0107-328 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (com ' mencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Clasg`- Exp. Date
70A. 1/02
Date Signature of Contractor— A
OWNER -BUILDER DECLARATION
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 "fork for which this permit is issued.
have andwill 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:
CarTier % Policy No.
11" 0114 Ir RA, P Lo If B WN 30-1203-5
(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 I manner so as to become subject to the
workers' compensation laws of Calif, =4 I n ree that if I should become
subject to the workers' compensati � rovisions ' f Section 3700 of the Labor
t .1.
Cocl�, I, s 11 fdrthwith comply with —_ e r V1,SIOTS..
1 0
Date: .Applicant--
"IY
arning: Failure to secure Workers' Cori�pensation coverage is unlawful and
� 1, 1
shall subject an employer to criminal penaltiesiand civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3�06
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. V
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, indemnity
& 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 adfh'orize rl�presentatives of this City to enter upon
th6 above-mentioned property for in)pektion purposes.
S
Signature -(Owher/Agent)
Date—'
BUILDING PERMIT PERMIT#
DATE VALUATION, LOT TRACT
2
JOB SITE
TPN
ADDRESS 7&.2415, PLIPMACGIE.POTTIT
OWNER
CONTRACTOR / DESIGNER / ENGINEER
Col�()TF, cojxmli:r�., 1,VL
ROBEG-1 ikMT3WOK111 POM C"CINSIRUCUO
raol BOXX 342
74852 LUNNONPLACE03
PAIM DEMERT CA 92261
RALM DESERT CA 92211
(166)"68-4993 MW 5115
USE OF PERMIT
1100L MINOR fWA
J , JSPA. ALARAWBARRIERS SHAIJ, 89 INt PLACE ATPR.&PLASrER
POM
POO), ANWOR. SPA 25,000,00 1.49
=11MAITT COST or, CONSIRUMOIN
PEIRA6113TRE, Sla"My
PLAN CNECK, MR,
C014STRUCTION FES 101-000-41"00
UIRCHANICAL FTM -- POO ' I 101-00a-421-000 $24.00
EIA= WCAL F= - POOL 101-000-420-000 14-45.00
MUUMIRING ME _ POO)., 101 -000-419-.000 $97.00
YrAL C6.R6,,, 'LUCTMN A14D PX.0TCfWP_Y,
.;j
UYSS PRE APAM PYRZ)
LAIU'JG 1 2SO01 PMWT1,',=S D
r ff F L., 0,,,! �4 T
IA
RECEIPT
DATE
_V_FINA
DA
-2
INSPE JOR
1;l< -
le-
INSPECTION RECaRD
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
I
Final J
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
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
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole I
UndLziround Conduit j
Rougl��Wiring
LowV,oltage Wiring
Fi4-ures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
JUL-31-2001 14:08 TRADITION-GOLF.CLUB.
U,
ARcHITECTURAL DESIGN R'FiviEw
July 31, 2001
Ms. NicIde GoM-IleY
Buildinj and Safety
CITY OF LA QUINTA
78-495 CalleTampico,
La Quinta, CA 92253
-73
Re: V;dcUtion
Old Cal ia Village,. Swimming POOLS
ifom
760 564 2356 P-01/01
WaYdesimi&
760-777-7011
bear NicIde,
This letter will serve as ADRC approval to obtain a building permit for the swinuning Pools
at the Old' �-alifornia Village at Tradtion. if you have� any questions, please do not hesitate
to call.
Tbank you.
Sincerely,
Christina J. Dores
Architectural Revie.w Coordinator
A�d
cc: Jody Jones, APC (Vidfirst class maiD
78505 OLD Avwa 52 — LAQuNTA — CA 92253-1120 — PHoNE 760/564-3355 —. FAX 760/564-2356
TOTAL P. 01