9707-030 (PAT)LICENSED CONTRACTOR DECLARATION
I hareby affirm under penalty of perjury that I am licensed under provisions of
CtGpter 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
6782 5% C:-61 J (-I4 v! 97
Date °? I r r .'r` 7 Signature of Contract • r -
i
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.
j 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.
� /� !'..t fs � 1it4M r fi
(This sec to nee n t be completed if the permit valuation is for $1!00.00 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
Wo.kers' compensation laws of California, and agree that if I should become
s3 ject to the workers' compensation provisions of Section 3700 of the Labor
Code I shall forthwith comply with those provisions. "-
Date I = 47 7 Applicant -
GY
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to t
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such'
permit, or cessation of work -for 180 days will subject permit to cancellation.,,.
I certify that I have read this application and state that the, above informations L
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize reprresentatives of this City to enter upon
the above-mentioned property -fa inspection purposes.
�� r ..
t/Signature (Owner/Agen fi. + ', x L • �� 4-t ',, ft- Date !j +f �
BUILDINGPERMIT PERMIT# CONTROL#
5464
DATE VALUATION LOT 9707-030 TRACT
JOB SITE �(y�Sq�
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
JIM 4 BE_%TRLY RA,.iNE
ATLAS AWNING COMPANY
47845 VIA JARDIN
754 WILLIAMS ROAD
LA QLTINTA. CA 93253
PALM SPRINGS CA 922,64
(7,60)327-8466 CBL4r, 182$
USE OF PERMIT
r�1
440 S.F. Al til[CA,`t.IM.t.ATI�jCF PATTO LOtr2 (IMC) ii ---621,P)
PORCH/PATIO 440,00S9
CS`I NI,3.`#'ED CUS'1: OP CC};<S.S'1 1JCfION
5,� s2.Ut1
PERMIT T FEC SUNIKA.R`1'
N.1,,4W CHECK Iar3E 101.OW-439-31.9 S52.65
CONSIRUCTION FET 1.01-000-4.1$-000 �i11,ttU
-WONO AIc. TIOIK Ffie .RESID 4010 000 2'41 3W
r
tf
1q ► TAY. CON'zfRUCRON AND PLAN CIIECK
$1- "4
_- t1 ''LESS PRE -PAID 1'EES
60,0',3
1997
TOTAL
P1"sR11•11T .FEES DUE NOW
S13414
` t} �'
RECEIP
DATE
BY �i
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
COMMENTS:
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)
i
V-_ >
'`cF • ��� Tily-4 4(4V
78-495 CALLE TAMPICO - . LA QUINTA, CALIFORNIA 92253 (619) '777-7000
"OF �� FAX (619) 777-7101
October 23, 1997 1
To Whom It May Concern, i
This letter is to certify that building permit #9707-030, a copy of whidh is attached to this letter,
was issued on 7/8/97 for construction of an aluminum lattice patio corer at the residence of Mr.
& Mrs. Raine,' at 47-845 Via Jardin, L' a Quinta, California (APN: 643-130-034).
The County of Riverside Assessor's Office Statement of New Construction dated October. 25,
1997, which shows.that this permit was issued for construction at 47-8,75 Via Jardin (Walter J.
Bennett residence, APN: 643-130-035) is in error.
If any questions: arise concerning this certification, please call me directly at (760) 777-7012.
Sin rely, ,
Usti
Greg Butler, Counter Technician
Department of Building and Safety
's MAILING ADDRESS — P.O: BOX. 1504 LA OUINTA, CALIFORNIA 92253
cooE
COUNTY OF RIVERSIDE •OFFICE OF ASSESSOR
Noocoou % o rfiM%,r_L Nulvlocrl
643-130-035-3
R1
PROPERTY OWNER'S STATEMENT ON NEW CONSTRUCTION
Owner's Name and Mailing Address Property Situs
87TVAA475IJARD N
LA QUINTA CA 92253 �a � � IN ✓�
Tate Sent:
I OCT 259 1997
Our records indicate a building permit was issued, for the above situs. Please
complete this form and return it to the Office of the Assessor within 3 weeks
.of the date shown above. Also include any additional information you believe
c-.
important in evaluating the new construction.
