0107-327 (RPL)LICENSED CONTRACTOR DECLARATION
I hcTeby affirin 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. ClassExp. Date
A 7' ft i i
- ,, t
Date r Signature of Contractor v _ l
Y f'
I hereby affirm under penalty of perjury that I amkexe4t from the Contractor's
License Law for the following reason: 'V
( ) 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
.zr
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 Policy No.
(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 provisions of Section 3700 of the Labor
Code, hall forthwith comply with those provisions.
Ls
Date: a d �'4 f Applicant C j Af
-Warning"Feilu're'to"secure-Workers'-6'jnpef- atioe-coverage is unlawful and
shall subject an employer to criminal penalties(and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicator agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property�for inspection purposes.
t
Signature (Owner/Agent) "� 49-� Date f f j
T ..
PERMIT •. PERMIT#
/BUILDING
DATE / / VALUATION LOT TRACT
f!
JOB SITE' %
APN
ADDRESS 78-2 .58 11KNAnA++ POINT I y
,-
OWNERpp
CONTRACTOR / DESIGNER / EN (NEER
qq yy
L 0 -ft -YE CORWdf y S. X
R0R1r�e P AiNSWORTH 1000L COOS TPXIC'TIO
PA BOX M2
7485 LM40. 'Pfi.AAM 9,21
PALM 17. A "kmsV.f CA 92261
TIALM, b.{'X:.Ab'ILE d t:;A 92211. .
. _•.
y
�7�Vliri �7W�^Il�Y� �8+f3' .../fib d�Y
USE OF PERMIT
:F'+t'%f?JL AldDs'OR YPA
1. C40?1AP4f4..A2,FaRNIVIIJ2$f119..1'US a3.JKA1,L,1jN' 1W +'e IL A10E AT P".11-PL•AaV Z1Z
INSPECTION, POCKY.1;6�Ui!'1�1�2J�'.��C3t�3(li�� 1t¢ia i1iCL1F0 '�.
+ a:? JM.S31YWOR S8 ASL 25X 00.00 WV
c
1'i A'3ED COST OF�:OR91 Y&<I:��.'1 ON
Q1liY�i�tf�
"FV.R'.WT FIX SUMMA"
C t"i'8d.�',i'3t l7S� `F CYAi FEZ $252.00
HLEC 4.AMIr' LRZ •- POOL 101.000442! -WO $9100
EL,ZCT111C.ALHar.,,POOL 101-000-4,2€-0100
PUMP NI O RZ _.. POOL 101.000.419.001 .._ • &7. oa
rm� TP Ma -'['a?}` Ar CC 'ZTs"."E ke Al . &'T.,F 9 C rg(X-X
- $511.80
if �., L1I1a_ ._ j SW3 .EY RE—PX0 ;~EBS
` � . FERWrX YN 6. DU: r�ca��r
_
AUG — 1 2001
CI"f'r OF LA QUINTA
FMOICE DEPT
RECEIPT
DATE
yg J t
BY
DAT INAL
INSPECT
INSPECTION RECORD
OPERATION
11
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
,'BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs li
Underground Ducts
Forms & Footings
Ducts
Slab Grade 11
Return Air
Steel 11
Combustion Air
Roof Deck I1
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing. I'
Compressor
Insulation (&
Vents
Fireplace P.L. li
Grills
Fireplace T.O. b
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall FirewaW
Exterior Lath I
Drywall - Int. Lath 11
h
'
V
Final
Final 11
6LOCKWALL APPROVALS
Set Backs
Footings I.'
steel
Electric Bond
Main Drain
POOLS - SPAS
g
Bond Beam II
Approval to Cover
]i
Equipment Location
i.
Underground Electric
L/,j 0-
/-o—
!.
Underground Plbg. Test
Final Ii
Gas Piping
/
F,,LUMBING APPROVALS
I
Gas Test
Electric Final
—
Waste Lines r':
Heater Final
Water Piping I°
Plumbing Final
Plumbing Top Out 13.
Equipment Enclosure
Shower Pans V
O.K. for Finish Plaster
Sewer Lateral I:
Pool Cover
Sewer Connection Ia
Encapsulation
Gas Piping 1
Gas Test 19
Appliances 19
1'
Final
�/ b v 2
-
Ir
9 a.
I
Final !I
Utility Notice (Gas) I,:
ELECTRICAL APPROVALS
Temp. Power Pole II '
Underground Condut
Rough Wiring I
Low Voltage Wiring I
Fbdures !
Main Service 13.
Sub Panels p
Exterior Receptacles
•G.F.I. 19
Smoke Detectors 1a
Temp. Use of Power;'
k
I
Final I
Utility Notice (Perm)It
COMMENTS:. .
'
-
JUL-31-2001 14:08 TRADITION GOLF CLUB 760 564 2356 P.01i01
racdiffor
ARCHITECTURAL DESIGN REVIEW
July 31, 2001
Ms. Nic1de Gormley
Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re Tradirion
gip_ 11d_Caiifor_nia Village; Swimming Pools
Dear Nicl ie,'
Via Facsimile
760-777-7011
This letter will serve as ADRC approval to obtain a building permit for 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
/rid
cc: Jody Jones, APC (via first class mail)
CWY Damos+w�ngaJ,a Il�.wwpo ved,-�
78505 Ow AVDAA 52 --- LA QuNTA — CA 92253-1120 — PHONE 760/564.3355 — FAx 760/564-2356
TOTAL P.-01
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�\ _04CITY OF LA QUINA
BUILDING & SAFETY D .P1
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FOR CO STRUCTION
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