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RPL (0005-254)LICENSED CONTRACTOR DECLARATION °I hereby!�ffirm ufder-perialty of perjury'that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and -,'Proies'sionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date Date Signature of Contractor OWNER-BUILDERADECLA ATION 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 & Profe'ssionals 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'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'., Policy No. STA.T&'I�fN D 1344032-0 . ,.,(Th'a 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, sh II 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', 1 II f rthw th comply with those r6v signs. 'Date: Applicant f t r- Warning: ail re to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penllties and civil fines up to $100,000; in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set. forth' on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall, indemnify & hold harmless the City of La Quinta, its officers, agents and'employees. 2. Any permit issued as a result of this application becomes null and void, if work is not commenced within 180 days from date of issuance of such. permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby a Itho 'ze' representatives of this City to enter upon the above-mentioned propel or inspection purposes. Signature (Owner/Agent)Date j. BUILDING PERMIT PERMIT" DATE / VALUATION LOT .5,25A TRACT .. JOB SITE " ` ADDRESS�JSsid APN u OWNER q r ry CONTRACTOR / DESIGNER / EN (NEER �4 P. % 'i$a i Qi7iA7T3 .. �` s.. " PAA�,YPf7ccs C SmiTC'T ICiP,1 49460 60 NilSSIONDM.E't�G T - ! . 53304 AVMQrAR&tV1I1Z Z - :. LA. Q[lIN'TA • '* - 1_-A . 92753 LA QTT(kt TA (1.A. 92233 w, (7601564-3,655 CBVI 2893 ; USE OF PERMIT { POO AI -MX R OV l°, POOL ct SPA. ONLY - A3 AkiVIS10A IZD'..iERS SHALL ME, IN PLACE ALT PRt«:1 LASTr;R D48PEc CION POOL EQUIPt1 MINT Fi W_-%SURZ IS NOT YNCLIUDED IN THIS PERMIT, ; t. VALU.ATIO]N 1 000.00 LS . yyRXHM1> co.YA 01f i0N9. RyCRy.N . ' o 1 J:p.M0.0�0 ' I PERMIT FIFF y� PLANCt1 CDS I'I; 141 ©4tk43 v3? 8 . $123,88 CONSTRUCTION .F99 101-000-416-000 �1f;5.00 MIX.iVAVIC AL Kit I'('3OL 1.01-000.421-000 524,00 int ECTkICAL �� r r. -POOL 101-000-424-000 �s.r10 P1,UPdiH1N0,i PO! -L 101.000.4197000 $%04 SM -TOTAL CONS'i`Fi.LTtI-ION AND -PLAN C14EC K $41.85 USS PR33-PAID.1,T.:R„S Al $9.04 S. RECEIPT DATE BYE S * DA FINALF� INSPECTAGi- f — s"� t?' ' moi. .. ,. .. • a v„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 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 POOLS - SPAS Steel v Set Backs Electric Bond 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 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: - May 16, 2000 Mr. and Mrs. Jim Quinn 49-7601Mssion Drive West La Quinta, CA 92253 Dear Mr. and Mrs. Quinn: The Rancho La Quinta Architectural Committee has reviewed and approved your submittal of revised plans for patio extension and landscape at 49760 Mission Drive West, with modifications agreed to by your contractor in their May 4, 2000 correspondence to the Committee, with the following condition: N That you furnish the committee the written approval of both neighbors with regard to the queen palms. Those forms are enclosed for that purpose. Thank you for your,patience in our review of the plans. Sincerely, Gary LeCroy, Property Manager The Master Association for Rancho La Quinta c: Family Pools 564-3655. V Q (br