0107-325 (RPL)LICENSED CONTRACTOR DECLARATION
l.fhereby 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
t� Y868 1 0,5 �3� V 1102
D t 'ontr'
e Signature of C actor
OWNER -BUILDER DECLARA,7TION
I hereby affirm under penalty of perjury that I am) exbmpt from the Contractor's
License Law for the following reason:
( ) 1, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure 's not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, 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 Sianature 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
perfom ance 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 FREMONT Ufllu)" Policy No. MIX IM 2034
(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 p ovisions of Section 3700 of the Labor
Cocle, l4halll forthwith comply with thos pr6vi'sions.
Date: �f Applicant—
Warning: Failure to secure Workers!
Compensation coverage is unlawful and
shall subject an employerto criminal 'penalties and civil fines up to $100,000, in
V
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 cf 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 hereb�j t auihorize representatives of this City to enter upon
the above-mentioned property fo nspection purposes.
Signature (Owner/Agent) Aft, I J Date
PERMIX
BUILDING PERMIT
DATE VALUATION LOT TRACT
JOB SITE
APN
ADDRESS
-104.98 11M.A.CJS POJfqT
OWNER
CONTRACTOR DESIGNER ENGINEER
CO TOTE, CORWR, R, 11,T.
ROBEKTAINSWGRIN P001, CONSIRUCTM
1'.0, BOX342,
74852 1.1-INNON KAM 03
PALM DEWT C,A 92261
PALM DF,'ZPXI' CA 92211
(760)5684993 cm -A si I -s
USE OF PERMIT
Wfi.
POOLASPA, ALA,rZ_M31L0kKRJFA1%.S Slihl.J, OF, HN PLACE, AT PR_RPLAN'r2',R,
INSPAMON. POOL EQUIPMENT ZNCIA)SUPURNOT 01CLUDED,
POOLANTAR)RSPA AMAIN U3
WMIMATED CoYr 0F COMMIMC170K
1VR%?bM' b"IM FUMMARY
PLAN CRECK. FEE 101-000-439-318
CV14STR.UC*T10N FEE
P.19MMICAL FRE P001, 101-000-421-000 324.00
�KLYXTRICAL TpKep .. POOL 101-000-4�0-000 V S. 00
PLUM811�110 PER POOL 101 -NO-419-000 Vullloo
JIM; aff JaY110H, ANT) MW CHECK
$111.80
LEW PRE -PAM FM
$0,00
-OW
RUOUTFEES DUE N
Loo
AUG 1 2001
Cly'f 0F L.4 0IJ1;i\1TA
'�!�qAVF flPPT
RECEIPT--- --
DATE FINALED
SPECTOR
INSPECTION RECORD
L 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
OX 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
I I
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
ShowerPans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
4E�EFF Power Pole
�erground Conduit
Wiring
'Rage Wiring
-IS
A.,n Service
Sub Panels
Exterior Receptacles
G.FJ.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
COMMENTS:
JUL-31-2001 14:08
July 31, 2001
TRAb.,I TIONIGOLF CLUB, 760 564 2356 P.01/01
...... 11radi n,
ARCH.ITECTUAAL DE§wN REvisw
Ms. Nickie Gormley
Building aO.SafetY.
CITY OF LA QUINTA
78-495 Calle Tampico'
La QWnta, CA 92253
on: -.---'-
Re: TrAt!
0 1 1dCalif6 rhta Wilap,'Swirnming.Pools
Via Facsimile
760-777-7011
Dear Nickie,
This letter will serve as ADRC approv� to obtain a bxdlding permit for the swimming Pools
at the Old Califormia Village at Tra.dtion. If you have, any questions, please do not hesitate
to call.
Thank You.
Sincerely,
Christina J. Dores
Architectural Rev.'ie�v Coordinator
/cjd ...........
cc: Jody Jones, APC (VidfU-SE Class mail)
a" 00pMM.\Am�\,Xj, o.WWnI&V".ft0.-0
78505 OLD AV&MA 52 —'LAQuNTA — CA 92253-1120 — PHoNE 760/564,3355 — FAX 760/564-2356
TOTAL P.01