtnvs of I^ (pltix or minirt
G.
llrCrhltr>c Cantu intnlatlnn shell is ^lintt�xl :ggrlir`il In;, n4,min-tt
Inch). Atlditimiril R•nn► i! ill Ira )trtllf�vi in the i-ril"Ji►tg n.rrrls t0 he1P di -Ter" th0 etaltding wAter.
The millif imlicl (:►1tl will 1m;j lnaxisitutit or 1.5" Ihlc* The eddhionil foam is ant ftatemled to
taY,Btt•. pIf!titivC 1lflr . Ai•t iYfel netip 1"-irn Ihr: ,art lilt drplh orthc rModing wBIGC ltmd allow
for f3r9ter ev"pnrsttiun. 4)nly 3 W.R. derlvlt)• forint twin tltr. used In thb appllcrltit"L
D. —
C:onling shall be -ippliM In a nainitrium of three (3) scp;lcate coals. Acrylic comHng, to be fAW*
scliris. ( r0as or rnititts 2%).
OL hareand inlcrmediate cirri Sluill On itpl)licd M a rate of 1 7,1 f3ilifon9 per .100 -Vin�T'
r
fact
2EMPAGFIC
Adw- s
0
01/05/01 1.4:25 TX/RX N0.8879. P'.0.04'
MAY -30-2001 11:25 AM
't 8y: WESTERN PACIFIC noorMa COM". ;
P. 03
700 tia0 6012; Apf-S.01 2:26MI; Page 5/7
Lagunw.ibe Le Pa IIQA
Aptrd 5, 211111
Prtj;e 3
IL 'I'be Ifm creat shall Fal sir plitx! al n title. n!' 1 50 1pilloim per M sv uam I% ,yirlding a
hullosle-tet Ibirkuccc rot. lloNl vmtc IS ( If►. 1') 1,111711 Ofty MRS.
I•. I lucinl.. Ilrr li-l:l 14111 .`I1:11 orlK+111•:11icur. •:i.•r !rt I I-'rr11kill 5 .Pill be. etnkxyklal Into IhC WC -1
full, I-InI 'ii;tl Id :t tate ul 411 r+m1110v vvv I'Al �ycCtru rrt:l. 'rep coal culvr its ire
1.11"l1'1' CAIA 1'.
it. All himit lr: lu leer exalted Ctirthirgo rhnll t:mtru,) ttt+ mad over fell $mmml vent rtif►rs and
tcrminited a miuitilunl of 2 irchte almvr. 11w faatrt, crcadnga treat aptmrsince, self
tcrminathig lint;tsin•g. jeter attached detalll
Thio spetificatir n curets mnrnrt cturer reclWrclnente, t►,rrlt;rwrites Laboratory
Spoc)lieatintm and 1t DO cvtnrainnce, This syetetrt, Miele 1twied (m r an cxdsring-firc-
mie d Clnss A ar R huilr up roof sysicm has a M. 740, A rhomificaclon. Wimi sapplied
aver an existing C ruled raor sysicuL tlar_ cxisting fttling mmaina. RIC 1(130 fa• ER 46311
Tor. touts ml for all I:rtsur, 111murial, sigwfivislun, ilmlilnce, luxe, Inc., is:
Ck)k t&Ct A i h1JlnT
88.414:60e Florintax Model:g S6.744.60
WnRtlAm-Y
A'1'cn•1 dj year Marrttf tcturt-r'.s Milli Sy:rte n wnt.rnaty trill lx- issrted lay Kt ah TectlNtlt►gv
C'arfll Itr►n And Weviern PpcHTt RoefinR Corr.nrntiun irr"Prl mcitrieiiott of the rmfmid 6A payineot
is M01*41.
PAYMkNT TIMMS
loth tkq jlit repot approve! of III(; Contract. Pmgmss r+ns heals ro he //redo twice a r»onth trnll) cdd►ipiction.
Balasioe 46e utitri� 6,h i� kllim Held tfltid within Iit days vi recclltt of the Avice.
The pride t�ltottic� ni (tdttut to rellect Nlilijt:t�hN hr, asliW4-- alo ittrhutdy desired; ctllttlity
111stalltsl nn, scrvl ii i. Illy ;tnc�'dltr; tG*m per�rnitliit+ls. 'llta fit is a riii be 9llbJetet to LlttttlgC 15 days
f lit Iht; tic of t s nl.
