9908-102 (RPL)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.
Licensee90�T� : . ' ") °`:a L.s47' C29 Exp. D��ltr�/201
Date Signature of Contractor
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
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 3?.rA'1',il 1.FL44O Policy No. 229-9S Li Orr W20130
(This section need not be completed if the permit valuation is for. $100.00 or less).
( ) -1 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 those provisions.
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 providedfor 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 a11" 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) Date
BUILDING P�R�IIT PERMIT[(�� $f;
DATE VALUATION ' LOT TRACT
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JOB SITE 9. 4.15 h -1 V ?,
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ADDRESS
OWNER CONTRACTOR / DESIGNER / ENGINEER
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1.-A QLWfA CA PALM, DESFR't CA 92260
(Tti'J)b i fg? fi C AL0 .5220
USE OF PERMIT
POOL A;I IXOR SPA
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PLASTFR 07SPEC'i' ON.
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PERMIT YEE SUMMA.13Y
PLAN CI1WX EF,.E 3.01-000-13.4-318 $117.00
0C1N&X— t,U;C TLOfa FEF; 101-000418-000 $180.00
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DESS PkI E -PAID RES
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TOTAL PERM IT'VETS DUE NOW
S393.00
RECEIPT
DATE
BYp
DATE FINALED
INSPECTOR
- I? . °,1 47?
/ tf r ."-t
.
INSPECTION RECORD
OPERATION
DATE
I 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.
Fratriin9
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
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 Covei
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
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)
Final
COMMENTS:
+`
01/28/1992 01:31
o�
i�
TO:
CC:
FAX:
DATE:
FROM:
7607713365 BROOKS ASSOCIATES
DALE E. BROOKS
11454 Lausanne Way
Truckee, CA 96161
530 550.1288
530 550-1288 (Fax)
FACSIMILE TRANSMITTAL
Taml Lehman
Melissa Layton
760 346-9918
8/8/99
we E. Brooks
Fax is 4.pages, including cover.
COMMENTS: Gourley PooVSpa, Decking, Trellis & Fire Pit
Please refer to my comments of 7/20/99. 1 have reviewed the revised plans
resubmitted by Mr. & Mrs. Gourley for the additions to their residence at 79-875
Ia. I received these revised plans on 8/2/99 & 8/6/99. 1 have also discussed
my concerns with Mr. Gourley and his landscape architect. Additionally I
received an 8/2/99 letter from Ms. J. M. Gehrke, the Gourley's next-door
neighbor.. in which she expressed some concerns over the placement of a wall
and associated fire pitA copy of Ms. Gehrke's letter is attached.
PAGE
On the items that I disapproved initially, I offer the following: a) the proposed
modification to the outside wall --This modification is approved providing the
lateral cut is no more than six feet wide, as indicated on the landscape plan,
and the depth of the cut is no more than two to two and one half feet deep.); b)
the bullet and pagoda lights that face the house on the west --This lighting is
a roved. _ (Mr- Gourley has assured me that the lights will not cast light directly
into the windows of the adjacent house); and C) the wrought iron fence at the
rear of the pro pert r. (The revised plan now shows the fence to be a maximum of
three feet and painted black.) This meets_ our requirements so the fence is
approved.
On items on which I requested additional detail I offer the following: a)
dimensions on the landscape and Fire box plans that show the exact location
05 r'
01/28/1992 01:31
7607713365 BROOKS ASSOCIATES
PAGE 06
and h ht of the proposed fire box (The revised plans show the fire box
location and the ape of fire box that meets the city of La Quinta standards.) Ms.
Gehrke had raised concerns over the height and location of the fire box. I
understand from Mrs. Gourley that the revised fire box design is now acceptable
to Ms. Gehrke, thus the fire box is approved; b) dimensions and design of the
stepped screen, wall, item 3 on the landscape plan. I understand that this wall_
already exists so no additional detail is required; c) the wood stain color of
the proposed trellis (1 have been advised that the trellis is to match the color of
existing house soffitts • dpool design, i.e., depth and dimensions of the pool
and spa. The revised plan does not show the pool and spa depth, but
according to Mr. Gourley's note to,his landscape architect, the pool and spa is
really a hot and cold spa, four feet deep. Spa depth should be shown on the
Ip an for both bid and city approval purposes, but is not now required for our
a roval: e) location of the gas line to the pool heater (the revised plan shows
the location of the gas line); and0 location of patio, lawn and garden surface
drains and drain lines to the street. (There is a new drawing noting drain and
drain line locations, which is approved.)
The Gourley's have been very cooperative in meeting ours and Ms. Gehrke's
concerns and for that we are very appreciative. I now approve their plan as
revised.
Please share this fax with the other members of the Architectural Committee. If
you -have any questions, please give me a call.
IL
If problems occur during transmission, please call (530) 550.1288