BRES2020-0119BUILDING PERMIT
DESIGN & DEVELOPMENT
DEPARTMENT
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
Permit Type:
Building Residential
Permit Number:
BRES2020-0119
Property Address:
47620 VIA MONTIGO
APN:
643120021
Legal Description
Property Zoning:
Valuation:
$30,363.00
PHONE (760) 777-7125
WWW.LAQUINTACA.GOV
APPLIED DATE: 06/11/2020
ISSUED DATE: 10/09/2020
CALIFORNIA
Owner: GARY MARTIN
47620 Via Montigo, La Quinta, CA 922532139
Applicant: GARY MARTIN
47620 Via Montigo, La Quinta, CA 922532139
Contractor: OWNER -BUILDER OWNER -BUILDER
PRIOR TO THE ISSUANCE OF THIS PERMIT FOR CONSTRUCTION, ALTERATION, IMPROVEMENT, DEMOLITION, OR REPAIR THE OWNER, APPLICANT AND/OR
CONTRACTOR UNDER PENALTY OF PERJURY HAVE AFFIRMED WHEN APPLICABLE, THROUGH THE SUBMITTAL OF FORMS OR BY OTHER ELECTRONIC MEANS, THE
FOLLOWING:
LICENSED CONTRACTOR OR OWNER -BUILDER DECLARATION (1 or 2)
1) They are licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Business and Professions Code, and the
referenced
License is in full force and effect, or;
2) That they are exempt from the Contractors' State License Law for the
reason(s) indicated by either (2)(a) and/or (2)(b), or (2)(c) where he or
she is exempt from licensure by a valid exemption. [Section 7031.5,
Business and Professions Code: Any city or county that requires a permit
to construct, alter, improve, demolish, or repair any structure, prior to its
issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the
Contractors' State License Law (Chapter (commencing with Section 7000)
of Division 3 of the Business and Professions
Code] Any violation of Section 7031.5 by any applicant for a permit
subjects the
applicant to a civil penalty of not more than five hundred dollars ($500).)
a) As owner of the property, or my employees with wages as their sole
compensation, will do all of or portions of the work, and the structure is
not intended or offered for sale (Section 7044, Business and Professions
Code: The Contractors' State License Law does not apply to an owner of
property who, through employees' or personal effort, builds or improves
the property, provided that the improvements are not intended or offered
for sale. If, however, the building or improvement is sold within one year of
completion, the Owner -Builder will have the burden of proving that it was
not built or improved for the purpose of sale.).
b) As owner of the property, will be exclusively contracting with licensed
c) Are exempt from licensure under the Contractors' State License Law.
As an Owner -Builder, they acknowledge that, except for their personal
residence in which they must have resided in for at least one year prior to
completion of the improvements covered by this permit, they cannot legally
sell a structure built as an owner -builder if it has not been constructed in
its entirety by licensed contractors. It is understood that a copy of the
applicable law, Section 7044 of the Business and Professions Code, is
available upon request when this application was submitted at the
following Web site:
http://www.leginfo.ca.gov/calaw.html.
DECLARATION REGARDING CONSTRUCTION LENDING AGENCY (If
applicable)
A construction lender will be used for completion of the improvements
covered by this permit and the name and information of which is on file for
public inspection during the regular business hours of the public entity.
Failure of the applicant to indicate the construction lender on the
application does not relieve that person of the requirement to give the
construction lender preliminary notice from that duty.
WORKERS' COMPENSATION DECLARATION (1, 2 or 3)
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($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.
1) Has and will maintain a certificate of consent to self -insure for workers'
compensation, issued by the Director of Industrial Relations as provided for
by Section 3700 of the Labor Code, for the performance of the work for
which this permit is issued.
2) Has 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.
3) Certifies that, in the performance of the work for which this permit is
issued, shall not employ any person in any manner so as to become subject
to the workers' compensation laws of California, and agree that, if should
become subject to the workers' compensation provisions of Section 3700 of
the Labor Code, shall forthwith comply with those provisions.
