0205-212 (RPL)LICENSED CONTRACTORi 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 M
C53 B MIC
I 117K
{
Date? ` �°` n " �"` Signature of Contract11or
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). .t,,,
( ) 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
flection 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:
Cartier oT,&Tg FI)WD Policy No., MMS -01
(This section need not be completed if the permiYvaluation 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,4shall forthwith comply with those provisions:
Date"=...._rw s E; Applicant
r f'
Warning:. Failure to. secure Workers' Compensation coverage is unlawful and
shall subject an`employe�•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 property for inspection purposes.
Signature (Owner/Ageni) j" °1 T �/ � Date>
� r r' 4 :: •'4 -
BUILDING PERMIT PERMIT#
02,054,12
VALUATION LOT. TRACT
DATE y,`-
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J09 SITE
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ANF SS ;47-370
APN _
OWN+rE,.R�a�y�,
CONTRACTOR I DESIGNER EN (NEER
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47-870 :;;I:lLV]M>:3M7, Y 87MM
P10. BOX, Is("
CA 92253 '
PALM SPRNG9 CA 92 263
(260)322-1782 MA 6219
USE OF PERMIT
POOL A4T'.TS/(YR ' PA
PL?Li).4;Ti'A, AL.AR..MSf1;4,AR1'ti1ERS SHALL 139 IN PLACE ,PRIOR TO
PW1.,fNWOT%SMA IL; t?<I.G31 LIS
101. ,'�TIRM COW or CCa3,rMUMON
PLAN C:UCK TME TfBi, Xi 3��32F .Q33
C:UN'a"9"RUC7I'.1014 Ufa 101-f ^3W-418-0 ,W $111.7100
WCHANIC 1, FFEE -- POOL' 101-000-421-000 00.421-000 ' $414.00
F WECTRJCAI 3?IBL-� POOL 101-000420-006 $45,00
PLUMSIM ... POOL -000- 19!-000 WAD
11
CITY0F`gQ1j1KA
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• LFJS PRE -PAID Irk=
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RECEIPT�.
DATE f
BY .
D E IN
INSPECTOR
O
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
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Electric Bond
v z
Footings
Main Drain
—, 9 --7
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
�_ fZ.1a
Underground Plbg. Test
�(�Z
Final
Gas Piping
PLUMBING APPROVALS
Waste Lines
Gas Test
Electric Final
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fb(tures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
i
May 15, 2002
Robert Arlt
47-870 Silverberry St
La Quinta, � CA 92253
Re: 47-870 Silverberry St. Architectural Variance Request
Dear Mr. Arlt:
This letter is to inform you that the Architectural Review Committee. for
Miraflores Community Association approved your request to install swimming
pool, decking, patio cover and landscaping per plans submitted with the condition .
that the tile and decking colors compliment the exterior of the house.
Thank you for your cooperation during the review_ process. If you have any :
questions please call me at (760) 346-1161.
Sincerely,.
Ray 6 —K
Gayle Bock,
Community Association Manager
Miraflores Community Association
P.O. Box 4772 • Palm Desert, CA 92261-4772
73-550 Alessandro, Suite 5 • 'Palm Desert, California * 760.346.1161 •` FAX 760.346.9918 -
Email: drm@drminternet.com www.drmihternet.com