0107-330 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chap�ier 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
Date Signature of Contractor \/I
OWNER -BUILDER DE611_1�R ION
I
I hereby affirm under penalty of perjury that I am 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
Sectioa 3700 of the Labor Code, for the performance of the work for which this
permit 11 is issued. My workers' compensation insurance carrier & policy no. are:
Carrier FR&MONT rrYMPLOYU I Policy No. Ayclq. "1203-5
(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 Calif&rnia, A agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
I ! Y . jq.
Code, I'shb,11 fod�with comply with thos�proyi C 9SI.,
Date: Applicant— A J,?k
Warning: Failure to secure Workers' C ompensation 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 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 iri�pection purposes.
Signature (Owner/Agent) Date
PERMIT#
(BUILDING PERMIT
DATE VALUATION LOT 010,7-330 TRACT
4
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN61NEER
o,nram, cmwn, us,
ROW= AW RW0,R'rr1 POOL CONSMUCC10
P;01 BOX, .442
7 405 2 u2MY-4. Pijvcill 1113
.PPLI-A r).R1.9E_k1r CA 92261
PAIm buma (,A 92211
(760)56S-4993 evil# 5 115
USE OF PERMIT
POOLMiNOR RM
P00LA'P,VL ALARMSMARRISPS S-HAU, BY, IN PLACE AT PRFE-PIASTER
POM EQUIPMINT W-CLOSURIE NOT INCLUDED.
POOL ANDPOR SPA 23,000,00 La
ESTMMED MST IDY CONSTWIM-ON
PIMMIT AVE 9IMPAAM
PUN CHECK MIN 103 -000-439-319 $163,90
U014MIUMON Vat 101-1000-0418-000 $252.00
W�CMNICIAL VIR __ POOL 101-000-421-000 424,00
MECTRICAL IrElt - POOL, 101 �000-420-000 $45.00.
MIUMBIN(I Flu __ Pool, 101-000-419-000
HUR-',rQUL C WMION AM) PLAN CHXCT-.;'�
IAZ�iE
U LE.". PRE -PAID FESS
$D-00
T
T PMM"341M DUE NOW
A U G - 1 2001
JL
CITY OF LA QUINTA
FINAMH DEPT ,
RECEIPT
V
\L/
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
j
Final
Final I
BLOCKWALL APPROVALS
Steel
POOLS -SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
I
Underground Plbg. Test
Final 1
Gas Piping
PLUM61NG 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
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.L
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Final
COMMENTS:
JUL-31-2001 . 14:08
My 31) 2001
TRADITION GOLF CL 13'
on
qlrddift
ARCHITEC . TURA L' DE :S�I'GN REVIEW
Ms. Nic1de Gomiley
Building and Safety.
MY OF LA QUINTA
78-495 Calle. Tain
Pico
La Quinta, CA 9.2253
Re: D*dditEq'nt
P601s
61� 61ijbrnia IWIlage, Swimn!47
760 564 2356 P.01/01
. Via Facsimile
760-777-7011
Dear Nickie,
This letter will serve as; ADRC approval to obtain a buildingpermit for the swin�g �ools
at the old California Village at Trd4t,ion' Ifyoti . havi any q'uesnons, please do not hes itate
to call.
Thank You.
Sincerely,
Dores
Christina J.
A.rchitectural'Review -Coordinator
/cjd
cc: Jody Jones, APC (viaftrsc class m0l)
78505 OLE) AvExnx 52 — LAQuNTA — CA 92.2.53-1420 — PiioNE 760/564,3355 — FAX 760/564-2356
TOTAL P.-01