NOTICE TO APPLICANT (1, 2 and 3)
1) Each person upon whose behalf this application was made, each person
at whose request and for whose benefit work is being performed under or
pursuant to any permit issued as a result of this application, the owner, and
the applicant, each agrees to, and shall defend, indemnify and hold harmless
the City of La Quinta, its officers, agents, and employees for any act or
omission related to the work being performed under or following issuance of
this permit.
2) Any permit issued as a result of this application becomes null and void if
work is not commenced within 360 days from date of issuance of such
permit, or if cessation of work for 180 days will subject permit to
cancellation. On or after January 1, 2019, every permit issued shall become
invalid unless the work on the site authorized by such permit is commenced
within 12 months after its issuance, or if the work authorized on the site by
such permit is suspended or abandoned for a period of 12 months after the
time the work is commenced.
3) Certified that they read the application and state that the information
provided is correct. Agree to comply with all city and county ordinances and
state laws relating to building construction, and hereby authorize
representatives of this city to enter upon the above -mentioned property for
inspection purposes.
IMPORTANT: An Application for Permit was made to the Building Official,
subject to the conditions and restrictions set forth at the time of application,
which is now hereby an Issued Permit. If any part of the information being
supplied on this permit is inaccurate or untrue, please contact the City of La
Quinta at (760) 777-7125 immediately for correction.
Printed: 5/15/25 8:52 am Page 1 of 3
Permit Type
Building Residential
BUILDING PERMIT
Permit Number:
Property Address
BRES2020-0119
47620 VIA MONTIGO
MARTIN / 108SF PATIO ENCLOSURE TO EXTEND LIVING ROOM *** MARTIN / 108SF PATIO ENCLOSURE AT REAR PATIO AREA to
EXTEND LIVING ROOM [CONVENTIONAL LIGHT -FRAME CONSTRUCTION DESIGNS]. THIS PERMIT DOES NOT INCLUDE ALTERATION
TO OTHER AREAS OF DWELLING OR REPLACEMENT OF HVAC EQUIPMENT, WATER HEATER, OR ELECTRICAL DISTRIBUTION
EQUIPMENT. 2019 CALFORNIA BUILDING CODES.
,instruction Dpta
Residential Work Type Remodel
Conditioned Square
108
Construction Type V-B
Footage
Code Edition 2019
Building/Unit
R-3: 1 & 2 Family
Grading Required? No
Occupancy
Dwellings
Classification(s)
Remodel Area Square 103
Number of Flag or
0
New Electrical Square 0
Footage
Light Pole(s)?
Footage
Number of 5
Miscellaneous
1
Receptacle/Switch/Lig
Mechanical
ht(s)
Type Group Sq Ft Value
Invoice No. Fee
Fee Amount
Amount Paid
PERM IT-BRES2020-011 REMODEL, FIRST 100SF PC
$26.79
$26.79
9 OTHER MECHANICAL EQUIPMENT PC
$40.25
$40.25
PLAN CHECK DEPOSIT - ADDITION/REMODEL
$125.00
$125.00
DEVICES, FIRST 20
$26.83
$26.83
RECORDS MANAGEMENT FEE - MAJOR
$21.00
$21.00
REMODEL, FIRST 100SF
$54.74
$54.74
BSAS SB1473 FEE
$2.00
$2.00
HOURLY CHARGE - CITY BUILDING STAFF
$80.50
$80.50
SMI - RESIDENTIAL
$3.95
$3.95
OTHER MECHANICAL EQUIPMENT
$40.25
$40.25
TECHNOLOGY ENHANCEMENT FEE
$5.00
$5.00
REMODEL, EA ADDITIONAL 500SF PC
$19.32
$19.32
DEVICES, FIRST 20 PC
$26.83
$26.83
REMODEL, EA ADDITIONAL 500SF
$24.15
$24.15
REMODEL, FIRST 100SF PC
$122.94
$122.94
Total for Invoice PERM IT-BRES2020-0119
$619.55
$619.55
Grand Total for Permit
$619.55
$619.55
Workflow Step / Action Name Action Type Start Date End Date
Inspections v.1 06/11/2020 0:00
----------------------------------------------------------------------------------------------------------------------------------------
FINAL** v.2 Inspection
-----------
FINAL** v.1 Inspection
LATH v.1 Inspection
Printed: 5/15/25 8:52 am Page 2 of 3
BUILDING PERMIT
Permit Type: Building Residential
Permit Number: BRES2020-0119
Property Address: 47620 VIA MONTIGO
DRYWALL NAIL v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
INSULATION v.1
Inspection
------------------ --
FOOTINGS v.2
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
FRAMING v.4
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH ELEC v.3
