0006-271 (RPL)N U)
W
W
r1 -
C Z ti
O O
�C)
tea~
Z
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
356126 C53 1,'2(
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:
( ) 1, 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.
(T;,) 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 FU;aD Policy No. 046-ad-a�ti�td8-1�
(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.
Date' 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 inspection purposes.
Signature (Owner/Agent) Date—/, ,•-,
lBUILDING PERMIT PERMIT#
/ S7
DATE(: � f V LN LOT n" �- • � TRACT
JOB SITE
APN
ADDRESS
19.401 CASA MA CIRCLE
_
OWNER
CONTRACTOR / DESIGNER / EN (NEER
713)1j1r1WRT.DL-VEL0T%GWf
CAV:.•1;Fy)1:14IikP00L,8 & SPAS
F10 BOX 1716
74.72.5.1QNI1' RIVI� #A
LhQTJIW—,A CA 92233
PALM 12>~,&`lERT CA 922E+0
(760)340 9000 Mlb 355
USE OF PERMIT
POOL AJI IVOR 01PA
POOL &SPA. ONL;V-AJ, ARMS/RARRJERSI SHALL fig IN PLAC;F AT PRE
PWITER WSPECTiO•NfP001, EQUIP tNCLOSURK 12 N0T I'WCJ,01)FD
POOL AVD/OR. SPA 21,400,00 LB
F..N'ITMA•IED CO`b-T OF CON:IRLFC7110..11
21,4111.0U
FFRAM'i'BIX NUM9 ARY
PLAN CHECK WE 101.000.439-318 $146.21
CCrNSTRUCTION FEE 101-000-41 B-000 W3.00
MEi,1JANICAL PRE -- POOL 101-000-421.000 $14,00
ELECTRICAL, FEE -, P001. '101.000 -420 -QUO $45.0111
PLUMBING YEE -• POOL 101.000-419.000 %27.00
MM -7Y rAL C':ON� `i'.RUCI10N' ANT) PLAN CNIi�',X
$467.25
L H23 :PR} PPAIT) FEZ
$0,00
't'(YSAb 11X1Z•liffr k'PJTN 1),U9 P4 )1W
167.'
RECEIPT
DATE
BY
E INA D
INSPECTOR.
i
"�f
^�SPECTtn�! REC�JRD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
Ift BUEL.DINC 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.Q.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final .
BL,OCKWALIL APPROVALS
Steel
POOLS a SPAS
— l C..r
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
3 cam)
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PfL.�JJRfiI�WG APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
11ok-
Gas Piping
Gas Test
Appliances
Final
-
Final
Utility Notice (Gas)
ELECTRICAL ECTRICAL APPROVAL S
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:
Jan -09-01 04:17P Valentine Construction 760-+-341-t-719.3 P.02
P,02
January 9, 2001
Mr. Frank Tomesy
79-101 Casa Vida Circle
4a Quinta, CA 9225.3
Dear Mr. Tomosy:
Sent via fax to 650-343-1172
iiia Rancho La Quints► architectural consultant has reviewed your submittal for the proposed
addition of anew guest Douse at 79.101 Can Vida Circle Before the committee can review, the
plans, the toilowing corrections need to be made.
1. Approval of guestixase shall include clarifrcaton that only one cart garage door is
being used, and the other door shall not be installed. A revised mar elevation shell be
submitted for review/approval
2. Landscape lig OBS is not spoKified and mud owftm to the "lightigg" requirernants
ire the Architectural Review auidelines.
3. The Hibiscus shall be kept'triemtted to a maximum heigbt'of 30".
4 Palm Trees shall have a,ininemum, trunk height of 7.0,
I appreciate your-mmediaft attention to the above, and� k that you have a memo faxed to see
regarding items 2-4 as soon as possible. My fax is 760-V-46-991 6. Regarding item 1, you will
treed to re -submit your -revised plan. I will present your plan in its present form to the committee
tomorrow, but until we have your revision, final, reviewlapproval cwmt be c ompkted.
E
' �.
Toy; Pry
Manager
a Quinta Master Association
PWIF"slonal Community Management I Desert Rego t Mutag*ment
Host Office Bax.4Tn .4 halm L'>06eri, CA 92261.6772
73 550 Alessandra, Suite S • Palm Desert, CaldOrnia • (760) 3{6-1162 a FAX (760) 316.49E8