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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.
License # Lic. Class Exp. Date r
72F96 C53 C61 IVS /� 101310
Date t %! Signature of Contractor
r OWNER -BUILDER DECLARATION /,
I hereby affirm under penalty of perjury that I am exempt from the(o)tractor'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.
. ( ) I 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 STAIT FUND Policy No. 1635411-03
(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: j / 6, jApplicant A1 0 l t E
f i I - .., .,, .:
Warning: Failure to secure Work6rs',Compensatiorncoverage is unlawful and
shall subject an employer to criminal penalties and• !vil,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.a66ve-mentioned propertypfor inspection purposes. B
'Signature (Owner/Agent) y ,. ryt t• Date � 2-h
BUILDING PERMIT PERMIT#
DATE •� . �.. VALI `ATION LOT 'D-112-141 TRACT
JOB SITE
APN
ADDRESS 7.8-MCA.Z LE 1N01M
-
OWNER
CONTRACTOR/DESIGNER/EN INFER
78-081 CAUR NORTr4
71.509 SAW GORGOM
L.AQU?sNTA. CA 92253
AeiWICH0:MMA rL" CA 92270
(760)341.2336 CBVI 5456
USE OF PERMIT
MOL A2?DMIZ HP,A
SPA
f1��:1't�T':CNZ. %�tY'iPMF'3d't LTYiCri�f..�U�ti�:?�fDT 31+iCLJT.�)?47
POOL JU IOR FINk 10,600.00 Li
HSIMA,'. IM MST O1"i CCiITMIAX710IN
10.►3W,01 D
PLAN CHECK FEF 101-000-439-M $81.90
CONSTR1lCTIONYZ 101-000-418-000 $126,00
MECHANICAL FEE -- POOL 101-000.4214000 $2.11.03
CLEC:` rZIC•AL. VIM •• POOL. 110.1-000-420••000 $45..00
MIMING FFA -• .POOL 101.000-419-000 WIN
�t_�-TOkAI. CO2d�;iTtl'3'��:t3' A>1�� k'L•A!�' �'•1' �'�'�
�3s�3 9th
MI f1 L :E'ER21!!ie`.'T rim, N DUETTOW
w�53 .317
DEC i 6 2013
.8EChIA•T•-• --
DATE �!�
BY
DATE FINALED
INSPECTO
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 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
�r
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
Gas Test
/—
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
S;,awer Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
2 -
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
r
,
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)
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVE®
FOR CONSTRUCTION
DATE
12/10/2003 23:29. 7603469918 DRM PAGE 01/01
December 10, 2003
Francie Ste.inwedell
1515 Descanso Drive
La Canada„ CA 91011
Ref: Duna Gardens HOA Architectural Submittal. 78081 Calle Norte, Lz �uinta, CA
Dear Ms. Steinwedell:
I am writing on behalf of the Duna Gardens Homeowners Association. .• chiteetural Com aittee. The
Architectural Committee met and reviewed your plan to construct a :pa at the above referenced
address. The Committee approves the concept as submitted subject to the terms and conditions set
forth in a letter from KSL Desert Resorts, Inc. dated November 21, 20C i regarding the ri w property
set back and any other approvals and permitting required from the City o:l ' La Quinta.
Please contact Tami Lehrman, Community Association Manager for Dun: Gardens :HOA to advise City
of La Qulnta. permit number once City approval is received.
IMPORTANT
We would like to take this time to bring to your attention our eoncer!n, regardimg constr action sites.
This will most eertaWy bring additional construction tree and it is yc - tr responsibility to see that
contractors conduet themselves ia.a professional manner, it cleaningg up the job site a t the end of
every day, parldng legally, e.W I assure you that Security and hn meowner s will i c reporting
violations and offenders can be denied access to Dungy Pj Oninta. Plea! 3e help me keep t he peace.
Good luck with your construction at Duna Gardens. If you have any qui: ►tion or.concem ?lease don't
hesitate to call our office.
S- rely,.
On behalf of the Board of Directors
Duna Gardens Homeowners Association
Tami Lehman, Community Association Manager
P. S. Pleaw provide all contractor inforanation to Security.
Cc: Bubble Springs
P.O. Box 4792 • Palm Desert, CA 92261-4772
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