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
BOTTOM PLATE BOLTING v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
FRAMING v.3
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH MECH v.2
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH PLBG v.2
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
FRAMING v.2
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH ELEC v.2
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH ELEC v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH PLBG v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
FRAMING v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
ROUGH MECH v.1
Inspection
----------------------------------------------------------------------------------------------------------------------------------------
FOOTINGS v.1
Inspection
Construction or work for which a permit is required shall be subject to inspection by the building official and such construction or work
shall remain visible and able to be accessed for inspection purposes until approved. Approval as a result of an inspection shall not be
construed to be an approval of a violation of the provisions of the applicable code and other ordinances of the jurisdiction. Inspections
presuming to give authority to violate or cancel the provisions of the applicable code and other ordinances of the jurisdiction shall not be
valid. It shall be the duty of the owner or the owner's authorized agent to cause the work to remain visible and able to be accessed for
inspection purposes. Neither the building official nor the jurisdiction shall be liable for expense entailed in the removal or replacement of
any material required to allow inspection.
It shall be the duty of the holder of the building permit or their duly authorized agent to notify the building official when work is ready for
inspection. It shall be the duty of the permit holder to provide access to and means for inspections of such work that are required by this
code.
A building or structure shall not be used or occupied in whole or in part, and a change of occupancy of a building or structure or portion
thereof shall not be made, until the building official has issued a certificate of occupancy therefor as provided herein. Issuance of a
certificate of occupancy shall not be construed as an approval of a violation of the provisions of the applicable code and other ordinances
of the jurisdiction. Certificates presuming to give authority to violate or cancel the provisions of this code or other ordinances of the
iurisdiction shall not be valid.
A person shall not make connections from a utility, a source of energy, fuel, or power, or a water system or sewer system to any building
or system that is regulated by the applicable code and other ordinances of the jurisdiction for which a permit is required, until approved by
the building official.
Printed: 5/15/25 8:52 am Page 3 of 3
CERTIFICATE OF COMPLIANCE?)'I
Desert Sands Unified School District
47950 Dune Palms Road DESERT
SANDS
La Quinta, CA 92253 UNIFIED
Date: 9/1/2020 (760)771-8515 SCHOOL
No.: 20-01756-1 DISTRICT
Owner: Gary F Martin/ Melinda C Martin Email:
Address: 47620 Via Montigo Jurisdiction: La Quinta
City: La Quinta
Type: Residential Addition < 500 Sq ft
Lot # Street No
,t762;)
Comments:
Street Name
Via Montigo
Sq. Feet
1C7
Tract #:
APN Permit No.
643-120 021
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered patios/walkways, residential additions
under 500 square feet, detached accessory structures (spaces that do not contain facilities for living, sleeping, cooking eating, or sanitation) or replacement
mobile homes. It has been determined that the above -named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
Exempt
This certifies that school facility fess imposed pursuant to
Education Code Section 17620 and Government Code 65995 Et Seq.
in the amount of $0.00 X 107 S.F. or $0.00 have been paid for the property listed above and that building permits
and/or Certificates of Occupancy for this square footage in the proposed project may now be issued.
