0204-188 (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 # Lic. Class Exp. Date —
20133.5 B RIC--) p01.4
Date`s `� Signature of Contractor j
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 VTATrJ FUND Policy No. 101400-201
(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 complywith ihose provisions.
DateL I l : "—Applicant
Warning: Failure to secure Workers' Com nsaUon' coverage is unlawful and
shall subject an employer to criminal penallties 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.
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. q
Signature (Owner/Agent) ` 'A�� Date i '-•`"�'Lr
BUILDING PERMIT PERMITIrD2+q04��
yp
DATE 1 - VALUATION%loam LOT TRACT S
JOB SITE
ADDRESS 7X_5 1TVYA'NN101YIA
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
CONTRACTOR
fia; 10 VfA MMORIA
78455 CALL!? FiMRTUJNA. _
LA tiT1;#1bi'1 A CA 92253
:LA (,rLYNTh U11 M53
(`760.)771.8071 CB -L# 6238
USE OF PERMIT
516 S.F. ALLTiNf flMOOD RATIO COVER,
.D�.3
FRUIN ED Mir OF CONSMUCI'1:ON
Y
PT.mfxr ME Sul +Y1 MARY
CHIWK F.U.
CO'sV5'1`Ft.(:fCTIDA M B I01,, 000.428-000
S`!'kA01 f1 M0 CICt FE .FYI SID M •t700 -24'S 4*0
APk
lau1
3—u9-, (YT 1�1;, �%OY S:1ZT�'E'�`. ON AIMPLAN �;�I�,
RECEIPT
DATE
BY
D E �JA�LE �J
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 4
Exhaust Fans
O.K. to Wrap
F.A.U. -
FramingkK
Compressor
Insulation '
Vents
Fireplace P.L. I UZ
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final - "
BLOCKWALL APPROVALS
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 Test
Electric Final
aste Lines
Heater Final
Water Piping
Plumbing Final
P:jmbing 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
';Fatures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
PARC LA QUINTA HOMEOWNERS ASSOCIATION
- Avail.Property Management
P. O. Box 1032
Palm Desert, CA 92261-1032
(760) 5684717
April 10, 2002
Penney Beasley
78-510 Via Melodia
La Quinta, CA 92253
RE: Architectural Variance Request
F
Dear Mrs. Beasley:
. Y
Your request for the installation of an Alumawood patio cover in your rear yard was
reviewed by the ARC and the Board. Your request was approved as submitted.
Please have your contractor obtain all necessary city permits. Do not store any
debris or materials in the street overnight. Any damage to the common area, or
surrounding properties, will by your responsible 'to either replace or repair.
- Thank you for your cooperation:
Sincerely,
Cam Anderson `' .
Project Manager