0010-283 (RPL)LICENSED CONTRACTOR DECLARATION
C/) I hereby affirm under penalty of perjury that I am licensed under provisions of
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License is in full force and effect.
O =) M License # cc'' tLic. Class Exp. Date
f� y y/
Z � DateSignature of Contractor
COO O "
W OWNER -BUILDER DECLARATION,"
W W I hereby affirm under penalty of perjury that I am exempi from the Contractor's
~ U) License Law for the following reason: i
Z_ ( ) 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). .
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'`)() I am exempt under Section
LO B&P.C. for this reason
N Date Signature of Owner
ON
rn
ZWORKER'S COMPENSATION DECLARATION
O Z I hereby affirm under penalty of perjury one of the following declarations:
Lo FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
O � Q performance of the work for which this permit is issued.
EDQ () ( ) I have and will maintain workers' compensation insurance, as required by
O U QI Section 3700 of the Labor Code, for the performance of the work for which this
H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Z Carrier Policy No.
06 � lD.j�ii#�,t+.NCaDfi'iIT1fi�
(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,provisionse,
Date: -0Applicant C__
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'sl'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
• j 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.
!\ nature (Owner/Agent)-'`'�`f'~ % Date
BUILDING PERMIT PERMIT#
DATE t VALUATION LOT 0010-203 TRACT
JOB SIE
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
78-1360 Cl. `V0
71509 SAN COR001410
.f�,l9,tm CA 92253
1-1-634L'°HOMMAG CA 92270
(760)34-1-2336 M4 5486
USE OF PERMIT
!N`00L &.%Ire &(I)WATtr.3�i 7 A.7URZ ONi...'S'-.ATAp:I1R633ARRIERS � ilAIA, BE IN
PLACE AT PRE KrAMA IMPFC- 3ION POOL RQUWMENT F.WWli RE 18
k4GT 114CLUDED D1 THIS ISA'RMIT
1?00LANDICNISPA .12,481.00 YA
COST OF Ml �!'WaA`6i1CA.,a.O
ppw,p*����k��eeee yy �,�; ry••ggqq ������rr�� yii'i,Udm'C'.➢dxA,IKY)
�.XidY7LER.'.A}gi2t�� �ndddA7Wf.1A�� �~ .
PLAN IGEi1It:K Yu t��a `rf�i9�4��°'✓�.� ���.��
CONS7'RUCT1,00 PEE 101-000-418-000
MEC:if'iMTCAL TrY?1 ,,.POW, 101,000 -421 -`POO $24,00
EL,lrCTRIC:A 1, Y'?L? a« POOL i o I-t..€tC2-rd 20-000 $4.9.00
FL17MDR40,P1,91F _ POOL iot!-000.419<000
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x CUD-:1"MAL C 01T8' I�`a�.L3CnT3.0) ., PLAW SWC.
IM3 I 1`.1rd- AM MIS
$0.00
">;MUs F ERKYJ ITEC k1 DE, NOW
$597,60
'NOV 3 0 2000
.oily I Al&k +
RECEIPT 'TATE
BY '
•
DATE FINALED
INSPECTOR
,
i$4
AN
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground d
Underground Plbg. Test
Final I 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 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
Fudures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
November 21, $000
Jeff and Joann Paugh
_ ,7.93<80__Citru§-Street _ --
La Quinta, CA 92253
Ref : Citrus Course Architectural Submittal
Dear Mr. & Mrs. Paugh:
I am writing on behalf of the Citrus Course Architectural Committee. The Committee
has reviewed your application to install a pool, spa, barbecue and fountain. The
application and revised�dr.:a=wuag is approved and you may proceed.
Thank you for your patience through the architectural review process.
Sincerely,
On behalf of the Architectural Committee
Citrus Course Homeowners Association
Joanne Williams, Community Association Manager. _
i
Professional Community Management / Desert Resort Management
Post Office Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 Palm Desert, California' • (760) 346-1161 • FAX (760) 346-9918