Fees Paid By: Exemlpt- Gary Martin
Bank Name/Recipient of Certificate
By Scott L. Bailey
Superintendent
Fee Collected/ Exempted by: Yazmin Henry
I V� � J
Check No.:
Telephone: 760-777-1235
Funding: Exempt
Certificate Fees Due: $0.00
Original Payment(s) Rec'd:
$0.00
New Payment Rec'd:
$0.00
Over/Under:
$0.00
NOTICE: Pursuant to Government Code Section 66020(d)(1), this will serve to notify you that the 90-day approval period in which you may protest the fees or
other payment identified above will begin to run from the date on which the building or installation permit for this project is issued, or from the date on
which those amounts arr, paid to the D-strctis) or to another public ent,ty ,authorized to collect them on the District('s) behalf, whichever is earlier.
Notice to Building Department: This EXEMPTION document has been emailed to recipient and
therefore, this document is valid WITHOUT the Embmie-d Seal.
LAKE LA QU I IOTA
September 16, 2020
Mr. and Mrs. Gary Martin
47620 Via Montigo
La Quinta, CA 92253
Re: Architectural Request
47620 Via Montigo
Lake La Quinta Homeowners' Association
Dear Mr. and Mrs. Martin,
I am pleased to inform you that the Association has approved your architectural request to extend your
living room based on the plans submitted. This approval is conditional upon the City of La Quinta
approving the plans and issuing the required permit.
Sincerely,
LAKE LA QUINTA HOMEOWNERS' ASSOCIATION
Bobbie Gaffney,CCAM`PC�,�rNl
Association Manager
Lake La Quinta HCA c/o The Gaffney Group, Inc. — 1111 E. Tahquitz Canyon Way, Suite 107
Palm Springs, CA 92262 (760) 327-0301
)NUMENTAL
WINDOWS AND DOOF�:_.
OldCastle Building Envelope
5631 Ferguson Drive
Los Angeles, CA 90022-5199
Phone: (800) 888-9990
Fax: (323)888-2215
P02571 JO1694/ PO 82922
Order/
1" SB70/CLEAR (61VIM) TEMP OS
J01694/ 0001 PICT. /G.A1/1 W1
Special Instructions
REF QUOTE 234441
CLEAR SPACER, COBB LABELS
Purchase Order
Monumental Windows and Doors
79-919 Country Club Drive
Bermuda Dunes
CA
92203
USA
Tel. (760) 360-3589
39770 Garand Lane
Palm Desert
CA
92211
4/22/2020 4/22/2020
93.0000w x 93.0000h
5/22/2020
D. W�nWOV-)�
Page 1 of 1 Authorized Sianature
OIdcestle BuildingEnvelape-
Bill of Lading # 181750
Order: 759168
PO:P02571
Job:J01694/PO 82922
Customer #: GLA0 716
I Due Date: 5/22/20
Ship Date: 5/27/20
Route: T74 B
5631 Ferguson Drive A CRH COMPANY
Los Angeles, California 90022-5199
Customer:
Ship To:
obe.com - Phone (323) 887-6000 - Fax (323) 888-2215
GLAZCON PRODUCTION INC.(DBA)
GLAZCON PRODUCTION INC.
