9913-134 (RPL)_ - T
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapa, r (commencing with Section 7000) of Division 3 of the Business and
�rofesslonals Code, and my License is in full force and effect.
License # - Lie. Class Exp. Date,
X6377 C53 C27 C* C r� tk13!)ri&i'
ate � Signature of Contractor.
OWNER -BUILDER DECLARATION
I hereby affirm under penaltyof perjury that I am exempt from the ContYacto�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).
() 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.
(A. 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`t' 3d'!? RAWPolicy No. cy' VS IJ (TT (1F.3s'0130
J (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 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, I shill forthwith comply with those; provisions:—,f,.a
Date. �....... Zi Applicant R'*-t"iWzs (� . 1-�QA.�2f
f'
Warnirfg: Failure to secure Workers' Compensation coverageis �U� lawful and
shall subject an employer to.criminal penalties and civil fines up to -V 00,000, 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 authorise representatives of this City to enter upon
the above-mentioned property for inspection purposes.
(,Signature (Owner/Agent's I 4Date
BUILDING PERMIT PERMIT"
DATE VALUATION S '7 44110 1 LOT TRACT
JOB SITE 74-.299 C. +E.TRINO
APN .. ..
ADDRESS
OWNER
CONTRACTOR / DESIGNER ENGINEER
MI. 1GkT TAII�O
iVIVIECIS
I HOLTOR DILVE
kT1i:,.FIVvAY' i 1:, SIRE 5
NEWPORT REACH. CA. 92660
PALM T..lLSERT CA 92260
('13LS 3120
USE OF PERMIT
P-1-9 , ANEW* SPA,
F1010L PWD 1WA CAbliN.- T3^F:k%Ti.ACE AT 'PRE �
to
VC -10f, A.NWOR i,: J'P 17,:000.00 l..r`S5.
C:'C):NSTR'UC19 ,11.4
a� ,itbiV;£E e FES:t3CTikiNtAt Y
PLAN COCK FEE' 101-4TfJQ)-43S�-318 $11e.4;tt
CIONI, 101-000-4_184V SIS0.00
NV-,CtTAN1+`,;At.'OR: -• a?OO1, 1101-009-•471-000
!'+: 0L 4J 3.00k;4j 70-60
!' Lt3fW3l:(*3- Fff, „ 101-O -419.00 $270)
1
t I3$=1')'tti.C. (;f„s�fn'7'4zZpC"(C3i� f11T>,A:N
393,0(9
LESS P1U?-P4!V1D PEES
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$:391041
A
RECEIPT
DATE
By '
DATE FINALED
INSPECTOR
INSPECTION RECORD
'' . OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
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
i.
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: .
The Citrus Course Homeowners Association
1-1
November 16, 1999
Mr. Aike Galardo
1 Honor Drive
Newport Beach, CA 92660
Ref: 79-299 Cetrino, La Quinta, CA (Citrus Course)
Dear Mr. Galardo:
We are pleased to inform you that the Citrus Course Architectural Committee has
approved your revised plans to install a pool, spa, barbecue and landscaping.
We would like to thank you for addressing all of the points we raised previously and for
being so prompt in returning your revisions.
Sincerely,
On behalf of the Architectural Committee
Citrus Course Homeowners Association
Tami Lehman, Property Manager
Managing Agent: PCM -Desert Resort Management
73-550 Alessandro, Suite 5, Palm.Desert, CA 92660 Ph. (760) 346-1161 fax (760) 346-9918