0103-155 (RPL)LICENSED CONTRACTOR DECLARATION
-.1 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^" #• V . .
C5671' s t . 'C5341
ki1L l 1 n'
/Date Signature of ContracdV//_°
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 isnot 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 i
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
Suction 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.
MATE COMPI:~'� ATI 046006968
(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 ovisions of Section 3700 of the Labor
CodVL&II forthwith comply with th r rovls•ons.
Date: "I -y'' : 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
construction, and hereby' authorize representatives of this City to enter upon
the ab ment oned property f lnspec ion pur ose " , J
"Signature (Owner/Agent) d"� Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ��,•'� TRACT
JOB SITE '`_ �1/+jj� �"
APN '
ADDRESS
10 irt.
OWNER f ��` L
CONTRACTOR /DESIGNER/ EN6 (NEER
CATLWOMRA-PO ULZ & MAS (MP MAW C01
49.040 5AI TK 3A C'URTd
7 4725 ,:0NI3 RIVE; V6: ITE #A
LA Qa DrrA.+. CA 92253
PALMgR�'�d.'� CA 92260
(760>-.410R9000 CBrA
USE OF PERMIT
�� 7j�y ��y (/��
k « 4✓LJ r A`�F31 �/OR O A
z
TOWSPA. ALA.l`MIZ, R,RI ; SHALL 89 N r AT PRE-PLASTEP,
LiT,, CK WAIA,, P001, ENCLOSUA9<
Pt0OL VIWOR SPA !€t.9Lf3,+D€i LS
"mt NOM C0bT OF C:`OMMUMON.
PLAN CHECK FRX 101-000-43"18 5120170
C(.?1J51d1tR.UC 1110N RIF. 101-00-418,4100 $102,00
M11CHMICAL FEE - - POOL 101-t3W-421-000 $24AV
F%` TRIC..Eiifl'3b'kye• POOL 1,01.000-470-000 $45,N)
t#LUMMO F9Z POOL 101-000-419-000 $27.00
Awn-JTAT, C"Ic iii ' MC-1109t��R) z�T.AH C':T&)!P'�MC.
D
$422.70 -
1;..k03 PpRl; -P AM MrS
$0.00
APR 1 1 2001 �a e � , IMUM ME& DVE now
CITY OF LA QUINTA
FINANCE DEPT
S421,70
RECEIPT
DATE
BY
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
i 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
i
i
i
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
N steel
Set Backs
Electric Bond
/
Footings
i Main Drain
Bond Beam
. Approval to Cover
1 Equipment Location
Underground Electric
Underground Plbg. Test
Final
j Gas Piping
/
PLUMBING APPROVALS
Gas Test
i Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
_
Zd
_
7-
Gas Piping
Gas Test
Appliances
Final
13010/
sem.
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
Find
Utility Notice (Perm)
AVAIL PROPERTY MANAGEMENT -
P .O, BOX 1032
PALM DESERT. CA 92261
(760) : 568-2717
April -5, 2001
David;Butt_les
�4�9`040 Serenata Court
La Quinta,.CA 92253
RE: Architectural variance Request
:Dear Mr. Buttles:
Your request for a pool/spa to be installed in.your rear•
yard'at the above referenced address was reviewed -by -the
Architectural Committee.
The'Committee approved your request as submitted. All re-
quirsd permits from the City must first be obtained. No
construction debris or materials may be stored in -the street
overnight. You will be responsible for any damage to the
common area during the course of construction.
After the construction is. complete, please contact this
office.Por inspection and the -return of your deposit.
Thank youforyour cooperation.
Sincerely
Cam Anderson
Project Manager
cc: California Pools (fax)
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