MONUMENTAL WINDOWS AND DOORS
39770 GARAND LN
79919 COUNTRY CLUB DR
PALM DESERT CA 92211-7124
BERMUDA DUNES CA 92203-1279
Phone: 760 360-2800 Weight: 401 Trailer: P437 Stop: 5
Item
oty
Description
Width
Height
Shape
Weight
S Qty
Qty
Shipped Prev
Qty B/O
DO NOT SHIP 134 05/22 PER CSTMRS REQUEST
1
1
INS.88930 wz
93
93
61.36
1
114 S70T TP 112 MILL (SIL) 114 CLEAR TP - 1 00/00
401.60
TOTAL UNITS: 1 TOTAL SQ FT: 61.36 TOTAL BOXES: 1
TOTAL RACKS:
RECEIVED BY:
i' , DATE: </7-7/71)
UNLOADED BY: DRIVER CUSTOMER BOTH
PAGE 1 OF
JCM Inspections
39725 Garand Lane Suite F
T1.J Palm Desert, CA 92211
INSPECTIONS Phone: 760-275-5020 - Fax: 760-327-8907
IT
INSPECTIONS
EPDXY INSPECTION REPORT
Date:
Project Name: Project No:
'V, y
Project Address: 4 City:
Client: Sub -Contractor:
General Contractor: Architect: Structural Engineer:
Anchor Bolts L Rebar
Epoxy Type:
Epoxy Shelf Life: -- — — - — --------- ----- -------
II
Hole Cleaning Method(s): tc
IBC
L Title 24
Other:'
Unresolved Items:
❑None
F� See Below
Description of Work Inspected: -N
-M
V tS C r -I( k clzl�--
'77 C e-
r 4
L
Work complies with written approval from Structural Engineer and ICC Evaluation Report #
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications -applicable building laws. Final report issued at project completion.
Inspector: Jack C. Millin ICC Certification No: 0842216-49 Contractor's Representative:
i i
Copy 1, JCM Inspections Copy 2 Project Superintendent Copy Governing Agency Page of Y
JI-m mspet:uons
39725 Garand Lane Suite F
hfi
TIN
,To',Palm
Desert, CA 92211
INSPECTIONS
Phone: 760-275-5020 - Fax: 760-327-8907
INSPECTIONS
EPDXY INSPECTION REPORT
Date:
Project Name:
Project
No:
Project Address:
City:
Client:
Sub -Contractor:
General Contractor:
Architect: Structural Engineer:
IBC
Anchor Bolts Rebar
Title 24
Epoxy Type:
-
Other:
Epoxy Shelf Life:
---
Unresolved Items:
Hole Cleaning Method(s):
None
See Below
Description of Work Inspected:
V
L
1
Work complies with written approval from Structural Engineer anti ICC Evaluation Report #
I hereby certify that I have inspected all of the above work, unless otherwise noted and to the best of my ability I have found this work to comply with the approved
plans, specifications applicable building laws. Final repurt issued at prulecl comp etion.
Inspector: Jack C. Millin ICC Certification No: 0842216-49 Contractor's Representative:
Copy 1 JCM Inspections Copy 2 Project Supenntendent Cor.v 3 Goccwir9 Agercy Page of
tev Qa 0 fr(v
CALIFORNIA
Disclosures & Forms for Owner -Builders Applying for Construction Permits
IMPORTANT! NOTICE TO PROPERTY OWNER
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified at Y'%%:k Mwitigc , L I ��, :11h, rX`�
We are providing you with an Owner -Builder Ark edgment and Information Verification Form to make you
aware of your responsibilities and possible risk you may incur by having this permit issued in your name as the
Owner -Builder. We will not issue a building permit until you have read, initialed your understanding of each
provision, signed, and returned this form to us at our official address indicated. An agent of the owner
cannot execute this notice unless you, the property owner, obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEDGMENT AND VERIFICATION OF INFORMATION
UIKEC TIONS: Read and initial each statement below to signify you understand or verify this information.
4
1. I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner -
Builder" building permit that erroneously implies that the property owner is providing his or her own labor and
material personally. I, as an Owner -Builder, may be held liable and subject to serious financial risk for any injuries
sustained by an unlicensed person and his or her employees while working on my property. My homeowner's
insurance may not provide coverage for those injuries. I am willfully acting as an Owner -Builder and am aware of
the limits of my insurance coverage for injuries to workers on my property.
2. 1 understand building permits are not required to be signed by property owners unless they are responsible
for the construction and are not hiring a licensed Contractor to assume this responsibility.
