0002-434 (RPL)U)
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LICENSED CONTRACTOR DECLARATION ,
I hereby affirm under penalty perjury that I am lirapVAjXder provisions of
Chapter 9, (commencing with Section 7000) of Division 3 of the Business and :I
Professionals Code, and my License is in full force and effect.
.Licenser# Lic. Class Exp. Date
656128 C53 1(3/31120(
Date �2' Signature of Contractor'
OWNER -BUILDER DECLARATION
I 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.
(FI have and will maintain workers' compensation insurance, as required by
Section 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.
.il(l:`,6'63-00
'1
(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.
I
spate:; = F' ^ ` Applicant k IV
/
Warning: Failure to secure Workers' -Comp ne sation cgyerage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to ,the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees:
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
J � }
;Signature (Owner/Agent) t �` � � R "' �, Date _'�-tehotm
BUILDING PERMIT PERMIT�#Ii=$
DATE ( VALUATION +�}q,1uQO LOT TRACT
'OB SITE
ADDRESS 52-728 C LARE'T COVE APN -
OWNER CONTRACTOR/DESIGNER/ENGINEER
SIJ' %r' -r11. "N"fr OT'"�1ua`•TC'OP.P. C;ALIr0�:�`llr'% P0,.Y,S .�` ",T)AS
77899 WOL 74-125 JONI DRIVE', #A
PALM D.?s5EsRT CA in260 PALM DE'S1'IRT t:,A 92260
(760)340-9000 CRIX X 355
USE OF PERMIT
1°(..tC.IL A)tTu-J )R i&PA
POOL & SPA ONLY- AU—.R icVDAiaRXR5 1`71W1. 1. B N 1 ik.4!, AT t` ttCU
JPLAS'1'Ut .INSPUC110N
POOL JVDIO% 319A
►9,90.0.00 3
ESTIMATE]*,* CGST OF CV.NST1k1v=II; N
PT+,'RNU T 5+'CE AJ?%5Ti'TtiIfY
K AN CHECK F VX 101-000-439-318 5 i?4.55
f`.oNs"IrR (tr Ttow 1--t. . 101 -(XM-4(8-()()0 sy)7 (xl
N 1r1C1,l` u"dtC L rrE - tIcat. :C1-000-121 10110t) 4.00
C,f,17CTR1CAL f;iili -- i' )L lot -000-1120.060 &15.00
1'I.UMHJNAJ Irl*, -- MyX 101 -OW -419-M) .12700
ROI ltd)T$f, C0N. `sTRU(.`rfON .ANE) PI,_ N C"FrX�v C.
RECEIPT I DATE
TOT At, #'k,R3i4}"1 FEES( .Ul3E tNOVY
DATE FINALED I INSPECTOR
59,9'00.(1`
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 ij
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
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
Final2 1Z
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)
:a p4
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February 18, 2000
Mr. Greg Butler -
Building and Safety
CITY OF LA QUINTTA
78-495 Calle Tampico
La Quinta CA 92253
tradition
B��L 22 RECD
`Via Facsimile
760-777-7011
- 1
Re: Lot 13, Phase 28470-2, 52-728 Claret Cove
Swimming Pool Approval
'Dear Greg,
This letter will serve as ADRC approval for the above referenced swimming pool (plan
attached). If you have any questions, please do not hesitate to call.
,l
Thank you.
Sincerely, f
Christina J. Dores
Architectural Review Coordinator
/cjd
pc: Rob Capetz, (via facsimile)
r
CNdy D0-&-ADRC\Ki1LP LwN
MAIN CLUB HOUSE PRO SHOP SALES & MARKETING GOLF COURSE MAINTENANCE
TEL: 760/564-8723 TEL: 760/564-1067 TEL: 760/564-3355 TEL: 760/564-5429
FAX: 760/564-6691 FAX: 760/564-7405 FAX: 760/564-2356 FAX: 760/564-6928
78505 OLD AVENUE 52 - LA QUINTA - CA 92253-1120
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