0008-026 (RPL)U)
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LICENSED CONTRACTOR
I hereby affirm under penalty of perjury that I
Chapter 9 (commencing with Section 7000) c
Professionals Code, and my License is in full I
In :e # Lic..Clas
'e'894 C53
,Date ¢ Signature of Contractor -
OWNER -BUILDER DEC
DECLARATION
am licensed under provisions of
f Division 3. of,the Business and
ON
Exp. Date
11130/20
I hereby affirm under penalty of perjury that I ani 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 SrA.,p
FUND Policy No. 134402-00
section need not be completed if the permit valuation,is for $100.00 or less).
O I certify that in the performance of the work`r w
-fohich this permit is issued,
I shall not employ any person in any1manher so as to become subject to the
workers''corrpensation laws of California, and agree that if I should become
the workers' comobr
s bjecttl o isation"prodisions of Section 3700 of the Labor x:
Lrode,`hs, all port, with comply with those 11rovisions. <q•
Date: _ ADDlicant 1 - P' -Q,
Warriirig:faiture 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 it
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 wortk 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'"w(th all City, and State laws relating to the building
construe 'en, and herebylautho ze representatives of this Citydto enter upon
the a ove-mentioned properTf� sp tion purposes.
Signature (Owner/Agent) Date t Y
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 1008-026 TRACT
S22A*. 0
JOB SITEAPN
ADDRESS �_*760 M_Yde.w•.Lo WA -1
5!2��+
OWNER
CONTRACTOR / DESIGNER / EN &NEER
a Tc�? w 3h #27
FAMILY POOLS CONMRU(," ON
78.760 CAD1SU.O WAY
53300KVfJN1DAR.A1 WLPZ
.LA QU7XTA (."A 9223?
LA Q'U1 r.A CA 92253
(160)564-3655 CBTft 2893
USE OF PERMIT
POOL AM/CYR SOPA
POOL &SPA ONLY-ALARMS16AP.3 IERS atAi..H, BE IN PLAczNr
PRF,PLASTER i1WSPEC"TUYN, THIS 1 Is11MIT DOP.,S NOT INCLUDE BLOCK
WALL FOR EQUIPMENT ENCLOSUW
VALUA'1) N 2 004.40 I'S
E5 -*MW J9D GOIRT OY C;0149;li; UC'TIOiV' .
2:11400,00
PERW ' b'1+7: 9MIMAR'Y.
PLAN CHU% FEE 10) -000.439.315 $146.25
C°ONS'rRUCTICYN ME 101.,000.418-000 $225.00
MECHANICAL ME -- F°CyCaL 1101,000-471-000 $24.00
t?.LEC:'4 RIC.t L ME— POOL 101 -alio 420-000 $45.00
PLUM6X O FEE -- POO), X01 4100419-000 $" Do
:)1'M -TOTAL C'01qf4'I:3=01f A14D FLAW CMCK
$4611.25
a
j TOTAL F30M..CItXWOLIE NOW
$4!,7.2,5
RECEIPT
DATE
Bf
DATOFINAL D
INSPECTOR
V
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
0. 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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test i
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
COMMENTS:
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)
_~ ,r3 Mediterranean Fan Palm 24" Box
Oo 00. 00 11—Pittosporum Wheeleri 5 gal
O O49
00
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Existing Deck
I �r ®® JENSON HOME �
0 78760 Cabrillo Way' I
Rancho, La Qulnta I
j
i
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE BY
I
POO&
Construction i �
Pools Spas Fountains
(760)564-3655
Lic. #658996
Aug—OA-60 10:42A
.1
�w July 31, 2000
Mr. and Mrs. Duane Jensen'
5525 S. 900 East, Ste. 110
Salt Lake City, UT 84117
Dear Mr. and Mrs. Jensen:
A
The Rancho La Quinta architectural consultant has reviewed your submittal of landscape and
pool plans for your home in Rancho La Quinta. Before submittal to the committee, the following
corrections need to be made:
1. On the golf course property line, only lawn to match the golf course or a 12" wide
concrete mow band shall be allowed within a 12" setback from the property line.
No planters, including trees, shrubs, or groundcover other than lawn shall be
allowed in this 12" setback.
2. Landscape lighting is not specified and must conform to the "lighting"
requirements in the Architectural Review Guidelines.
3. No Palm Springs Gold fines, gravel of any type, or cobble shall be installed where
visible from either the golf course or front street side.
I`appreciate your immediate attention to the above, and ask that you have corrections, etc. back
to me on or before Wednesday, August 2, 2000 . Response by memo is sufficient on items 1-3.
My fax is 760-346-9918.
Sincerely,
GaryCroy, Property Manager
Ranc La Quinta Master Association
Cc: Family Pools via fax at 564-3655
Professional Commur►ity Management/ Desert Resort Managemenf
P.02