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RPL (0009-204)LICENSED CONTRACTOR DECLARATION t -1 hereby affirm under penalty of perjury that I am licens'edlunder provisions of Chapter 9 (commencing with Section 7000)'of Division 3 -df The Business and Professionals Code, and my License Islin full force' "and effect. License# Li�%Cliss"a. ` Exp. Dates ' s Ls C5 ,Date J Signature of Contractor( 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. Q,, 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: CarrierSTA M FUND Policy No. 1;344032-00 (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that_in the performance ofP6 work for which this permit is issued, I shall not.employ any person in any manner so'as-fo become subject to the workers' compensation laws of California, ar d agree that if I should become subject,to{the workers' compensation provisions of Section 3700 of the Labor Code, If"'s a 'f rt �Ith comply with those rouisions. Applicant _-p' e 1� ►ii Warning: Failure to secure Workers' Com e 9-atiop, 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 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 tconstruction, and hereby authonzber!6presentatives of this City to enter upon the' above-mentioned property ol'i spyection purposes. Signature (Owner/Agent) ✓� _+ Date I ' 1 BUILDING PERMIT. PERMIT# DATE F VALUATION LOT`'Z� TRACT f g ��}� /meq r JOB SITE �. APN ADDRESS 45A_36s mOmA AwAY OWNER CONTRACTOR/DESIGNER/EN (NEER WM E ROUT FAWLYPOOLIS C©NM.UCAO)a' 49365 MONTA>•TAWAY 53300 AMMEDA RA` kE*7, LACll%TJNTA CA 92253 LAQtMqTA CA 92253 (760)561-3655 0311 2893 USE OF PERMIT { 1100L AM/0R. OPA� POOL & SPA ONLY-ALkPIMSfB.l3RI2t21Ex SHALL, AZ IN :MACE AT PRX P3AWMA iRSPl,C` ON. POOL EQUI IN401IT 0714CLt SUkE [4 NOT INCLi MID 1N '1 HIS i'EP MIT ` 1 POOL AN,DIOR SPA 22,000.00 LS 74I MATED CODE Od.' C0R1�1 UCMO.N' 2_2,0W.0U P-EIRMT ME 611MMARY PLAN C14 EC. K FL,E 101.000.439318 $146,25 CONS CR.UO'FIf« N FEE 101-000-418-000 -000 $225.00 MECRA1N1E:AL FER --'POOH 10.1-000421.000 $.24.90 RUXTRIC.A.LFEE.e POOL 101-000.420-000 $45,00 PL1)MBINo nz .- PMOL 101.000-419.000 $27.00 Ft-'POTAC. CONSTE2I.1�• I` ON AND 1.51.AW C1: ECK $467.25 L.FM. PRE -PAID ).ES $0.00 TOTAL rMUT FEES DUE NOW • $46125 f RECEIPT DATE C i BY DAT 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 OX 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 BLOCKWALL APPROVALS steel POOLS - SPAS • �_ Set Backs Electric Bond 42 . cki GC 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 Neater 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: Sep= ]L _9 : 53A ���e1� �ered, ortd ®:NTOIC4IV September 18, 2000 Mr. and Mrs. Orville Yearout 49-365 Montana Way La Quinta, CA 92253 Dear Mr. and Mrs. Yearout: The Rancho La Quinta Architectural Comntittee has reviewed and approved your submittal of revisedplans for landscape, pool/spa and front door at 49-365 Montana Way, with modifications agreed to by you contractor in your September 7, 2000 correspondence to the Committee. It was noted by the Committee that the two citrus trees originally shown on your plan will be replaced with queen palms, and that. the front doors will be finished in "light cherry".... 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. Si cerely, /10 Gary ,Toy, Property anager Rancho La Quinta Master Association Cc: Family Pools via fax at 564-3.655 Orville Yearout via fax at 360-574-6332 p—r... inniat Cr„nsn11nitV M.anaeement / Desert Resort Management mi A RE -INSPECTION FEE OF $30 WILL BE CHARGED IF THE APPROVED PLANS AND JOB CARD ARE NOT ON THE SITE FOR A SCHEDULED INSPECTION. 12'-5" NO D(CEPTIO-NS! 1/8 N JPI" Construction' Pools Spas Fountains. (760)564-3655 Lic. #658996