0206-023 (RPL)r'
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions
Chapter 9 (commencing with Section 7000) of Division 3 of the Business a
Professionals Code, and my License is in full force and effect.
License
ry#�f pr Cec2 Li&c. Class [ + C Exp. Date
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3 (161
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Date fir" Signature of Contractor'
OWNER -BUILDER DECLARATION'
.
I hereby affirm under penalty of perjury that I am exempt from the Contracto
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their s<
compensation, will do the work, and the structure is not intended or offered 1
sale (Sec. 7044, Business& Professionals Code).
( ) I, as owner of the 'property, am exclusively contracting with licens
contractors to construct the project (Sec. 7044, Business & Profession(
Code).
() I am,exempt under Section B&P.C. for this reason
Date Signature of Owner
r.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury .one of the following' declaratior
() I have and will maintain a certificate of consent to self -insure for worke
compensation, as provided for by Section 3700 of the Labor Code, for t
performance of the work for which'this permit is issued.
'(4t I have and will maintain workers' compensation insurance, as required
Section 3700 of the Labor Code, for`the�performance of the work for which t1
permit is issued. My workers' compensation insurance carrier & policy `no. a
Carrier AnCC ,; .ff) 1 �`.�' Folioy'No. FWD " 34015
(This section need not be completed if the permit valuation is for $100.00 or les
() I certify that in the performance of the work for which this permit is issue
I shall not employ any person in any manner so as to become subject to t
workers' compensation laws of California, and agree that�if I should becor
subject to the workers' compensation provisions of Section 3700 of the Lat
Code, I shall forthwith comply with th se provision's.
Date:e_- ,,. ,,L Applicant-'
--Warning: Failure to Secure:Workers Compensation coverage is unlawful a
shall subject an employer to criminal penalties an5,clvil fines up to $100,000,
addition to the cost of compensation, damages a "provided for in Section 37
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Saf(
for a permit subject to • the conditions and restrictions set forth on 1
application. it I r."
1. Each person upon whose behVithis application is made & each person
whose request and for whose benefit work is performed under or pursuant
any permit issued as a result of this applicaton agrees to, & shall, indemn
& hold harmless the City of La Quinta, its officers, agents and employe(
2. Any permit issued as a result of this application becomes null and voic
work is not commenced within 180 days from date of issuance of su
permit, or cessation of work for 180 days will subject permit to cancellati(
I certify that I have read this application and state that tlie•above information
correct. I agree to comply with all City, and State laws relating to the buildi
construction, and hereby authorize representatives of this -City to enter 'up
the above-mentioned property for.,inspection purposes.
`4 Signature (Owner/Agent) ^%` Date
of
PERMIT #
BUILDING "PERMIT
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DATE VALUATION LOT TRACT
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JOB SITE
ADDRESS -9$,t).5 SFAf%VH fty
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
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130.695 ;WAX.)MIRAY
71509 UAN 001R.130"WO
1A (x' IWfly LA. 92253
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CSA 92.,227 i -
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USE OF PERMIT
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RECEIPT
DATE
BY J�
DAT FI A
INS CT
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
BLOCKWALL APPROVALS
Set Backs
POOLS - SPAS
steel .1
Electric Bond (O
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping let
4 PLUMBING APPROVALS
Gas Test ,
Electric Final
Waste Lines
Heater Final
:Vater Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation g Q
Gas Piping
Gas Test
Appliances
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)
Final
COMMENTS:
Ma.B 27 02 11:42a Falck (310) 375-4680 p.2
Gans
PGAWE�M
FAIRWA'Y'S ASSOCIATION
March 21, 2002
Mr. Falck
17 Ponderosa Lane
Rollin- Hills Estates CA 90274
Re: 80-895 Spanish Bay
Dear Mr. Falck,
At the March 18, 2002 meeting of the Architectural/Landscape Committee your
landscaping plan was approved upon the following conditions:
A. The two deck area setback agreed to by, the Director of Agronomy for KSL
Desert Resorts is 12, inches from the.rear property line.
If you have any questions, you may contact meat 760-564-3858.
Sincerely,
14
Sonna arinaccio
Association,Manager
Post Office Box 1658 - La Quinta, California 92253 • Phone (760) 564-3858 Fax (760) 564-2329
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