RPL (0102-193)LICENSED' CONTRACTOR DECLARATION
I hereby affirm, -under penalty of perjury that I am licensed under provisions of
%ri&pter_4 (commencing with Section 7000) of Division 3 of the Business and
,-Professionals Code, and my License is in full force and effect.
w License # Lic. Class Exp. Date
o, •
3 '21112'
r '
Date '~ `" t; Si nF wre of'Contracto� .t ' { • l" E'er'- Era--? 1 i -
��1 9 gyp.
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
SWCtion 3700 of the Labor Code, for the performance of the work for which this
A,. permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
STATE FUND
(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 isissued,
I shall not employ any person in any manner so as to become subject to the a
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 shl forthwith comply with, those pro_vjsions. r:
Date: i f ,t Applicant' ,L 4
Warning: Failure to secure Workers' Compensation 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'a"s 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,,,0is
application. a
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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent)"w`4>.=-f1��''� { f�•*its
Dat
BUILDING PERMIT PERMIT#
DATE `j� Hwy VALUATION LOT0102-193 TRACT
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
N -UMSE
.aUTWICAITPCtOL t;."t5NSTRIJM7013
79.020 ]VL9Ii W,"N Dl�t�JE WEW
739£0 XCGHWAY 111 -
l.,A QULNUA CIA =53
PALM .L►EMZ C.A, - 9225:5-15
(760)340-25€8t 11 M
USE OppF��PERMIT '
�
, .i'9S+!tOR 111.0A".+ `
Pb.�01d"O
SPA. 0Yq1. ''nA"=ff tx'i St RRZR3 SHALL, -HE .17.4 PL.ACH AT .PI 'PLAw;`C R J�
940PEC9'):° MPOO- L i' QUIPgniT04T ENCU)SURE, 13 NOT INCL1)'DED R4 THIS
Ta1`'..RMIT,
PC) OL AN NOR SPA. A0119,60 L-19
WI A'3ED !:C.1W PWXF C'MMM'd7CMON
1715 .tt .00
PIAN CHBC1A M3- V301-000-439-319 $103,80
CO-433'.IMC."•iii3'tJKPM r 101-(bW-4118000 $252.0
WCHANICAL ME } P061,, s 101-000-421-000 S2410
91.,T"t}.p�pTRiC,wb�1;�L,c,M.S. —.POpl., 1101-,}000.4:�2e'#�'�/?ry�0 �fl3,�J�01
S-A.lV FFt l Vd C �.ty ' Q�yJh/� 101 -000-419° 000 $27.0
,
FEB 2yy8.�2001
NI
SMW1'AL Wk WR(TC1'T0), .,A,NyD PLAN C�,jtiy�fi2q:9gK
$511.80.
t✓� r�g �
81'a'L'rn1'JA). �JL'7rYY'.C'fTh.+��C+.�1.�
f' ''1'
.A`di S9ALLA Ar n: .}.%Y.L8..8 3FIK S �w`'M SZAFW
IM
I I /iDV
RECEIPTDATE
' C'
BY
DATE FINALED
INSPECTOR
"' f
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
Footings
Main Drain
Bond Beam
Approval to Cover
_
u
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
2P� —
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)
QUINTA T --
BUILDING & SAFETY-D€ V
PP
FOR CONS1
• �/ J �_ T Lo
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moo
DATE �ay;
m
Lo
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WILL BE
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° PUNS A 40 JOB CARM MMM
= THE SI W LEO
INSPECT)�N
NO EXCEPTIO
v a D
d • , LIC. 51874
MAW
owl,
— 3 ry = lft,cLmq ,rte
---•— PROPERTY LW POLE L;J J.R CTION BOOL ® HOW w � R r OECKOORAIN � TLE 11r TELE
-- •-- -- LfTEfTY EA9EHAENT (E� ELEC. PA EL BLdNER — Ftt LVE LIGHT AREA AREA DRAIN A AAAFQICAN
FENCE 0433HT, E O 6AS 1EMA Q "PER LEVET ER QF MTER •'DR IETLM -� PVC MAN v : f T�Jf,TI�!d
—E—E— t"XRGROLIO ELEC- DEMN MAW FaMTE MLVE I] HEATER THWPY !GRAB RAILS —r P.O. BOA, 11996
--G—G— ►s�Ff+GRD O GAS vs►iFA DEPFH ®WTE vLVE ® MW MW � AERATOR LAGM �� PAW CESERT CA.
-� @r OVERfEAD £LES ®o`�� SU6 ANLL (760) 322- 6'9' n
$� OVERWAD TELE �"'S/ : RECESWFTPTACLE
-- P TRAP d ap m
�$ ELEC. PEDESTAL A�S� RECEPTACLE STVB d CLP ANOH�[t SEE rATES frI
CS)
IJ
'February 20, 2001
Mr. and Mrs. Steve Melrose
79-020 Mission Drive West
La Quints, CA 92253
Dear Mr, and Mrs. Melrose:
The Rancho La Quinta Architectural Committee has reviewed and approved your re -submittal of
plans for landscaping, spa, pool deck, and barbecue at 79-0201bYi.ssion Drive West, with the
following conditions:
Reaarding drainage, the owner is to run his drainage to a dry well or run it via
an underground drainage fine to a bubbler box at the golf course.
All work is to be done in accordance with all applicable requirements of
governmental entities, including the City of La Quinta, and in accordance with all
Homeowners Association architectural guidelines and governing documents.
When the above conditions have been met, and the work begin 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,
9
Gary L roy, Property anager
Rancho La Quinta Master Association
Cc: American Pool Construction via fay; at 760-674-9438
Professional Community Management/ Desert Resort Management
Post Office Box 4772 s Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 4 Palm Desert, CaWornia o (760) 346-1161 . FAX (760) 346-4915