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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
f'
690377 C53 C27 C29
•'Date 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&RC..for this reason
Date Signature of Owner.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations'.
O 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.
( Yf 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.
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(This.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 for which this permit is issued,
I shall nd employ any person in any manner so as to become subject to the
/ate:
' compensation laws of California, and agree that if I should become
to the workers' compensati.Qn proYislons of,Section00 of the Labor
shall foythvuith_ comply witfi.those provlslonsr'
./ f• < gpPlicant 1
Warning: Failure to secure Workers' Compensation coverage,is unlawful and
shall subjectan employer to criminal penalties and`civil fines up to $100;000, in
addition to.the cost of compensation, damages as provided for in Sectiom 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:
21 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 proper fbrinspec`hon purposes..
kSignature (Owner/Agent). ``-i�_. ' - ate
PERMIT #
BUILDING PERMIT
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DATE Rg/o,• 99 VALUATION '7,�td➢119tf LOT TRACTJOB
SITE
ADDRESS 'b'.�-.2.8 5 .ASA 0E.L .R10
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
+9-211 r-.liaiA iDEL RIC7.
73-960 i 161 -TW AY I I i, si;t1"I? _t
LA ['A CA 97,yi 3
PAl.i1:l DE41'17RlJ' CA 92760
0601S69-6720 t_'F)Ur'• 5220
USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINAALEDINSPECTO
y -a-4f
,r
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS o SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
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Utility Notice (Penn)
September 7, 1999
Mr. William Thom
49-235 Casa Del Rio
La Quinta, CA 92253
Dear Mr. Thom,
The Ventanas Architectural Committee has reviewed and approved your submittal of pool, spa
and landscape plans subject to the following comments:
1. You will need to have area drains and a drywell with a bubbler adjacent to the street.
2, The rear yard contains existing landscaping which shall remain. The landscape plan does
not reflect this.
3. Construction cannot begin until the construction deposit of $2,500.00 is submitted.
Please make the check payable to the Ventanas Community Association.
We have received the Grading and Drainage form signed by you. The construction regulations.
have been signed by you and your contractor. Thank you for your submittal and patience in our
review of the plans.
Sincerely,
r
V
Mindy Gutierrez, Property Manager
The Ventanas Community Association
Professional Community Management / Desert Resort Management
Post Office Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 • Palm Desert, California • (760) 346-1161 9 FAX (760) 346-9918