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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
67 46 7111
17111 r+r�
Date.Q 3 �^ K' —7Signature of Contractorr�
r OWNER -BUILDER DECLARATION
1 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 Policy No.
S7'A1'i; r7mr) _ 13"01 0 51,17
(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;Sec ltlt on 3700 of the Labor
Code, I shalt forthwit(i comply with those provisions.
Date: IN l" f if 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
the above-mentioned property for inspectio purposes.
/� r -
Signature' (Owner/Agent) ` 7 Date 2 1 Y -.'
BUILDING PERMIT PERMIT# CONTROL#
971 1-t►�,.><
DATE VALUATION j};;S"S�{i,,r1(� LOT 10 TRACT 26370
1 _�3 �# 7
JOB SITE ADDRESS 7i� ..%10 CARfilLLO t•VA
APN .1136-,110.010
OWNER
CONTRACTOR / DESIGNER / ENGINEER
SPARK S C^1,1.7 3111C 71110N
P.O. zi+'JX 1716)
7929-5 ItANC110 U QUINTA DJZL
LA t1111N•1'A CA 11253
1.A (,XAN')'A CA 92?53
(7r�(11771.1')d1 CTt;.1! 2�x>a;
USE OF PERMIT
►1'1..1
�`.
LOT 16, 'rfi�AZik PLAN 1 - PF. -MIT EiCiRS WiT ttwri.UDE BL(.k'WALLS
0H Pt')OL. A1111' 0 1,10V Of S,"1 3.Wi PER r;ONIM. DEV. I)1i1'I', 1'L,AN
C111iCK FIX rr.25°•: fr( )R MIX r -ISI NUIs.
Lv;rO,41CONS RO•CTICN 123t1.110 •l DEC
0 3 1997
1101kci i'PA'riv 170.rr1 tiF'
e
VARA6E:1QtWk,)RT 486 INI 8F
C)ITY of
LAOUNTA
l
I�T
PERNUTIFIF ,sUMM. RN"
PLAN C'MCK Flt'h 1K $193.64
rg�r(�7lNpC'p121 tt; rf 1 i►f 1%1,F 1 f/�)1 R•ti(?0 RWI1 50
Jiyi((�N�1•.{31
NL:i.'il jil4.1C M. I1 XI 101-000.4211-000
131.E 1'l ICA). FE 101 1ti•d2G 4CK1 $1111.111
PU.lf M1NO FM 1014" 419-000 $142.11211
;;r )W-1 N101' (1W FIFT, _ R S!t) 101-r}(y(1 ;4f -111N) 1;111 G':
OPWj3NC FEE 1111.000-123-000 520.00
KIRAN i itUCI e I FrIM 225-006-44.1.342 $4,124.71
AW1 1N PUALK,' PLAC ES - Ri 310. 701-WO-2554ft 110.95
A44T fN P1.111,1C P1,AC1 S - Fli :10 701-ll(1 - 55-(111{1 _151.11.4,95
S01340T',AT,t;Q CT1tT,lC:110NANDPLAN011-CK
55,919.67
1,1•::+5 1'111;-t'1#1U}�1;C:�
-521:1„15
'1'£1 AI. PIERNIUr 14M% I0)E NOW
$5.705.72
RECEIPT
DATE
BY !
D'T FINALED
INSPECTOR
a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
'7-,Z2-
!
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
,_
Ge-
Compressor
Insulation
-
L
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
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
- %- t(J -
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection U
-
Encapsulation
Gas Piping
Gas Test
LG
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 5 —
Utility Notice (Perm)
COMMENTS: �r
/ '� �� /Oul C�
0=1/29""99 THU 10:15 FAX
tit
April 16, 1999
Mr. and Mrs. Donn Borg
73900 Cabrillo Way
La Quinta, CA 92253
Dear Mr. and Mrs. Borg, ir
The Rancho La Quinta Architectural Committee has reviewed and approved your
submittal of pool and landscape plans subject to the following comments:
1: On the golf course property line, only lawn to match the galf 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. The landscape lighting is not specified and must conform to the lighting
requirements in the Architectural Review Guidelines.
3. A drywell will need to be installed with the bubbler adjacent to the. street.'
4. No palm springs gold fines, gravel of any type, or cobble shall be installed where
visible from either the golf course of the front street side.
We are in receipt of your construction deposit, signed grading and drainage form and
signed construction regulations. Thank you for your submittal and patience in our
review of the plans.
Sincerely,
�uto/n-e'Z
Mindy Gutierrez, Property Manager
Rancho La Quinta ""Master Association_
Professional Community Management / Desert Resort ManagemeAt