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0305-293 (RPL)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 151 C-53 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 STATE Fir K'D Policy No. fit OV11-02 (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.`" ,6ie: Z t: 12Applicant-11 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 foniinspection purposes. 'Signature (OwneOAgent) A - �h,.��7 i'� .^ r'� Date b,. y BUILDING PERMIT PERM 03W29,4 DATE f S, , VALUATION iq,LOT TRACT DDRESS�.�lA��%i aiF��1..�±i1 APN e - '79-&50 OWNER CONTRACTOR / DESIGNER / ENGINEER XOMWCA;NP0101. C403 f3'i z,)c:!"IyAl 7:9601-14:f11WAY 11 I si. QT 0,i=JA CA 92233 Pr' 1 -i':)I SFRT CA CMIO INA USE OF PERMIT P0 fyt RPI, .2rLF .• 0 IN FE"OS,i.:E711 JASP '.L'<` 0,14, PQU[>3MMIT f ffk-;!,0S'!JRr-? F1(Yr €3�1CL.upSI :'D FW -14 eVr4WK lE.L x0��U00�S39 3).�S ti0 .$1 FrIlE l 8-000 S352.00 PPER -••F101111.. 101-000.421-00 t�.�'e;'1`i'fw3rG•FRE -&>C;OL 101 _000-420-000 $43, OP TMAX, YXIMMXXX5 ME HOW $511 A30 RECEIPT DATES I BY / DATE F ALED INSPEC I v— �U 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 OX 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 steel POOLS =SPAS _ Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test Final i 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 63teral Pool Cover Sewer Connection Encapsulation _ J Gas Piping Gas Test Appliances ` Final Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Nxtures - Main Service "Sub Panels .Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: ' Lon - .: , . LCD00 �. m W .� NOTES ^' CD d CITY OF LA QUINTA ► , , BUILDING & SAFETY DEPT. 3a APPROVED 4 a m FOR)COTRUCnAim - A lD _ o �r o „ 0 O L� AREA MAP . M WhmpNo ;1< WNERS d A F DAT Lo ��. - W f LIC.`5187112 ram o {� 9C1ilf. - t'-cl LOT llACat S£c ar T —.—.— �P Tr L LITT EASaENT Q(� ultrri POLE❑ .ax+cr�a+ eooc e R { s�osE, ae —to LK s L41T oeasocwAw ® AAEAawu+ S -EACd k OO D ,ELEC. GAS WTER Q W M LEYEiER © MTEA :' Cat I EAM pvC DAA►! S AA4 R0CAlU ,- --ti—c.-. uoE ,►D cis 9 DEW'+ r %ALVE TES --•.► awr aw was CO ATLIWITIeN VtFKAID ELEC. a�,eo TELE.� VA-eR oto WE 'ALVE (i) mm owua -. AERAM ' LAflOER ; - P o. eoix 119% PALFv1 RT DESERT ,a I:> � '10 ELEC, PEDESTAL� X55 � srrrtx �PTACLE P Tw -••3 SRt9 a aui,w' t1 CLIP 11/lQOR cis �L SEE NOTES G4. (760) 340-2588 ITl June 23, 2003 Ms. Agnes Russell 79-650 Rancho La Quinta Dr.' La Quints, CA 92253, Dear Ms. Russell: t The Rancho La QuWta Architeeftnal Comanittee has reviewed your submittal of plans for poi,1, spa, waterscape, and decking for your home in Rancho La Quinta at 79-650 Rancho La:Quint, . Dr.ive. It was the decision of the Committee that your plans are approved subject to the following condition: 1. All work is -to be done in accordance with all applicable requirements of governmental entities, including the City of La Quinta, and in accordance with al] Homeowners Association architecturaFguidelines'and governing documents. NO= the work is finished, please fill out, and return to me the enclosed Notice of Completion. The consultant will perform a final inspection after receipt of that notice to verify installation according to the approved plan, and then your deposit can be processed for a refund. Tbanks l i,r your patience in this review process. :Sincerely," Gazy Croy, Property Manager Master Association for Rancho La Quinta Cc American Pool Construction via fax at 674-9438 P.O. Box 4779 • Palm Desart, CA 82261=4772 73-550 Alessandro, Suite 5 • Palm Dosed, Caufamia • 760.346.1161 • . FAX 760.346.991a Email: drmQdrminternat.com • wwwdrmintemet.com