Owners' Nae --
I
Owner—builder
•
......... Yes ......... No Please com lete below
Permit a 07/08/,
ermit Number 970703_
Contra for � � p
\Permit Info o�LUM UM LATTICE PAT
Contractor's Address
D
Completion Da aced date if piece
1
City
Zip
Telephone*
-
Please Check Where App"
pp iate Lim
1... STRUCTURAL CUANGES �-� L
a).....Addition ..........k? ...........:... Square feet (complete items 3, 3a & 4) Arn.(�/l�/y
b).....Alteration .......Q ............... Added Square feet (compete items 3, 3a & 4)
c).....Patio .............................. Square feet (complete items 3, 3a-&4)
d). .... Pool or Spa ....C. ............. (complete item 2 or 2a)
e)..... Other .................Q............. Square feet (complete items 3, 3a & 4) Please explain....ac.A ...
......................................... .1............... !......
`
TOTAL COST OF WORK (Labor and Material) $...l ........................ lir lou
2... POOL/SPA
2a... SELF-CONTAINED• SPA ONLY
Type) ...... Gunite ..... Fiberglass
Type) ...... Gunite ...... Fiberglass ...... Redwoo
..... Plastic Lined
Size) ......................
...... In ground ....... Above -ground
Heater) .....Gas ..... Solar ......... None
Size) .............................
Pool Sweep) ..... Yes ..... No
Heater)...... Gas ...... Electric
Decking) ............... Approximate square feet
SAA
pa)..:.. Attached ..... Detached ..... None
aAA�
2
d
TOTAL COST OF WORK FOR ABOVE $ ..................
TOTAL COST OF WORK FOR ABOVE $....................
3 ... INTERIOR DETAIL
Floors) ..... Tile ..... Carpet ..... Vinyl ..... Concrete ..... Wood ..... Other.................................................................................
Walls) ..:.. Drywall ..... Paneling ..... Plaster .....Other......................................................................._. .........................
Plumbing)..... 1/2 Bath...... 3/4 Bath....... Full Bath ,^
Remarks: .......... ....Q....... ..... �?� Te. ..... ..............
.. .... ....... �........................
3a... EXT AIL r ,
Walls)..... Stucco ..... Siding ..... Brick ..... Other................................................................................................................................:
Roof Covering)..... Clay Tile ..... Concrete Tile ..... Composition Shingle ..... Wood Shingle ..... Gravel or Rock
..... Composition Roll ..... ttice ..... Other.............................................................................................................
Remarks:..../ ..........: .. S�j z
•�✓1 .. `........... :-................................
.........................................................................................-................. _............................. �....
Please complete reverse side
ASR -749-20 (REV 10-96) ✓ \ { 1 54
4 ... SKETCH OF NEW CONSTRUCTION
Make a sketch of the --new.construction'• showing its dimensions and position in relation to any existing structure.
/V J:;�r -C .
s„oe,
Sketch example
W 32'
New
New Room Addition 12'
Patio
Existing
Residence
Existing
Garage
Stree
PLEASE COMPLETE BELOW
The Assessor's Office may audit this statement for completeness and
accuracy andmay contd t you �cr t^7c altionai mrormatlon as require
Signature of owner or went Date it e (agent)
Address
City. State & Zip Telephone Number (8am — 5pm)
DISTRICT OFFICES
For any inquires, please contact the - -ict Oft -ice in your area.
I .... RIVERSIDE ...HE`✓ 3 .... PALM SPRINGS
4080 Lemon Street 88State Street 3255 E. Tahquitz Canyon Way
P.O. Box 12004 ; -•.pct. Ca. 92343 Room 114
Riverside, Ca. 92502-2204 (90';: 766-2500 Palm Springs, Ca. 92262
(909) 275-6200 (619) 778-2400
ASR -749.20 (REV 10.96)
- � r
i -
F ATLAS, AWNING & SCREEN
754 Williams Rd. ,Lic: No. 678256 x
•
t : - :PALM SPRINGS;' CA 92264
(619) 327-8466_ FAX: (619) 327-8467
� a -'" 1 � Y � 4 � •y -.s �%•
L -1 10 L
e t, ,}� , T#rf "� { � �, Yr \ - •c ., ` a' . � cif �': h, • }f • 1 F �'r+r a ,. ..
. ' d � J \ �!./�` . ,, S "" � is " k♦, ' .
i 4s�*. �, ��/ \"'vim � - (/`'�i_t •? ;�:� 7' • ',� m ° • "� .� "
ra 72
•
12
,
.._:. s_.
• ..k , .. per. r .z�, " � { � �i• 1. - n � � - '�'.
