RPL (0007-012)LICENSED CONTRACTOR DECLARATION
1. hereby affirm;under,penalty of perjury.that I am licensed under provisions of
Ch'pter'9.(commencing'.with Section, 7000) of -Division 3 of the Business and
Professionals Code, and •my License is+.in full'force and effect.
r'- License # a .R Lic: Class ` Exp. Date
6s
C5. .'%'� 11130/2(
Yate Signature of Contractor
OWNER -BUILDER DECLARATION A,
I hereby affirm under penalty of perjury that I am exempt from the Contracto_r'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'`$ 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, sfor 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 STATS FUND Policy No. 1344032.00
(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 rriannel o as to become subject to the
workers' compensation laws of •Calif ro�, and agree that if I should become
subject Jo the workers' compen a ion provisions of Section 3700 of the Labor
comply
Applicar
Warninb: Failure to secure Workers' C'bmpensation coverage is unlawful and
shall subject an employer to criminal peAalties 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.
f
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
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 'll ity and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the, above-mentioned pro>erty-fQr inspection purposes.
S gnature (Owner/Agent)' Date P !
/0 BUILDING PERMIT PERMIT
t14J0'9-tlfi
DATE VALUATION S2210MM LOT TRACT
JOB SITE
ADDRESS 4.9k-.364 MbMA,NA I%A N
APN
-
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MIM GOODBAN .
FAMML,Y POOLS CON'SMi': MON
49-364MONTANA'WAY
53300 A' INDAl.ZAvSl£i L
Ill QUIEJTA. OA 92253
LA QUINTA CA 92253
Q60)564.3655 CIT 2893
USE OF PERMIT
P007: ARD/0R EVA
POOL & NP&A BBQ- ALA,RMSfBARRIERS 5i1+fA" BE rN PLACE AT PRf
PI `fEfi AA1 i,EGf'Iti ;IsOOL EQUIPMENT MCV001URR I'S NOT NCLiTM i
POOLE ND/OR SPA 22,900100 LS
ESILIM,R:M COSIr OF COIdSITRilMON
iPE'RUI C}i"1 FTX MUMMY
PLAN CHECK M 101.000-439.318 ' ' 41421
C011STRUCTIUN BEE; 1014000-418-000 P25100
MECHANICAL, FFM-- POOL, 101.000421.000 E29..00
ELECTRICAL t17.& •- POOL 101-000-420-000 $45.00
ALUMAI o Vrw -- POOL . 101.000.419.000 $27,00
SUB-IMAL CONS M1'1'MION AA7<`yD PLAU CMCK
$;461.21
LFM PRE -PAI) FFX`
$010
T(Y)!A a YE�'S.'�%.-�..' �'.E S IME VOW
$46725
..fr
RECEIPT
DATE
BYE
l i,-
1117 FINALES
INSPE R
"'_'4c�l
r —
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
/ oC
L
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
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)
06/28/0 LVED 14:20 FAX 760 346 9918 D R bS 002
Desert
t IvOrt
�:ipailement
June 28, 2000
Mrs. Linda Goodban
49-364 Montana Way
La Quinta, CA 92253
Dear Mrs. Goodban
The Rancho La Quinta Architectural Committee has reviewed and approved your submittal of
revised plans for landscape, pool/spa, deck, barbecue, and fountain at 49-364 Montana Way ,
with modifications your contractor agreed to in their June 23 correspondence to the Committee. "
The front door glass was approved by the'committee with the provision that it be clear glass, and
not colored. The misting system was approved by the committee with the provision that the pipes
cannot be seen (i.e. painted to match the unit).
s When the work is finished, please fill out and return to me the enclosed Notice -of Completion..
The consultant will perform a final inspection after receipt of that notice to verify installation
according to the approved plan, and then your deposit can be processed for a refund.
Sincerely,
i&L roy, Prope y Manager
Rancho La Quinta Master Association
Cc: Family Pools via fax at 564-3655
Owner via fax at 562-426-4106
Professional Community Management / Desert Resort Management
49-364 APPRUVLU.
CONSTRUCTION
:. I DATE'