0211-026 (RPL)LICENSED CONTRACTOR DECLARATION
r,Mhereby affirm under penalty of perjury that I am licensed under provisior.3 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. Class Exp. Date
310985 A MAZ CS 111C 05h; 1/2(
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).
( ) 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
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 S'P.dtTE FUND Policy No. 2,297221202
(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.
Date: Applicant
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.
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
therabove-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
,BUILDING PERMIT PERMIT#
+
,C+ATE VALUATION LOT TRACT
JOB SITE
ADDRESS .79-14 CA1An_ D BA
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER
:r JRCE'1vIt+,CX.
CAWY,011I7=J1, ITC: dha CMY'OXT
ly 914 0 (.ALUi1 DFMA
77 5190 :t+!J.Gtiti3'JUM V.EE:W
1:& 01111+1 A. CA 92253
P -1-M-34, R*1N 1k%T CA 92111.
(619)345.8200 MIX 74
USE OF PERMIT
POOL, AND/OR SPA.
:BOOL & SPA O\NL Y.1�.i,�,�at1+Jf WBARP RR.1; St�i,€�.LI, B1: fiq PI -ACE, , ` o .
P&WPLAS O V14,91 ."TION, PONMUsQll:1PW!,NT f?NOLOS"URF NOT i'rSCi.EIMID
POOLANWOR SPA. 59,000,00,14
XMITA'�,aE:� COS".1' 01j t:'t?I Iw'"Jt IiC:YT4A111'
K�C)gf3' 1.436
PERMIT FIVE. SUMMARY
PLAN 01 W.'K FEE 101-00vtA39-318 9209,43
4rGniS'e'RUCTION FifaF,If11-C1AC,i- 'i G3-Ot1ii "�atll�?.`.
NIEC:I- A141CAL At .-POOL i QI yOW421-000 $24,00
fwt,t�7'4:ICei.L �:� ., P}.aGt,, x G »I:1f1U•�2t?••titlf� � $4�.ff6i
1�Lt�iVltfi7+Tt:3 F •- t C 1, 101 JOO .19.000 S21100
lul
NOV0 F 1001 Of
CITY OF LA QUINTA
FINANCE DEPT.
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RECEIPT
DATEy
BY
DATE FINALED
3 - /9
INSPECTOR
INSPECTION RECORD
OPERATION
F 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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
l� --
_Set Backs
Electric Bond
Footings
Main Drain
—2- — �—
Bond Beam
Approval to Cover
— d
Equipment Location
Underground Electric
Underground Plbg. 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
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
t L�
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:
APPROVED 0 NOT APPROVED
REQUIRE INFORMATION
ROVED SUBJECT TO:
,NOTED ON PLANS gLETTER nATEr)
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A.G. ANNUAL COLOR ANNUAL FLOWERS BY SEASON
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4164 79-9 * calve Miss
- *:W Rancho La Q hita v imy C u
La Quinta, California
07 6 (T
anyon Pools
r 14114:
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W9TTIA . +- t2 , kel. (760) 3458200
Palm Desert, California
JOHN N. VOGLEY & ASSOCIATES
-LAN DSCAPEARCHITECTS.,
TEL. (760) 776 6677 FAX (760) 776 6679
45-175 PANORAMA DRIVE. SUITE C,
PALM DESERT, CALIFORNIA 92260
W'i'MI
Date; July 14 2002
Scale- 118"=I'- 01'
Drawn By: A.B.
�TIA 1� U-TiL-17/o z
s
October 21, 2002
Mr. George Mack
79-140 Calle Brisa
La Quinta, CA 92253
Dear Mr. Mack:
The Rancho La Quinta Architectural Committee has reviewed your submittal of pool, spa,
decking, barbecue, and landscaping plans for your home in Rancho La Quinta at 79-140 Calle
Brisa. It was the decision of the Committee that your plans are approved subject to the following
conditions:
1) All work is to be done in accordance with all applicable requirements of
governmental entities, including the City of La Quinta, and in accordance with all
Homeowners Association architectural guidelines and governing documents.
2) The platform area noted on the plans shall not exceed 12" (101.0) above surface
grade.
3) That the 18" raised area above the pool is an 18" bond beam, not the pool elevation.
When the work is finished, please fill out and return to me the enclosed Notice of Completion.
The consultant will perform a final inspection after receipt of that notice to verify installation
according to the approved plan, and then your deposit can be processed for a refund.
Sincerely,
Gary7roy�,�
Property anager
Masociation for Rancho La Quinta
Cc : Canyon Pools via fax at 200-4730
John N. Vogley Associates via fax at 776-6679
P.O. Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 • Palm Desert, California • 760.346.1161 FAX 760.346.9918
Email: drm@drminternet.com • www.drminternet.com