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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
1656128 C53 hol
ate � 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&RC. 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 isissued.
(y) 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 Policy No.
«4TAT'i'( 1D (146-99-01. 0114413
(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 -b'6
r.. -`
me
subjec,t,'fo the workers' compensation provisions of Section 00'of the Labor
Co�y1€, I sh II forthwith comply with those provisionss.��''"�"
,Date: AAZ = B ` f Applicant
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
const"ruction, and hereby authorize representati sof this City to enter upon
therabove-mentioned property for inspectio • rposes.
fSignature (Owner/Agent) Date
PERMIT #
BUILDING PERMIT 9*W-06%
DATE 1 iox.j"VALUATION $17,391).04 LOT TRACT
JOB SITE
ADDRESS 79-400 �i.O IU �. CANYON COU111 APN _
OWNER CONTRACTOR/DESIGNER/ENGINEER
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7844 COWIT- CAN YON Ci 74-72_5 J0Nf DRIVE, 0A.
LA, QUINA CA 92253 PAI M MSERT CA 9 760
(760II-440 90W CRIA 355
USE OF PERMIT
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PPL NVt,ir, fZ PA - ,;,;17(1.Do 1.. t;
PLAN CUE KF1;ts' 1{'tf•Gifi)•�I�u:?iIFr $M.33
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11,01"All �*V*IRMIT Mrs not, NOW
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RECEIPT DATE IBY/ IDA?II`ALD2/ (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
! �p
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
Final
Utility Notice (Perm)
TRADITION GOLF CLUB iff 760 564 2356 09/03/99 11:2415 :01/02 NO:728
Tradition
ARCHITECTURAL DESIGN REVIEW
September 3, 1999
Mr. Greg Butler
Building and Safety
CITY OF I.A QMNTA
78-495 Calle Tampico
I.a Quinta, CA 92253
Re: Lonegan Residence
Lot 52, Tract 28470-1, 78-400 Coyote Canyon Court
Swimming Pool Review
Dear Greg,
via Facsimile
760-777-7011
This letter will serve as ARRC approval for the swimming pool at the above referenced
residence. A copy.of the approved pool is attached.
If you have any questions, please do not hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
pc: Reid Thompson, California Pools (via fax)
Nicholas Akers (via first class mail)
78505 Ow AvENUB 52 — LA QUINTA CA 91253-1120 — PHONE 760/564-3355 -• FAx 760/5642356
TRADITION GOLF CLUB 760 564 2356 09/03/99 11:24
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:02/02 NO:728