J;
%3. I understand as an "Owner -Builder" I am the responsible party of record on the permit. I understand that I
may protect myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or
�1�
�hjeyr�name instead of my own.
t�14. 1 understand Contractors are required by law to be licensed and bonded in California and to list their license
numbers on permits and contracts.
5. 1 understand if I employ or otherwise engage any persons, other than California licensed Contractors, and
the total value of my construction is at least five hundred dollars ($500), including labor and materials, I may be
considered an "employer" under state and federal law.
O6. I understand if I am considered an "employer" under state and federal law, I must register with the state and
edeal government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to
unemployment compensation for each "employee." I also understand my failure to abide by these laws may subject
me to serious financial risk.
I understand under California Contractors' State License Law, an Owner -Builder who builds single-family
residential structures cannot legally build them with the intent to offer them for sale, unless all work is performed by
licensed subcontractors and the number of structures does not exceed four within any calendar year, or all of the
work is performed under contract with a licensed general building Contractor.
8. 1 understand as an Owner -Builder if I sell the property for which this permit is issued, I may be held liable for
any financial or personal injuries sustained by any subsequent owner(s) that result from any latent construction
defects in the workmanship or materials.
Page 3 of 4
%r /1! 9. 1 understand I may obtain more information regarding my obligations as an "employer" from the Internal
Revenue Service, the United States Small Business Administration, the California Department of Benefit Payments,
and the California Division of Industrial Accidents. I also understand I may contact the California Contractors' State
License Board (CSLB) at 1-800-321-CSLB (2752) or www.csib.ca.gov for more information about licensed
contractors.
10. 1 am aware of and consent to an Owner -Builder building permit applied for in my name, and understand
!Ld
that I am the party legally and financially responsible for proposed construction activity at the following address:
G) u�yt�
J//1I 11. 1 agree that, as the party legally and financially responsible for this proposed construction activity, I will
abide by all applicable laws and requirements that govern Owner -Builders as well as employers.
)JM12. 1 agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the
information I have provided on this form. Licensed contractors are regulated by laws designed to protect the public.
If you contract with someone who does not have a license, the Contractors' State License Board may be unable to
assist you with any financial loss you may sustain as a result of a complaint. Your only remedy against unlicensed
Contractors may be in civil court. It is also important for you to understand that if an unlicensed Contractor or
employee of that individual or firm is injured while working on your property, you may be held liable for damages. If
you obtain a permit as Owner -Builder and wish to hire Contractors, you will be responsible for verifying whether or
not those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
Before a building permit can be issued, this form must be completed and signed by the property owner and
returned to the agency responsible for issuing the permit. Note: A copy of the property owner's driver's
license, form notarization, or other verification acceptable to the agency is required to be presented when
the permit is issued to verify the property owner's signature.
ASignature of Property Owner. , ��" .1 Date:
Note: The following Authorization Form is required to be completed by the property owner only when
designating an agent of the property owner to apply for a construction permit for the Owner -Builder.
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner, the execution of which I understand is my personal responsibility, I hereby
authorize the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to
obtain an Owner -Builder Permit for my project.
Scope of Construction Project (or Description of Work):
Project Location or Address:
Name of Authorized Agent:
Address of Authorized Agent:
Phone:
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled
out the above information and certify its accuracy. Note: A copy of the owner's driver's license, form notarization, or
other verification acceptable to the agency is required to be presented when the permit is issued to verify the
property owner's signature.
Signature of Property Owner:
Date:
Page 4 of 4
CITY OF LA QUINTA SUB -CONTRACTOR, LIST
JOB ADDRESS PERMIT NUMBER _ OWNER ._ .._. - . .__ __ .BUILDER
This form shall be posted on the Rb with the RAding Inspection Card at all times in a conspicuous place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to t1iis list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
,_._a --ri- ca-- : ,t ,- ntahle response.
of buildingpermit. For
each applicable trade, an information
requested uviuw n,uct uc COM