0110-006 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I. am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
04 W Professionals Code, and my License is in full force and effect.
O ch License # Lic. Class Exp. Date
tY �°C53 jfG ,r> C?i31:2C
o Z ti �-Date Signature of Contractor
co O o
F' 10 OWNER -BUILDER DECLARATION
W W I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z_ ( ) 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
N Date Signature of Owner
ON
0)d Q WORKER'S COMPENSATION DECLARATION
C> --
F : ; I hereby affirm under penalty of perjury one of the following declarations:
Lo Q— 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
0 J Q performance of the work for which this permit is issued.
ED Q () ,() I have and will maintain workers' compensation insurance, as required by
O 0. Q 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 ;7'3,ATY, COidtPE148,A7d Policy No. SI+i, i�D31ff
w 5
�O
J (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: , F i � Applicant , K� i I
Warning: Failure to secure Workers' Compensate Kcoveragn 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 propert)rllf"br inspection purposSs.
VSignature (Owner/Agent). . r Dat/
BUILDING PERMIT PERMIT#
DATE VALUATION LOT �'� TRACT
S28,433,00
JOB SITE
APN
ADDRESS 79-s. f) camm gm%S.
.
OWNER
CONTRACTOR/DESIGNER/EN INEER
MkVYATr
C -DRUTAP JC3LS MSIAS (7rOP Mfi�+► Gail
119-630 C✓ 1° 1:RIUS''rRHEI
74725 JONI4DRIV4, =12 #A
UkC)UM. A CA 9.2253
3%d IM.1k SERT CA 92260
(760)340-9000 MArl 355
USE OF PERMIT
3r,001 AIT1.)/0ro, SPA
WiGCSLASia,f! RIQ ANSI WALL -CITY
555,T)UTI=3ARt•3
POOE, Ai.'JDIOR. SPA 28,0(10, 06
4 -19'. WALL 20.00 LIP
EAi3.'1E' `!Z'.'I�JI1' C011111 Q'ir +vO1'v`S'1 7.6;�.1�13N
26,4 .00
yy�, ,1,t;��(g y y oTc^,}�, r pd� R,t�,�
8"R7rEWi L%, A� H" E kix.dSYAc!'3A4��'�..7,�
PLN4 CHM-K FEE, .101-000-439-318
BJ'►+NS` RUC TIOW WE 30i-{.1 I-411 -ow
MECHANICAL ME --POOL 101 -000,421 -WO O $34.00
t'iI..F;t.` RICLIV., FEW — POOL 101-000-420-000 $45.00
r LLkMFatl`i0F1,4 ^- P001+ 1131.000e4119,*00 $27.00
t
OCT 02 2001
CITY OF LA QUINTA
FINANCE DEPT.
' DUB-T4:PS, CO.9.�"r;�,.i,TC'S':ldiNA9.0:64.41 CrMCIC
$514.10
IZ33 P •1".t+3•.Q ER173
$0.00
V TOTAL P22MT 111 ML!D E 1 iOW
. s
• r
RECEIPT
DATE /
BY
DATE FINALED
INSPECTOR
3 C- 1173 c
'1ii
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_ -7 ( �ti
Electric Bondi
—
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
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
/ �U
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
d
G.6`.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
seri
sort
,nagement
September 24, 2001
Richard Wyatt
79-830 Cetrino
La Quinta, CA 92253
RE: Citrus Course Homeowners Association
79-830 Cetrino
Dear Mr. Wyatt:
This letter is to confirm, in accordance with the Architectural Guidelines; the Architectural
Committee has approved your architectural approval request for the installation of the pool spa,
barbeque, Kiva fireplace and decking providing the decking is earth tone in color and the Kiva
fireplace has a city of La Quinta approved spark arrester installed on the top of the chimney.
When all work on the project has been completed, please notify this office in writing so that the
improvement can be inspected and signed off by the Architectural Committee and your deposit
can be returned to you.
Please contact me if you have any questions about your architectural application.
Sincerely,
Vra Wullahy'
Association Manager
on behalf of the Architectural Review Committee
Citrus Course Homeowners Association
K
Professional Communitv Management / Desert Resort Management
Post Office Boz 4772 • Palm Desert, CA 92261 4772
73-550 Alessandro, Suite • Palm Desert, California • (760) 346-1161 • FAX (760) 346-9918