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LICENSED CONTRACTOR DECLARATION
he*by 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
59869i i S:i r, 07f 00i-
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm, under penalty 'of perjury that I am exempt from thw,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, andthe structure isnot 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).
O I am exempt under Section B&P.C: for this reason, - -
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
hereby affirm .under penalty of perjury one of the following declarations:
O I have and will maintain aCertificate 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 37W 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 rrna.r.•+•rra;rrr sEr Policy No: :u.�.:wYi a'3 q
N ,%� a:�r_•:
(This section need. not be completed if the permit valuation is for $100.00, or less).
O I certify that in the performanceofthe work for which this permit'is issued,
I shall not employ any person in any manner so alto become subject to the
workers' compensation laws of California, d agree that if I s ould. become
subjec*1a
e workers' corripensatovi Ions o� Section 370 of the Labor
Wode, o with comply with t e pro isi s
Date: Applicant—* `
Warning: Failure to secure. Workers' Compensation coverage is unlawful and
shall subject an employerto criminal penalties and civil fines up to $100,000, in
addition tathe 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 led 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•'repr'e��entatives o this City to enter upon
the above-mentioned pro fqr inspection purposes.
Signature (Owner/Agent)` ` (1 -pate L�
V,
BUILDING PERMIT PERMIT" -
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DATE {i l){,0'� VALUATION 370A1fdl.Q) LOT TRACT
JOBSITE-{Yw�-
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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'7:8R. LENNON PLACE i#3
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VAi,Mk L)J3Z31 JVF CA 92211
(76(1;)%R 1913 CAf,ft 5115
USE OF PERMIT
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RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
7:'! I
E�Jr�l l fr P' CI
'yar';
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 a SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ptbg. Test CCT,
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste. Lines
Heater Final
Water Piping
Plumbin .Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.IC for Finish Plaster
Sewer lateral
Pool Cover
Seaver 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
Final
Utility Notice (Perm)
TRADITION GOLF CLUB
W, 760 564 2356
09 N/99 12:53 5 :01101 NO:872
ciraw-non
AFLCHIT'ECTUTLALDESICIN REVIEW
1. .
September 20 1 1999 Via Famimik
760-777-7011
W Greg Butler
Building and Safety
CITY OF LA QUWA
78-495 Calle Tampico
IA quinta, CA 92253
Hopkins Residence, Lot 6, 7tact,.28470-2, 52-620 Del'Gato,Drive
Re:
Swimming Pbot Review
Dear Greg,
This letter will serve as ADRC approval for the above referenced swimming Pool. If You
need, any additional information, do not hesitate to Call..
Thank you,
Sincerely,
ChrIstina I Dotes - v
Architectural Review Coordinator
,/cjd
pc-. JeffLohmanNafax)
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78505 OLD AvWLw 52 — IAQuwA — CAA922534120 FAx 760/5642356
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