' _ J
_ _ elf _ -� ei' • 1• f i,r' . � .. . ce "� ,
f,' - �, moi,,. ... ' inn .. •� .•;� ; f�.. '
i
BUIL i I�,4G S Ar "" P A IALLY
z CI' ,
`A CEPTED FOR CONSTRUCTION
SUBJECT � �
C O' NSTALLATION.AS PER ' r`
.AND ALL=APPLICABLE CODES
yam.. -
i •.�'s ` -
..
` ..•.,�
-' �� n
���'
45 ,-.. f
n
�-'
-
ts'.i"�^R�tH
.dYby VG {;�w1r. _4-'
'"% f .7-• '
Lake La nuinta
Architectural
Committee
=t
N
Date:.
j E /7
/az-
R'e
Your
request ;gar approval of�}
bo E
has been
Approved= eta v 10;.1S
Arc sEi
a,4 c1 2
./ /
Denied
Reason.for denial:
ha' Architectural Committee
- Cof
rnwnwI�IIwwnO�w.MIoLlI� r�dw Ud 3- � I1J1uta�.:von1riQ,w3� aHwv�.d.m1vo1ad•uwarnoora wrmu:yw.:rrwwov:rrrrrroowwcwo -S•fL:7UWii/ t �.:M�S.VS-'�N N. •, : . . L9I.S4,.1L0It3.1ih. 3.M!.L1 t�.M'�,4!� dy7 S '�'� '--.' ' •.i �'.''�!,j .r . .'�\\\';,:'Ur. .. ..� %'`��; / �'I`.4� wr�f+`I.J.j ?:�V1
NS`p%rIr3s4LIOSre, MOO L8v'
..Moe ........... .•:`c�.a".:'
,\... :�.�-w -GJ• i
' -f) • �,�y.�',���b.4
"My °s '93TIA�yw0H I�,�,;
1lyt
.i
9- �
ooad oNfavnoT
7' v9c
_
1r9� oNlbod3b NoI1df1'ld �'s3 o�oz i�.� ".I ,. _r?
O -Y gHro, �a ;?/ N a� F3 rad s dO y ' /ZL INMd'30111br1 SNolJVWJ--Ml-Id�
Ga f o� P,. „ �I fir?. �.��a���H3�nia7f�aro
�n1-�r►�11y ��Il1y� g,� I�,r✓'��`Ir ;T 'I ' s4F'� No *I# �L���o/s,QL d.90dar+,J39Nf/H 631JUa .Yo -i 'L sfvol 03r0 ,Oa n",4a
�d0 3dJ,l=`dNn9d-t '30�19 O a�yyv����r��� -1 r.. I �D :K 1dp-Svoj_`� 0m. f 2Q�1J'0��"�f�?tld 213d N�i1530 '% � SN011'3f0 LI "► -u OI
.d 2�_f9:1_!'_-- - --_'SlYO1TJPDXd.OZ;LI YOd 9N/JddS NWrI?o7 d0 ' '
'PI ply li•l .(I t^ 3 I 9 !' ; N j \ °G Ff 'SNc1/1731" .' I ' 1�1►
_.ri �►0 y y1 IJy N ?I. I �d�. Nld%7707"�!0 °OkO _ Wi A b N W
rr� �2 IS `� Fi 3v n/ //S £oOs£ O/V 9MG 335 57/ t/
� 'NNp�
t 1 IW 4 , �Z �d � _ fj1N � F O,N) 9M0
1. �Q 4' N + I £ - - dON7Nd 07538f%I N S d�S 'M
i „ x 'NO.. II Q� 3� tf/J d0
roan ,71 ol,ol
NIdR'10'J z o,ba�!
I I
9/ 9N6/NdyAO 701LZ6/7
Y0(I`
150d..Fx.f_
I9
y +
.
