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LICENSED CONTRACTOR DECLARATION
11,ereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of,.Wd Business and
Professionals Code, and my License is in full force and eft.
License # Lic. Class Exp. Date
C53 11'3(!?0
vDate`c F r Signature of Contractor
t ,
OWNER -BUILDER DECLA ATION
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
( ) 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 Irequired 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. '
STA -11T, FI. NI D 1 A )13243
(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 mannereso as to become subject to the
workers' compensation laws of Californjnd agree that if I should become
sub�ecteA.. the workers' compensat�n provisions of Section 3700 of the Labor
Code, Is I • f0 w't comply with thole rbvisions.
Date: �,4DDlicante_""" ' % E
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penaifies 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. C
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 aqd,state that the above information is
correct. Iragree to comply with all C'ty and State laws relating to the building
construction, and hereby authoree representatives of this City to a ter pori
th cove -mentioned proper4for'nsf ection purposes.
Signature (Owner/Agent) Date
i
BUILDING PERMIT PERMIT#
"0as..097
DATE t # vi"VALUATION LOT TRACT
JOB SITE
ADDRESS 78-800 1(A BB'}..RILO WA -V
j
APN -
OWNER
CONTRACTOR/DESIGNER/ENGINEER
Ad.r.AIN C%i1P.F'�OL11, ,.
i':�.ii• ILY 't- .#A CC"'I" %�'Ct.i:':'1 X11)
7�tcOQ%'ABIZ;LLC� W�1`.
�i:�t}0 t1'�'ii,�JIDA.�i-Ah4IREZ
LA QUtNTA. f1A W251-
f..,(i. i3i.Sl91-A. C'A 922!53
�7a:sfilSfSs-kS;F C:�tT.�f :t�')3
USE OF PERMIT
k'iXX.. AN a1OR 8PA
POOL i FPA i �Ei�;? - EAf.rZ.RMVRt+RkfEWS SALL 99114 T¢I.i'+CR r>eT
4300L ANDif sR SPA 20.400.(k 1.10
ES d,A�i A & .1;a8.J CO d O!4' C'UN'S�i HUCliIGN
MaCM CC PE�i.,:IUMVAI IV
PLAN, ("NECK 1+1t1; 1014)W-4349-'318 S 134.55
(Y11VSTRf IC*'0'i0A F01 tOi 4 i)N418-1000 '$247,00
P4 ii ,`#.6sti1N1C 4VV 111"tt'' -- fVOL 101-000. 421-000 %.^1,N)
rl.isXyfI(ICAL .,Fr1r,.,!'a'X . 101--0}E)-42&4*0 545.011
SI fT"i-TI17" 1, CON.'?'#t(SC'I'iON ANC) 141,A t;'T'jECK
S,:i:47 ti*
LESS PRE-PAIDI :PPS
'SO, 09)
at
RECEIPT
RECEIPT
DATE
BY r
DATE FINALED
INSPECTOR
7�
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 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
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:
1
Property' Line
Infinity Basin
3'
Pool
5' Easement
Property Line
BBQ ANSI 221.58-195
it .foo
.0=
Pool Equipment 0
'Oo
i F_
-@— Property Line
t
Carroll Residence A RE -INSPECTION FEE OF $30
WILL BE CHARGED IF THE APPROVED
78--8010 Cabrillo Way PLANS AND JOB CARD ARE NOT ON
Rancho La QU'Inta THE SITE FOR A SCHEDULED
1 INSPECTION.
NO EXCEPTIONS!
CITY OF LA QUINTA
BUILDING '& SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATE 1 BY
1/8 " 1 '
gam4 JD
Construction
Pools Spas Fountains
(76'0)564-3655
Lic. #'658996
--.e .7 - - -
7/29/99 THU 16:03 FAX
' I I�1i�liil
M
`July 29, 1999
J
Mr. and Mrs. Allan Carroll
78800 Cabrillo Way
La Quinta, CA 92253
Dear Mr. and Mrs. Carroll,
. s
The Architectural Committee for Rancho La Quinta has reviewed and approved your submittal
y of plans for the installation of a pool, spa, deck, barbecue and landscaping subject to the
following comments:
Y
1. A concrete mow strip or grass is all that will be allowed on the 12" area adjacent to the
golf course. This will allow the golf course mowers to complete their job with, no
damage to your plant material.
2. The landscaping will be flower beds around the edge of the concrete decking. Ground
cover will be maintained for both summer and winter color.
3. The maximum height for any planter walls; pool decking, or walls shall be 24".
4. The barbecue will be stainless steel or black finish. The barbecue, stand and concrete cap
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can be no higher than 36".
We are in receipt of the grading and drainage form, construction regulations, and all construction
and review fees. Thank you for stopping in the office yesterday, I look forward to working with
you further on the development of these improvements.
Sincerely,
T;; yMindy Gutierrez, Property Manager
4-. The Master Association for Rancho La Quinta y
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