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LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. Class Exp. Date
sDat
C53 C61 dA35— 17131./N
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 CTATE.701419 . Policy No. 3.6215412-V
(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.t ?
Date:- - Applicant—
Warning:
pplicant
�A; y
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 .toy 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
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date-"
PERMIT PERMIT0
`�y"
/BUILDING �
i 1 (r.IA 6
DAME r i VALUATION LOT TRACT
v•f �t,PA
C).t3ti�
JOB Sn;-+n
ADDREA 713 2.0 C..3ITU ,L0 WAY
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
RO HERt:?MWGIS
DUBBI E SixRM0 a
78.320 C.ABRILLO
71509 BA14 4: rO"tZ!,sC+NIO
iJ,P>.Q wl-A. CA 922:53
RANCHONM -U CrA 92270
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(760)341-2-436 CL0 5486,
USE OF PERMIT
POOL A13I IOR ."WA
SPA AIND'WA'LER trW., TURZ. PIKE PIT UL496tlGAL.,. AL.A1ZMS BAY -RI Ur
SHALL 1317 IN PLACE }'11iOR TO PREP ;.ASTE P. INSPECTION,
POOL AND,#ORSPA LS
X11,7LINTATED CM OF CONSTRUCk.l:ON
12,�fSf�,f31)
LA14 MECK K FTI E 101-000-439-318 $93.60
CO?1S"L1kUC1t1!0VFE.E 401-000-dt"81-000 $444.00
IAB+CHMICALF ER --POOL 101-000-421-000 $34.00
ELWTRICAL 1 E — POOL, 101-000•{120-000 $4.5.60
p1lu v403t•3ll PER -- Fool, 101-x%00--419.000 Mon
d t,0-B-1C'ATA , trO)E4IMMUC'1`tO AM FLAK 4:IM4W:ta
$33:3.60
PERMIT YKI LIS DUE NOW
Q 2 2004
I
CITY OFL.A C!!{INTA
/
RECEIP
DATE
BY-j�
DATE FINALED�
INSP�OR
.0
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I
vil
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 Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Ay A
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
A .
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
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)
Mar 23 04 02:15p Ronald & Margie Heronemus 760-564-7282
DESERT RESORT MA1�AE�
f
March 18, 2004
Ronald and Margie Heronemus
78-820 Cabrillo Way
La Quinta, CA 92253
Re: Spa, deck, fire pit, waterfall and BBQ
Dear Mr. and Mrs. Heronemus:
The Master Association for Rancho La Quinta Architectural Committee has reviewed and approved
your plans, subject as follows:
1. The fire pit must be gas fueled.
J 2. - Verification that there are no easement issues affecting the proposal. We understand that
r7-11
� you will be providing information in this regard.
If you have any questions please do not hesitate to call.
r,
SInC,e ,
To y. ufrter
Community Association Manager
Rancho La Quinta Master Association
P.O. Box 4772 A Palm Dosort, CA 92261.4772
73-550 Alessandro, Suite 5 • Palm Desert, California • 760.346.1161 • FAX 760.346.9918
Email. drm(gdrminternet.com • www.drminternet.com
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