0107-324 (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 f or ' ce and effect.
License # Lic. Class Exp. Oate
'np C5 3 7/3 1 1102
Signature of Contracto
Da— r
OWNER-IBUILDER DECLWfT'ION
I hereby affirm under penalty of perjury that I a4 exempt 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 is 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 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 1,7MMONT EMPLOVE Policy No. IMI 3012014.3
(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 051ifornia, and agree that if I should become
subje he� rkers' compensaltioA proy"isions of Section 3700 of the Labor
ct' to -t 11 0 k T N. .
Code,,f sla rthwith comply witft,!hQ'se provisions.
.� i 1 1, 'i
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
I , I
shall subject an employer to criminal 1penalties and civil fines up to $100,000, in
addition to the cbst of com pensati on,'&m ages 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
I , et
the above-mentioned property f6r inspection purposes.
Signature (Owner/Agent) �s.fl Date
BUILDING PERMIT PERMIT #
DATE d, VALUATION LOT 01611 -3 � 4 f, TRACT
J
JOB SITE
AP�N
ADDRESS
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
CO YUCE CORWR, LUT.
R01WRT AJX8WJRT1-1 P00L COMMUCT110
RID, BOX 342
74%-.2 LMIITO14 FL&M 03
imum rosF.R.'r CA 9 '22 6 1
PALM DIMAER'r CA 92211
clap 511r,
USE OF PERMIT
POOLAND/ORMVA
POOLISPA. RUSINAIRPURN SHAIJ, HE 04 91 A�CZ.AT PR&PI.A. STR-R
WSPE(MON. POOLIQUIPM104TEMCWSURP, NOT rMCWE119D.
POOL ANDIOR SPA L, 5, 0 D 0, " us
RM"TED Coull OF CONSM
PIAN CHECK 117KE 101-000-439-M
COWSTRUCT�ON FEE 101--000-418-000
MECHAVICAL ME -- POOL 101 -000 -4.21 -IM) $24.00
&&VTRICAL, 112P - POOL, 101-00"W-000 $45.110
PLIUMP11NO F0 __ Pt"M 101-000-419-000 S".010i
1.90
LES0 PU-PAU-) FMIS
$0,00
'WrAL F"WHI'FEES VIVIK N C)W
f
I AW
RECEIPT
DATE
(V e
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION I —F—DATE
I INSPECTOR
OPERATION
I DATE —TINSPECTOR
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 I
Approval to Cover
Equipment Location
Underground Electric
Final I
PLUM61NG APPROVALS
j
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
Waste Lines I
Heater Final
Water Piping I
Plumbing Final
Plumbing Top Out I
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) i
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
L,pW Voltage Wiring
Fixtures
ain Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
JUL-31-2001 14:08 TRADITION'GOLF CLUB 760 564 2356
P.01/01
q ift
r.a:d' ..*on
ARCHITECTURAL DESiQN.. REvI,EW
July 31, 2001 Via Facsimile
760-777-7011
Ms. Nidde Gormley
Building arid. Safety
crry OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA Oil -'53
77? �ID
I
Re: Tr6ditiori.-
Old, Cdlif&n.iq Villaige, Swimr�ing P001s
Dear Nic1de,
This'letter will serve. as ADRC apprp�al, to. obtain a building.pemik for the swimming pools
at the Old- Califonua Village at Tr . adtion. if 'you have, any questions; please� do not hesitate
to call.
Tbank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
cc: Jody Jones, APC (via fust clasi mail)
a" Mb--�W"-PW,H
78505 Ow Av&,nm 52 — LA Quwm — CA 92253-1120 — PHoNE 760/564�3355 — FAx 760/564-2356
TOTAL P.- 01