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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
chapter 9 (commencing with Section 7000) of Division 3 of the Business and
'Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
616116 C-36 MC 105341 64P3012C
,Date Signature of Contractor
OWNER -BUILDER DECLARATIOfrom
I hereby affirm under penalty of perjury that I am exempt 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 ISignature 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 70M84i ED RMI,AL Policy No. 003-111129
(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 shall forthwith comply with tho"se provisions/
,,,XDate: Applicant
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 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 authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. f
,/Signature (Owner/Agent) ;% +t' -r4 Date
BUILDING PERMIT PERMIT#
iii -10.12
DATE VALUATION � .LOT
TRACT
JOB SITE APN
ADDRESS 79-7M Ck 'O
OWNER
CONTRACTOR / DESIGNER / ENGINEER
.ADAA!f,SAb41U M
1XfiX DEI'W11?RS
119-715 cf I O
3065 N. PUER ADE:1', SOL
LA QUIl.J7:A CA 92253
PALM ST.+7?. UGS
CA 92262
_
(760)77 x.9070
%CBIJi 3326/
USE OF PERMIT
POOL ANVOR SP,A
POOIJISNR, AE.ARMSMP.RRIERS WA):1., BE IN PLACE -PRIOR TO
PRER-PLA-S L ER WSPECTION
Q a
D
NOV 0 4 2003
P )OL AND/OR SPA : 0,000.00 Ix
ITY OF LA QUINTA
FINANCE DEPT.
.d"
R~��' :A,TrJ3 COW OF CONIVIRUCITON
130000.00 '
Vul(TI&T Flief: t3iMAcC�. ZY '
PW? CHECK RE 101.000-439.318 $1,14,93
CONSTRUCTION FEE 101-000-418-000 $284.50
M ECI i 011CAL ITEE --:POOL 101-000-421-000 824M
LL%CTRICAL FBI?, •- POOL 101.000.420-000 `43.00
PLCllb BIN01<`EZ POOL 101 •U170413.000 WOO
SUB-TCYlAL COA3'13"fRT.1'f.MON AWD PLAN GHF..'G'I4:
$365.43
: S PKK -PAID MIS $0,00
RECEIPT
DATE r,.
BY a+"
DATE 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
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
POOLS - SPAS
Steel Zi
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric SeW
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Wafer 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 Vo Wiring
Fixtures
Main Service
Sub Panes
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power [,
Final
Utility Notice (Perm)
COMMENTS:
:_
7
WE FIND'EM
WE FIX 'EM
THE
LEAK
DETECTORS
1
-(800) 756 -LEAK
CITY OF LA QUINTA i
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE f�--q-o-' BY -5 1
Adams/Miller Residence
(THE CITRUS)
79756 Cetrino Street
La Quinta, Ca 92253
V
CRUS
COURSE HOMEOWNERS ASSOCIATION
October 28, 2003
M/M Miller
125 Santa Ana Ave.
Long Beach, CA°90803
RE: 79-755 Cetrino, La Quinta, CA 92253
Citrus Course Homeowners Association
Dear Mr. & Mrs. Miller:
Members of the Architectural Committee have reviewed the revised pool and spa plan
that were re -submitted. The Committee has -approved the revised plan as submitted.
You will not need to provide a landscape plan as required in the earlier report from the
Committee, as now there is no landscaping necessary.
You will need to contact this office in writing as soon as all work has been complete so
the Committee can conduct a final inspection and your deposit may be returned to you.
Good luck with your project!
S' erely,
T-3Tom Miler, Association Malag
On behalf of the Architectural Committee
Citrus Course Homeowners Association
P.O. Box 4772 Palm Desert, CA 92261-4772 - 73-550 Alessandro, Suite 5 Palm Desert, California
760.346.1161 - FAX 760.346.9918 - E-mail: drm@drminternet.com - www citruscoursehoa.com
r%
ADAMS / MILLER RESIDENCE
LEGEND
LIGHT DUCTION BOX El PUREX MINIMAX HEATER
HOSE BIB O PUREX 420 sq. ft. CARTRIDGE FILTER
AIRLINE LOCATION *_' PUREX WHISPERFLOW JET PUMP (6 jets)
RETURN LINES
DEDICATED VAC LINE
SAM LIGHT
PUREX WHISPERFLOW CIRCULATION PUMP
IRRIGATION AND SUCTION
DRAINAGE LINES
FI .ELECTRIC BOX
[�2
GAS LINE
South Neighbor Approval
y =DRAINAGE FLOW RETURN LINES -
v (TO FOLLOW EXISTING 2 I/2"
PRECISE GRADING PLAN) pV.C.
All Landscaping and SUCTION LINES -
Irrigation Existing 2" p.v.c.
K.S.L. - Barbara Larsch
(760)564-8023
LIST OF COLORS
AND VENEERS
DECK - Colored salt finish
TILE - At Waterline,
Quartzite
CHINK SPILLWAY (at spa) -
Sunburst Gold Quartzite
RAISED SPA BOND BEAM -
Quartzite
Pool & Spa -
Superior Pool Plaster
Pebble Coat -Sandy Beach
North Neighbor Approval
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THE
LEAK
®; DETECTORS
1 ( 800) 756 -LEAK
WE FIND'EM
WEFIVEM 1/8" o V Adams/Miller Residence
79755 Cetrino Street
La Quinta, Ca 92253
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