;IA H "�
1WWH-Al 3/16/.7 ?t6l1V&217,Y JOd 'E A
531tl7d30/S
211V 09N.Yl1Lt/ 3JlUJ/7d1S
,
1SOd M1/M Xa0N3H.9+..£
01 D'Nl/17/gN9dA57d 0-T)1N7d 7?Nt1d
\�
-10 37N1d NI S.y3Qd3H
LI
/M31/1 3v�s :�'� "'M
a ara�w v7s ae
/YC lYN1S .tl !dS
" �4 N f00-5£ tt 9AA0 33S S3LOA/ WAY -N39 Xo1 .4 N011vW ,
3:7/116/ 7 NSdO HIIN SNQ11�3NNOJ NwmOJ O.b3a1 219v"07?v
9350 7N a 99 l0A/ (bW 3Yh[.?/131L5 S//1'`x"agwp1?�M�aN-O*- t 620' '��-"O v
:S310N
•S,170t/aH;91..Z-0 .71611Vtl317VTL
('1ONN10 -Jccl�,gl)
LL'1H 'ldo 3iE
08/JS 7W.7JE 1d0
zz1"d DOOM y •v r2MVf7d
9 • ♦ 3"lv"L7N
Yw/n07 Pon 7e,.. C+' -r
3z,s y0e 7Nro7N7f 375
i a>vvb wrnu
33ZI5 v, mw
vvi
I9/913,ZI'OSO-1
-RF03 9N% WOWS NWn00 ON1100A 03
wco,m
1J3Vb3!H Ztgk.-SXS aV.W3QV3H.9S0-01.8*,f I 1' i30V3H„Ot0'Ox„8Y„E d3mH,6Z0'v.Z/1-9x.Z-Z 3dA1
P1J1 -read
' 3215 9N11003 CNV WOWS NWn10O WfIWI%VW 831lV8
HdV406 9 OL - OV01 3n11 clSd 0 1 - S3unlon8iS OliVd 30111171 03HOVilV L103 31(103HOS
9/ 9N6/NdyAO 701LZ6/7
Y0(I`
150d..Fx.f_
7'O..LdO„f£p� „�/x I'810:'37/llt/7
' 9fY/.Y707& a -,5-W5- CII Fl
531tl7d30/S
211V 09N.Yl1Lt/ 3JlUJ/7d1S
,
1SOd M1/M Xa0N3H.9+..£
01 D'Nl/17/gN9dA57d 0-T)1N7d 7?Nt1d
\�
-10 37N1d NI S.y3Qd3H
:(MY,,6'/yD.1S/S)V07 77WS..9-061
9'..Z Z 3LNNb3L7N
'5'cY2ld6+X Ol 5u75
O/ A Z N G.:7HXLlSU3'-�Jd'/717/7XLS
TdK �Od3QL h
73T)ydd/d 03;iY73'I7Nd d00c!0
z/1) x
p
9/ � JPS'Al J 7 f/S..V..'oODY *
° '11.7
'd'306w W/J76It760' e.BF..F WOYd '7ddS NWnl07 35n J30tl3H
W777t/.gA.. J'jOd V31NL115sn5
39 CHW X9063H OoOM 306X9 2 4 H7XH7-Yld Sifnnoo.8'.4• '
'Qa-znnmHnwtNlw sNhmo'J oml WW
-2iolDNv Hi-ev3 v75aev zio of rlwn-iM 9r1lK5Vj-LV ;WM-)NI r4a No 116
O/ -i AZ nL - ,L n01- ,9
- ' .1h L Al- .9 dhB'x .,Bx..E O/ '
- - - ,L
L - .L 5 x,.E
„E - ,8A
- .9 ,.p - .9 .,£Z ,.E - .8 .,E - .8 ..9E0'x ..BX,E .A
n6-.6 .1 - .6 ,1 - .6 ..tZ
..Z d ,Z - .L . - • Al .8 ..OEO'x .,Bx.,E L -/
OL- .6 ..01- .6
..Z - .c wZ - .8 ,9 - ,6 ..9 - .6 .,6Z0'x,.f9x,.Z 9 I
.71 =P. , - .01 w6 - Al ..OZ =P
..11 - .4 ..11 - .8 JZ =P ..S - .OL ..S - ,01 ..hZO'.x„ 9xnZ ..S .01
33ZI5 v, mw
vvi
I9/913,ZI'OSO-1
-RF03 9N% WOWS NWn00 ON1100A 03
wco,m
1J3Vb3!H Ztgk.-SXS aV.W3QV3H.9S0-01.8*,f I 1' i30V3H„Ot0'Ox„8Y„E d3mH,6Z0'v.Z/1-9x.Z-Z 3dA1
P1J1 -read
' 3215 9N11003 CNV WOWS NWn10O WfIWI%VW 831lV8
HdV406 9 OL - OV01 3n11 clSd 0 1 - S3unlon8iS OliVd 30111171 03HOVilV L103 31(103HOS