0105-032 (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
Date a Signature of ContractorT��' Y
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the fol lowing. 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 37.00 of the Labor Code, for the
performance of the work for which this permit is issued.
1 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:
Carrierq j q yy'�/r �q�p j—��yys�y Policy No. Np (! p
(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 pro ¢islons of Section 3790 of the Labor
Code, I shall forthwith comply with those provisions. ��
Dater �.° $_•.� lr APPlicant A A&, �''.✓-pa
,. _.. -
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
t
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (� f°,�2 TRACT
$1.9 15M.00
JOB SITE APN
ADDRESS78-730 MOP WAY
OWNER. CONTRACTOR / DESIGNER / EN (NEER
78 x'30 OlU�DIV WAY 74125 1011TS DRME, E`i".yn,19 HA
LA. QV0D,1•L'A CA, 92,253 PALMDESERT CA. 42260
USE OF PERMIT
P001.43PA, .�•`�IAIt'AISMAXI'dRR ►diM.I,8IP, IN KACEA.T VIII&P$.:t STIER
DISPECTrt,713, POOL, RQU Wks ENT M%at"lISURh; NOT R«40LUDED.
P(XX ANDIOR SPA
191500100 LS
Ehl.rWATED COW OF CX)JUSMUMON
PITUMUMET SUMMARY
ft CHECK FFIE
101 •(1'10-43.9.31, 6
$ 34,51
CG'ttf TRUC;'D1014 ME
101-000-418-006-
V07,00
M8;C1}.&NRC'.AbP U -- POOL
101-000-6,21-000
$24.$A
EL•RL.TRICAI., Piyl . - POOL
101-000-420-000
14 5.0
PL•'11M0.41 G YK - Pool,
1101-10W-419-000
$27.00
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 t3••"rq !� , ._,; tr"(',SR�3' hit:}'y J? `"g; +' , ;;
any permit issued as a result of this applicaton agrees to, & shall, indemnifyD 1✓ � PPX-1�x'XT)
& 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 MAY - 8 2001 `I<6 NW
work
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 CITY OF LA OUINTA
construction, and hereby authorize representatives of this City to enter upon FINANCE DEPT
the above-mentioned property for inspection purpose `�
DATEFINALED
01�,
J�`Signature (Owner/Agent) Dated D
F I
INSPECTOR
37. S.5
0.00
$4,%?e
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 Wall Insulation
Condensate Lines
Party Wall Firewall '
Exterior Lath -
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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
Gas Piping
Gas Test
Encapsulation
_
�Q15
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
1.
Final
UtiliE� Not (Perm)
ac 2'7 00 02: 1.7p 3z.5 --<?5'0p. p.2.
STARLIGHT DUNES
HOMEOWNERS ASSOCIATION
APPLICATION FOR R HIT T )RAI / LANDSCAPE
MODIFICATION APPROVAL
DATE:.k .>/
O%'N£R s NAME: 4!i ✓� r NONE: e*V
PROPERTy AddRE55: 7 Ln
ModifiCATiON REQUESTEd: c�iTiT%`ZfYI4.�rrr.Yw� /L�dL
(REPAINTINCT Of HOUSE dOES NOT REQUIRE cluwiN4� SUbMITTEd OR PERMiTS)
To: ARCHITECTURAL 1 LANDSCAPE REVIEW COMMITTEE
YOU ARE kEREby AdviSEd TW TIE ABOVE WORk Is pR pmAd ANd AppROVAI is REQUESTEd. ATTACIiEd ARE dRAVANgS
TO SCAIE MINIMUM 1/8' = I')
Of THE woRk TO bE dmE ANd TYPES Of MATERIALS TO b£ uSEd ARE iNdi•:ATEd ON THE
dR„WINC15.. WE l NdERSTA d TliAT BUilcbNq PERMiTS foR SOME MOdifiCATiONS ARE REQUIREd by THE Ci?y Of U
OIiiNTA ANd TkAT THE COSTS Of THE PERMiTS ANd ThE RESPONSibiliTy of ObTAinincr, *MiTS ANO SUb t-QvENTT
iNSPECTiON will bE boRNE by TITE ApoiCANT. '
WE ACkNC11VIE(kE 76T All APPROVEd 6ANgE5 iN TIlE ORiriNAI duiGN %41, bE AT -O'-IR- ExpENSE; TkAT ANy dAMACTC TO
OR RELOCATION Of EXISTINCi SPRINkIER >RqRTIIIT1Es, bUIIdINCT STRUCTURE A,Vd EXT£RICNt IANt�SCApINC1
TO OTl1ER dAMAC1E 70 ASsocIA Ty REiE:CONSTRUCTION AtidIOR.INSTAIiAT10N OFTIiESE
pERMITTEd iMpROVEMENT5 bE OUR EXP9
We ACkNOWIEkE A SECURiN T Of _ 1_NONE Of Tk TOTAL COST Of lk PPOfECT iS
REQUIREd TOCOVER ANY dAMACE IJF COMMN-UP NECESSARY IOR THE COMPIETiON Of IkE PROJECT.
DEPOSIT AMOUNTwill bE dETcRMINEd y T TO TkE EXTENT Of 111E woRk. THE dEpO6iT MIST bE
subMirrEd PRIOR TO COMMENCEMENT OI WORk. AITER iNSPECTiON Of TkE COMpIETEd pRojECT_.by THE ALC, THE
dEposiT Will bE REFUNdEd if All COMPONENTS ARE RESTOREd TO ORigNAI OR bETTER comcli-rioN. (�
"NOTE: CONSTRLOOWNSTAIIATION Of REQUESTEd ANd APPROVEd MOdiliCATioNs MUST bv4N VA &N 45 dAys of -� V
RECEIPT Of WRITTEN AppROVAI ANd sAid MOdifiCATioNs MuST bE COMpIETEd will.iN 90 dAys Of WRITTEN ApQRWAI.
PR;OR TO COMMENCEMENT Of pROposFd MOdikATiON, plEASE stlbbiiT w4h Ails ApplicATiON CoNTRAcnas l:Nsumma,,
BoNd ANd Copy Of UCENSE.ii OT4R TkAv HOMEOWNER INSTALLATION. _ FikhRE TO""C,O,'MPI} W)Tli TkESE OR ANY Of Ilii
ABOVE SPECifiCATIONS VAI.I RESUiT ir4 ik NLllif;rATi0N Of This docuMENT ANd subswuENTAAl IIIEREOf.
OWNER SIGNATURE
/
WiliNq AddAcss: Z77G/ clis AIA
PRONE # dAys 4: —
Sr -4d To: EWNiwls
PERSONAlitEd PROpmy M4MT.
6 89 10 AddbNA Road
CarhEdRAI OTy, Cc 92234
Arrm: ALC COMMITTEE
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TI+E ABOVE REQUEST L,u bEEn: ( tiTd ` iiEd pENdi
,
-
DATE REviEW'Ed: _ EPOMT AM J T:dL
APPROVEd By:�4
;i , (MUST k%vE TWO (2) SrfTNATUREs, i