If yme ail in axoidnn; a %4+ flip c ar>tiliiens herein, (!jt' tt c+xe�cttb: thQ + m ►t ter low ttrrrct tejuirn berth
cnpics ililhis roles. We will. in film, sight thcm stid ttliil 1 alle cot- / lu j1)u. '1'hdtlk YOU for yb11r
imcweial+vn In C:xrieAtlns this cotttraci (br yscar rubaht;A ill".
140TJCfi Tal OWUR
C rynlricttns Pre rrxrftircd by hi -m to he lit,",gcd anti rr gulnled lry• Itic 'Ce"trat:ior's Suets Lk—taw. Ne/1Rd.
Any cP.calions c anccrninR :r cmiliracicrr Play tic rcltrrect to lite Rcgisrrar. Cordraclor's Stme Liuenae 4*4rtti,
P.o. )lox ?ftm. snemim!"en, f'tflinim)n 951M,
-VYWQ-M
4 O""mmm
ar. to"
04/05/01 11:25 TX/RX NO'.8879 P.005
=a+b RM
P-04
tBy: WESTERN PACIFIC r100rINO 001111. i T00 C20 0912; Aim* -5-01 2:20PMi Page 0/7
t
�J
A
L*gurim Do La Par, 110A
April 1,.2001
pftm4
ACKNU'W1.EhAMRNT: f )tin<:r rrautmvk rlgrx Ihm Itr luta u•ftd nr•d frecived a iegiblo cxW of this
agrecment hicinMnl; all mrnt$ later vmvtiyrd prm irlomt 1-4mr. wo.1, x%wk IH perflor Med and that he itan rend
and nxxived a Icgihtc c•tpy ttl'uvuty ultra tktt:ammrll that Lm 11ce has ;rlume:d tJulit.l, this ucRoua ou. 1/%YC
Itetrb y acknowledge ufrtyr 11m pc+utlry of lsjttry thst Vw.i a alair IN: lclpd ovr rciu raid mn/am authorincd
to sign IAis contract ns nit ngc:m n[ the iWI otwtcr.
ACCIPTTAWFE: The aimvr pAcc9..4per1flcallnns and r iontlititm, are aatWactory and are hereby
accepted.. Yme err Aetho6zeli to iffy the work tis rtterifird. i`rrym!mt wUl he am outlined atone. You,
rite trrryc!r rany rutfcri thti e! arw flnte rein.• In ratifirf?,Af at tim Wed t4+rii+nt:tri day olifer
the bale. rrf this t: an-miriinn. Q: -r. the. :t4itichrd N!rfirr err !'Priced-vf- r fpr =a-c3gp(eaa1ion of (Isis right.
Chvner bis the right to mptire ennirncfor tit luiv -:r lierkyommaim attJ tzryment btmd it nwnrr'c "I-eicm.
LAGUNA DF, LA PAZ. HOA
Tide
ma-
Wl!STj!RN PACT "IC RO0nKG, CORP.
(II.-riractory I..icensp# 233717,E
Ilot)iu I... VVInkle
Ol►ernfl nttc Madager
aNFS78R�r1JrA •ITj��}ROVY1M1r:ifA,9't'fiEtijCII'1TOitllC4l=i1vt1'f1119�ll)!VtltAt'T��7TIILTfYLFTPENDt,Y9OF
�srt'��'I'.APL'1: �'•si1l4.�t7it$FpirS1'r r9 NlTr.iflNt)fV�: tll�t'r . AI:Y't+.PfRP ItY'rltl! OFF1C:lt MANAGEM:NT A? Jd62
LA C:AMIIA14A rVA'.', P)Ol b% tttNu!I, C.A 91[262. MIM IAt`L mm 1 H2 AAIiIT[OM TO'tB7SAGRF.EWNT S)1ALL RF,
EFPEC,7'IyE UNUL.Al9 MIViril FIV wY%TvstN raCIVIC MAt ACEMF,PtT.
IN..NAG MsACCE11rANCRr
waw rA ]c'40,01rix
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04/05/01 14:25
(-D
TX/RX N0:8879 P.006'