9806-030 (RPL)LICENSED CONTRACTOR DECLARATION
Ci) I hereby affirm under penalty of perjury that I am licensed under provisions of
H apter 9 (commencing with Section 7000) of Division 3 of,the Business and
C14 W Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
w 4�1�1�11 _ c53.__.�3/11/99
oZ r /Date<:56o; hesignature of Contractor
� 0 `.
J U C) OWNER -BUILDER DECLARATION
W W r— I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
�
O I am exempt under Section ===-B&P.C.,for this reason -�
O N Date 0C.. ®� Signature of Owner•- _"'�:�` _ ``��',,
d z WORKER'S COMPENSATION DECLARATION'S
oCc I hereby affirm under penalty of perjury one of the following declarations:
LO
H O ( ) I have and will maintain a certificate of consent to self -insure for workers'
X W 'i compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q U ( I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
0 Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
ob d CLART•:f� DON NiVrIvi
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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
C`de, I shall forthwith comply with those provisions.
ate: ADDlicant
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'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 propertyfor inspection purposes.
ySignature (Owner/Agent) r` ^- Date
BUILDING PERMIT PERMIT# CONTROL#
DATE 64 �� r� VALUATION $1 .9j,60(# J_0 LOT TRACT 7855
JOB SITE'
ADDRESS , 71,9445 f.�YC 11, CRECK
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
mmis fm,L[,1»P.F`JtTfF'D COVE j;�'t;.
A?:Ct"i"f'Ytt4? POOLS SF'.r1
50.445 ANiOUN17AIN S.RADOWS Ki)
P.O. BOX 1791
(,A QUINI-A CA. 92253
I..A QVIN fA. CA. 92253
(7f�t"i1;3ti0-3.585 r'T,S.,�P ' I,;,1.5
USE OF PERMIT
K40L
PCADL/Apit., �%LHitMSfbARRiM- S SI3ALi, W. Or:°kRAIJOivw3..PTtdOR ` O
t>RIS-PLASTER INS']►ECTiON
jtOkI., ruVWti -K. SPA 15,000.00 LS
En i at'6l 1) Cal::Y•( fit)' l..oNnL i'ajc Fim
:LrVU{l.l�/l
PLAN CHI CK FEM-1 101-000-439-31[8 $tf►S,_Ct4
c"'t;5t1STIRl K,11 ON fl- r 1014 1,'0.41 R-0041)
N11H.t'IxA.t•llCAL VEI-11—• 11001, 103 -Otto -1121 -ow SZ1,00
ELEC'1Ris:Al. FFI: -- P001. M-000-4110-000 S45.00
1111LJN _tNG I"EE — VCW111. 101-000-11i94M 337.00
t4
r. 'f•CY1'.f J.C:_ STRUC:TION AND FLAN E":R1ECK
1_531+3.30
JUN 0 3 1998 T01 AL VERIMIT F�WAS DUE NOVO
$363.30
ITS` OF LA QUINA 6A
RECEIPT
DATE ;
a Y
DATE FINALED
INSPECTOR
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
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
Final
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
t
Final
Utility Notice (Perm)
April 4, 1994
Mr. Tim Gustafson
General Contractor
Ministrelli Construction Company
Re: Alteration to Site Plan before cost biding commenced
Dear Tim;
In reviewing the plans to our new home immediately after they
were duplicated at The Blueprinter on March 30,1994, I noticed that
the "PAD FOR POOL EQUIPMENT SERVICE" was incorrectly placed on the
SITE PLAN drawing.
The correct placement of the "PAD FOR POOL EQUIPMENT SERVICE"
should be moved approximately 8' - 10' along the same wall in a
direction toward the street. This new location is approximately
adjacent to the five burner stove on the other side of the outside
wall. ( See Stein drawing for exact movement dimensions).
The space now shown for the "PAD. FOR POOL SERVICE EQUIPMENT
SERVICE" should have been used for an outside "BRICK STRUCTURED BBQ
approximately 8' long and 36" high and 30" wide". (Please see Stein
drawing for exact measurements). The Electrical plan calls for a
night light to illuminate this area. The Site plan omitted the
correct placement of the two elements.
Please be sure that a gas outlet is provided for the BBQ.
We hope that catching this oversight in a timely fashion will
not add any time and cost in correcting plans to be handed out to
subcontractors.
Thank you for your time and understanding in this matter. We
are so anxious to begin construction, and have so much faith and
confidence in you, our Builder.
cc:' Gordon Stein
File, C:\WP51\DOCS\TIM.1
,I t
Very sincerely yours