0204-109 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby 4run.1 inder 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
6645 3 2. t",8
ate;y W �� ZSignature of Contractor's--
OWNER -BUILDER DECLARATION/
I hereby affirm under penalty of perjury that I am exempt Gm 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.
t(<,� have and will maintain workers' compensation insurance, as required by
S 6 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 a'}.Ci+' C''U3d Policy No. 1620w
(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 ThalfQ"ithwith 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.
//.S,.
gnature (Owner/Age,hl Date
JV / f
BUILDING PERMIT"y .. y PERMIT#
DATES°'"' "" VALUATION LOT �'� TRACT
Jc MGM
JOB SITE
ADDRESS '69 X400 CIT1.kis
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
`a'U%RAR DOM
:R+;RC CONCRETE
T.ak'Q-141VA CA k253
PAU141DEMLz1f Cf. 92260
'
(760)345-8554 C 1B 4754
USE OF PERMIT 4
almna A?;RiJxumlax
i
12 1,11? 6' 0ARI 71-# WALL PER CITY S i't's,NE3AMO-HO.t4 .APPR.Cxi At CIN FILE .
a
6 F7. WALL
?UUL ..�
CffY
y.
7
FL.AWWA a
? cost- op CO.K:o.3'P�.�t"Tirm
300.00
gym per,g� y�;,f•�, ��+u�t^p.,�y,� �ESmxrx
as .�L#�.NY1L4A .fJ',riaL•e h�LJ'J.1Eq1M:[ddn3'4.� .
4:UYNSTRt1MIUM MEM 101.000418-tig0
a•,
TOTAL VXi.MUT MES 1) UE NOW
9 :.15.00
RECEIPT
DATE
DATE FINALED
INSPECTOR
��/'��
`lam
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
0. 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
BLOCKWALL APP VAL
POOLS - SPAS
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
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
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)
COMMENTS:
�' . -y� � �y�`'__✓ter � r� r
March 4, 2002 '
Tushar Doshi
79300 Citrus
La Quinta, CA 92253
RE: Architectural Approval Request
79300 Citrus
k, Dear Mr. Doshi:
Members of the Architectural Committee reviewed the application and plan submitted to in;,t dl a
front entrance courtyard wall and gate. The application and plan is approved providing the
following changes are agreed to.
1.
The front of the curved wall is at least 18 feet from the curb, instead of the 16 f� n 6
inch distance noted on the plan.
s' 2.
The radius of the curved wait is adjusted to compensate for the above requirerm Ott.
3.
The new concrete sidewalk to the driveway matches the concrete of the drivewa
and not the concrete in the courtyard.
4.
Existing irrigation lines are rerouted and there is not more than a 12 -hour delay i i
reinstalling the rerouted lines and activation of the system, (failure to do this cou i
result in severe damage to the existing landscaping.
5.
All shrubs, bushes, vines or flowers that are damaged are replaced in kind.
(5.
The planter bed next to the garage wall that was recreated by removing concrett; hat
was installed without Architectural Committee approval is landscaped with plant
material that duplicates the plant material used at other plan three houses.
7.
A more defined landscape plan is required. The landscape plan that you subrr ii ed
does not show what type of vines you intend to plant on the east and west walls In
addition a plant legend indicating what type, size and location of plants is requia i to
match the X's and dots- An irrigation and drainage plan is also required.
8.
Work on this project is to be completed in no more than 30 days from
commencement of the project -
Please provide the information as requested for Architectural and Landscape review and
approval.
Please contact me if you have any questions about your Architectural Application.
Zn
ely,
alh pssociatton Mana r
Y.
on behalf of the Architectural Rev Committee
Citrus Course Homeowners Asso Patton
PO. Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 + Palm Desert, California + 760.346.1161 + FAX 760.346,5 )l 8.
Email: drm@drminternet.com , www.drminternet.com
APR -10-2002 WED 04:16PM ID:A.R.C. Concrete PAGE:2