0111-148 (AR)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
.416304 RC'49 elT,tp., �� ,.�oea /3.] t..
Date �y �" Signature of Contractor .`fP• �'°�'"`---�
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 isnot 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 perjuryione"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.
(,, X11 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.
OOLIVEN E A£."tt P, NW' 1065.10131-39
(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 t` Labor
Code, I shall forthwith comply with those=provisiops. -may
'Date: /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 an&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 up6;,
the above-mentioned property for inspection purposes
-Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
�
DATEVALUATION LOT 0111-1-48 TRACT
JOB SITE
APN
ADDRESS 7"141:40,0 DR MW
OWNER
CONTRACTOR/DESIGNER/EN (NEER
.I,1 UITI- 1 LM'i�..s M
TCti"l.T16PS l 0149TRUC11.0.AT
36014 LAW DR
5775 TUCS ma vflky
L-A f,RBUIRTrA CA 922S3
TCi1alo, LINDA A Cts 92886
(714)993-3320 CMI.# 01819
USE OF PERMIT
AMU M-11
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f . RP011T 0%]VURS"JOH 49,00 101F
d -].Rt' N IMMOK FEE 101-000-4'.19-318 $011W
tc^,a,RUCy9`ION PEB 1��q?1-(00pf.:�t-41y8�'-(0�]pCy�0 M5.00
qC,'+
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EOV 111 2001 l�
C9TYOF I;�AL�Tr`itl
SHANCE .ERT
'03 YY
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d:
'Y0XAL,PXT&,HTTFJXX5 DT EJW0*
VMS
RECEIPT
DATE,% /
8Y
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
O.K. to Wrap
Exhaust Fans
F.A.U.
Framing
e���i
Compressor '—
Insulation
_
_-
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali 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
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
/= 25 –v= ,fig
Equipment Enclosure
Shower Pans
O.K for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final—lp
—
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)
1
LAGO LA QUINTA Homeowners Association
Post Office Box 1188
La Quinta CA 92253
760/564-2177 FAX 760/564-4882
November 9,2001
Planning Department
CITY OF LA QUINTA
P. O.Box 1504
La Quinta CA 92253
RE: Changes-to-Existing—
Residence
14 La
78-0go Drive
Ladies and Gentlemen:
The Architectural Committee/Board of Directors of Lago La Quinta has reviewed
the request from Mrs. Helen Everson to put an access door into her garage/golf
cart area.
Since there is no conflict with the criteria setforth in our governing
documents, we hereby approve the construction.
If you have any questions, please contact the office at the number listed
above.
ours truly,
Lawrence S. Krueger
President
LK/at
C:\WS2000\D0CUMENT\L3\C1TY.EVE
i
Add new 12"x12"
footing at.new wall
new
• 30'-8
3'-1'--8 21
. . +
Existing
Office
1
5—New 1
Existing Garage
Mrs. Helen Everson
78014 Lago Drive
La Quinta, CA
A R€ -INSPECTION FEE OF. $30
WILL BE CHARGED IF THE, APPROVED
PLANS AND JOB CARD ARE NOT ON
THE .SITE FOR A SCHEDULED
INSPECTION;
.NO EXCEPTIONS!
k
CITY OF LA QUIN'TA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTI N
4TE // k BY
DP6C1jy (-/g, ?0d6r