9707-050 (PAT)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 t, Lic. Class Exp. Date
C-61 j �% t3
ate/Signature nature of Contractor'
f!' 7 g
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). ,
O 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
perfopmance 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:
Cartier Policy No.
(This sec ion be completed if the permit valuatio is f'or'$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 I.
of the, Labor
Cede I; shall forthvi ith comply with .those provisions.
15ate: ' Mh/0�' / Applicant SJ ^1y1111 1617"1sXK� :�e_-
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. fv
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 .
thg.6bo�rgtntioned property for inspection purposes.:
Signature r/A ent f�'ir '1 Date
BUILDING PERMIT PERM T# °°NTR°`"
5495
DATE VALUATION LOT 9767=051 TRACT
7 !N7 �� 4aTP
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ALDEN W COOK
TONY N1. Y'BARRA. CONST. CO.
45.555 VIA ENCAN'TO
Sacs S:WRGEON DRIVE
LAQLIIMTA CA 92.153
CA _!32f�2ci
/COSTyAMESA
` l ap /g-.441 f.•�B01 4240
USE OF PERMIT
i T X 2J' & '! 1` XJ4' 1CB0 # 5038 Ai IMA'(U•OOi) .1.: ATT. Cr-, (7O't RS .
PORMPlal710 473:00 Sr
rI yrt!%t#,n,o Cowl OF CONS°f AUCTION
f,2�i1.91t1
PERMIT FEE SUMMARY
PLAN CHECK EEE 101-000139-3111 $58.50
CONSTRUCTION FEE 10.1-000-4184000. $90.00
STONE PACY.WN 1TE Os1T3.$.63
t
TOT6V. CONSTRU("I' ON AND PLAN(~llE�'K
1=13.13
, LESS PSL}: PAMFEES.
so -w
J U L 15 1997 TOTAL PERMIT nM DUE NOW
$:149.13
G'7
DATE ' 3 r a'
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
Final 11
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain '
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
fir''
MAY- 8-92 FRI 10:18 MARQUIS MANAGEMENT P-0.9
i� A� -
PR t �,
992 ..
NGUNA
1)E 1.A PA%
ARCHITE:TURAL VARI4MCC REQUEST
Unit� S �s 111A ACW4�dN.-,,� cute
Street Address
Local phone Other 'Phone z! 2:'y --1V-9/
To the Architectural Committee:
We, the undersigned owners, request your approval of the
modit.1cations proposed.on the reverse $ide of this forlq.
Attsphed are gratings of. the work to be dOnei types of
material to beused are indicated on the dra■ings. see
understand. that building permits for home. improvements ire
required by the City of La Quinta and that tho e-ost o.f the
Permits and responsibillty of obtaining permits and
sabse®uent inspections will be borne by'us.
it it a.kowledge that all approved changes in the original
design will be at out expense; that any damage to er
''•""relocation of existing sprinkler systems, underground
utilittess building structure and exterior landscaping or
ether .damage resulting from oonstruction-ar these permitted
Improvements will be at ovr expense; and that main;tenanee-of
the permitted Improvements will be at our expense:
signature of all owner.:
f '
MA1'- E3_92 FRI 10 C 17 MARQUIS M A M AG'EM E N T R. 0 0
j
e
�z
'Outs
oil
�w4111/iri��nri !
35-M Ow Paaim Driv% suft 200
Ct""C ly. C6001"a =04
1679) 92a-7700 FAX (6791324.79Q6
LAGUNA DE LA PAZ
ARUITECTURAL VARIANCE AUTSORIZATION
NAME Alden & Doris Cook
ADDRESS 48-555 Via Encanto
Irour request for Architectural cbitectural variance has been approved
by the Architectural Committee. Any changes requiring. -A
building permit must be obtained through the City and au$t
pas.$ any City inspection. All changes must comply.raith
City and County Codes.
$PECIAX, NOTES Color to match existing block.wall
Than your
-Nancy Dua ,
Recount Executive
REGIONAL OFFICES
Yw o 0 ftAcha cucamcnga . scum ilay o Coscha4a wey • san Dipc,
MAY-_ 892 PRI 10 18 MARQUIS MANAGEMENT - P 1 0
S AIA
APR ? 1992.
�.l4`}SGS - $'� ! `� �•�
• ' '
(wrB )516y"
•.
.. _
Please pcsvtde as much detail as possible
so that the
Committee m`ay Cansider appro,Val nithout delay!
The above proposal has been raviered by the
A:caite"otural
' Committee and has baent
APPROVED ) AEZECTED ) PCNOINC FURTHER
�(•„/ �,,/ INFORMATION
Comments:
LATE t
Committee Committee
- k0m 13 .er 'Meth ber.
Committee
Member