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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.
Licens r# Lic. Class Exp. Date
70 110 B 05n_11204
gate � �� Signature of Contractor
OWNER -BUILDER DECLARATION
1 hereby affirm under penalty of perjury that I am exempt from 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.
(,vh I have and will maintain workers' compensation insurance, as required by
Se 'on 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 Policy No.
ZI5:Pr3�•#1 I�iSL`$;.{4:iJC't::
(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 n/�mploy any person in any manner so as to become subject to the
workers' compensation laws of California, and agree that if I should become
subj to the workers' compensation provisions of Section 3700 of the Labor
C e, I shall forthwith comply with t, os' pr visions.
ate: 4�plicant ,
Warning: Failure to secure Workers' Compensation overage 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
iinspection purposes.
/g,ature (Owner/Agent) tV_" ate � Sl
BUILDING PERMIT PERMIT,:4;r�t44�
DATE "/2S1199VALUATION &3,'19.41410 LOT TRACT
JOB SITE
ADDRESS 52-190 MiiT.I.ON COURT APN _
OWNER CONTRACTOR / DESIGNER / ENGINEER
i?"W YNI. BORG "RAPIN CM1STRIJIG ON CO.
3212 LAKAM LANE 7S-120 CALL'6 ES'1'ADO #206
EDINA MN : 5436 LA Q.11M.CA CA !M53
17(fO) 77 T-761 }. CRI �fi 3751
USE OF PERMIT
6! KRR_J}k1.13k:-11.UtNO
154 1,.F., V {1A1 DEN WALL, CITY STANDARD. INVESTK1AXION, Fid:
PER 1991 UNI 01M AUN-UNISTRATIVE OQDF, § 304'.5lrOR WORK BEGUN
PRIOR WMV)0'i"1aRR&CM
150.00 LF
TUS A MATED COST OF CMSTIRUC TIL 10N
ft Mff.1•!` ESU.MMARY
CON.'TiltUCTIONFEE 101.-0004I8-000 563.00
NVIi!' 11gATT()NFEE 101^0-473-000 1563.100
STIR -'1'%3` AL C'0 N1KrR K;".FI0N AND K -AN CHECK.
t,F�s rz 1,-FIA.1DF F
', 011'A,'L PU.C4tMIT Iv'UES, DUE NOW
RECEIPT .+t ✓ I I DATE _,. f+ /^ I BY / t N*✓ I DATE FINALED I INSPECTOR
:3,750.0
$126.00
.;Ct3.t1i)
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR.
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 /
Footings Z, , ,
Electric Bond
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING A PROVALS
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:
ft"Tradition
ARCHITECTURAL DESIGN REVIEW
September 1, 1999
Via First Class Mail
and facsimile
Mr. Gordon Stein
STEIN & ASSOCIATES
74-091 Larrea
Palm Desert, CA 92260
Re: Borg Residence, Lot 42, Tract 28470-1
Revisions to Construction Documents — Golf Cart Doors
Dear Gordon,
The ADRC met today and approved the revisions to the golf cart garage to change the
garage doors to French doors. If you need any additional information, please do not
hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
for ADRC at. Tradition Golf Club
/cjd
pc: Ed Wright, Turpin Construction (via fax)
Greg Butler, City of La Quinta (via first class mail)
78505 OLD AvENuE 52 — LA QuKrA -- CA 92253-1120 -- PHONE 760/564-3355 -- FAx 760/564-2356