0107-326 (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.
License # Lic. Class--,, Exp. Date
10, 1 M
Date 11 IF Signature of Contractor- t 1
/1-a ;
OWNER -BUILDER
I hereby affirm under penalty of perjury that 1 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:
Carver MUM
y�tq �1 ARTy yy�y Policy No. y7y��p
�`'A�.fG�i.Yf�/'.iG d� dYAITl"1.OYR WIN 301204
(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 Cajifornia, arSd agree that if I should become
subject to the wprkers' compensation on provns of Section 3700 of the Labor
J.
Code, I shall forthwith comply with thosW provisions.
Date: r `} ' Applicant—
Warning:
pplicant 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 compensationtidamages 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 Quints, 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 t
t
Signature (Owner/Agent) '2t.Ri Date'' `
BUILDING PERMIT PERMIT# '
DATE VALUATION LOT �<.��.L�i•^,Pi�l:_P� TRACT
,/
JOB SITE ""
APN
ADDRESS
1M. I 86PINNAC3,1E FOR Cf
OWNER
CONTRACTOR / DESIGNER / EN (NEER
0".)I(1TS COR -10"A' 11JI.
lelOF ECY AIN SWORTIT POOL CC3NST.CCUCM
A0, BOX 342
7465: dNON FIACE 43
PA; F4 D.I4,3Y.{:Wr CA 92261
PALL -DH8 EMCC (".A 92211
Q60)568-4993 G'BU 511.5
USE OF PERMIT
Y:'001.1 A1'tTINO% SPA
P0011J.t?.A..AIsXoM.S3.E' RR111.0 SHALL BE rK PLACE .RtT;P_R •P1.ASTrR
flq. ;P �.f;TION..POOL EQ'0'IPMM4T ENCLQSUTUR NOT INC*umn
POOLIMWOR SP1?. 2WI40 00 Ls
COST Off?' C"O.i'��P1;�:�'C:' IG N
.'25F�t�.00
�y ;�/�•p,�,�y.�y�)7C.bA°8t�,TEV,
7 gg,�y�•� FRE
V111DRA , FRE CJ74Al!��3Y.UAS z $
P1U 1�3 G"k1 t".Y� Z IP 101-anad3lla439.,318 $163.30
CO'NS"t"d,.t,, rTION FSE 101-000-413-000 5251 W
MECM141CA1a 'F:1i: -. POOL 101-000-4-21 -ON 524,00
JUAC'F'RICA, . FlUr -- POOL 101-000-420-000 $45,00
I LUMB+1+ O FEZ -- POOL 101.000-419-ODO $27.00
;_ a 191 - i.' �,lL. G°Cb r.` IrC'Yi101+1 1k1,3E»t FaI.AaAj x A`
V51:i . 90
AUG - 12001 A. ` � � x-�r ES lyn, NOw
> �I,m .
CITY OF LA QUINTA
FINANCE DEP
RECEIPT DAT / J BY FIN LED INSPECTO
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Final
Underground Electric
Underground Plbg. Test
Gas Piping
t
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
L Voltage Wiring
Fir: ures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
COMMENTS:
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JUL-31-2001 1408 TRADITION GOLF CLUB 760 564 2356 P.01i01
rrra di o
ARCHITECTURAL D1ESIGN AEVIEw.,
July 3.1; 2001
Via Facsimile
760-777-7011
Ms. .Nici ie Gormley
Building. and Safety
CITY OF LA QUINTA
78-495 Ca11e Tampico
La Quinta, CA 92253
79
Re: Tradltton..........
pld Cdiforrlia Village, Swimming Pools
Dear Nickie,
This letter will serve, as, ADRC approval to ot%tain a bwlding permitfor the swimming.pools
at the Old California Village at Tradtion. If you have any questions, please do not hesitate
to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural, Review Coordinator
cc: Jody Jones, APC (via fust dass`mai.D
, - .cvey pxiuenoHonladwll�WviNpaoad.�d
78505 OLD AvEvuE 52. - IA QuiNTA - CA 92253=1120 PHONE 760/564.3355 --- FAx 760/564-2356
1 TOTAL P.01