0202-152 (MISC)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
CCiapter 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
7�i31(3'i B 05 '1 2(
Date., - > - Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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).
( ) 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 -1 Signature of Owner-.g.,i.,.. ,(
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 U2'l,ITH W. 100. Policy No. '=N*06
r
(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, I shall forthwith comply with those provisions. !J
Date:✓ - ? r n c Applicant �fi• t .-� _
Warning: Failure \to secure Workers' Compensation 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. ;f
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 inspection purposes. x
Signature (Owner/Agent 11,x. Qi,, .4 . a ZY06ate ) 1 E -C ZW.,
BUI�LDlNG PERMIT PERMIT
DATE VALUATION LOT {- TRACT
'1w 2.8961
JOB SITE APN
ADDRESS
OWNER CONTRACTOR/DESIGNER/ENGINEER
C,RVLAQT15TFA701P ImoV:A'liV'c. rmsCAp`i col'Rmu1Tal-fe 1, €i; a
2.00 FlIrr W91-10 CpTON AVIZIM& UTE 100
Wt:`C?A37 IDI C:A. 92029 Fes. CCIT01DO ' C' A 92025
(760)839-8238 Cha t 5413
USE OF PERMIT
1. 4ifSMLsKEC US
S'�1l�T?F.ffhiHtl '.IX)1p1i;lC.NUT 0109.190 V`OR 0Al;AO CONVK0I01 TO
VALUATION
SOIX00 LS
F:f rv+HBO;Y M 101 _00Q-43 9.318 0175
c-OwS't`RuC` IO l i� €:; 101-C1Os7-dE1£' 0xt0 r .idg
AiRCILM-11CALME 101 -000 -421 -WO
1. 'RPG, t.IY� 10P-000.420-000 �3C.tltt
1 2 �UO2
CIIYOFLAQL1197A
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"PmmlrW4'DUE NOW
. 174.215
RECEIPT DATE % / BYi" �+... r ,� DATE FINALED I INSPECTOR
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
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PIN. Test
Final
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
O
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
- - - - ..tin• . - • i a - r . JGf CJJ
bbll�ukl_1J.LYJ✓J14�1U•YJLh11��//!%i3ii LA QUINTA
me -,. �
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P.O. Box 1504
78-495 CALLS TAMPICO
LA QVINTA, CALIFOR191A 92253
14.2001
Peter Bilicki
Y La Quints 70, LF
) E. Washington Avenue, Suite #100
;ondido, California 92025
: MINOR USE 1P1ER11M 200I-296 FOR SDP 2001-701
Mr. Bilicld.
(760) 777-7000
FAX (760) 777-7101
Community Development Depar'brueut has approved your request to establish a model home
Plex and guest parking Iot in Trwt 28961 (Lots 28-31) pursuant to Section 9.60150 of the
icipal Code, subject to the following conditions:
prior to ismance of a building penT it, a S 1,000 security deposit shall be pasted jn� that
the teamPorary impravements ere removed from the sire once ibis permit expires. Building
permits cannot be issued for the model houses = it the fine] consmm6 m plans have bem
approved by this Department
Mounted on the Weriar Of the sales office hunt door sbail be a wrirtm notice,provic ing
eergeary pc�sosiael your 24-huur mnergerncy phone number they cars call in case problemsru
arse that need yotni prompt attention (i.e , minimum 1" high letters)_
T#ne proposed -rru"t parking lot shall be constructed before the sales Complex is used.
Ternpoxary landscape and asi laticz improverne= for tine pa&zg lot shall be installed prior
to Opening the model haute sales of oee. Please submit your plans io ibis oZre wit j.0 60
days for review and approval.
A Sian pemlit is requited for any on -site advertisinS.
Xnstallone ZA10$C fire eutinguisher inside the fiam exit door of the sales office.
inaNPOA Modest - 5D GIBS
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InAm
-TUN IS ' vo io - vg
fvU. 1✓J,j ~ Y.'1
C INN V! Y A n
79.799Old Avenue 52 To: Pete Bilicid bate: 6/15101
C A Y
L2 QoretS. ca UM Company: InnovaWe Resort Job *: 446-06
vacs ream.4o1a
Communkies
FAM 79D.Mama Fax (760) 83SZ246 Paget 5, including cover
f°•#Ai1L ca f From: George Prine cc:
Subject " EAgle Bend At PGA Wwr, Model Site
MESSAGE:
Attached is Minor Use Permt 2001-296 for SOP 2001-7004, Models and panting. The approval of the Precise Plot Plans
shoud be forthcoming, shortly.
JUN 15 101 10:15
uu��.JLill. IJ.LVJVJIa-)Iku-vie HIIIII IItjII LA WWI NIA
I NO. iio,� W. d. w
The City may elect to acid Conditions to this application request to mitigate any problems
that arise not previously addressed herein.
temporary facilities shall be removed on June 14, 2002, unless an ex wwioln is granted by the
LmvaiTy Development Director.
a.s decision may be appealed to the Plaimittg Cotumission provided the necessary papftwwk and
ing fee of$175.00 are Sled with this oface within 15 days,
have any questions, plesae contact me at 760-777_706'7_
DIRECTOR
MD$ Consulting
Commtmity Development Director
Building and Safety Director
FiSC Departweat
Bsv-sa-myex, F_%ecutxve Secretary
+—Mane Aaker, Senior 5ecaetary (B & S)
lwtO.plm Models - so oftu
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