0202-303 (PLBG)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 Eip. Date
Date Signature of Contractoru.4, av
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&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.
14&t)°'I"have and will maintain workers' compensation insurance, as required by
ion 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance'citnier & policy no. are:
Carrier Policy, No.
STATE F0Ix C�6-4�• Gf?1�i�f��s
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 provisions of Section 3700 of the Labor
Code, I shall forthwith comply yrithjthose_provisiops.
r� BUILDING PERMIT. PERMIT"
DATE VALUATION LOT rmy„. 0.4 TRACT
JOB SITE APN
ADDRESS
OWNER ' ' CONTRACTOR / DESIGNER / EN (NEER
NAR X1161E`#F,;t° I IEl�l,M.' , S ON f'AURARC A PLid7'LS eke ORAS
79q815 TAME= 741-7 2.5 Xyll DRIVE, AA
Irk, QULWTA C .92253 PALM Dull y' vA, 92260
(76Q)340-9000 CBLAV 355
USE OF PERMIT
Cffi,SLINY, FOR, IMPIT. t°. J OAi 4.7OINFIRMED
500M lea
P1,Lgb9,MNO ME 101.000.419.000 � SIM
9,
3M.f
Warning: Failure to;:secure Workers' CompeS�ation 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 a w
whose request and for whose benefit work is performed under or pursuant to' SUB- OTI& amt N'.Rm ;j�,'('J=09 AND Pj,,K9 r,+ , W
any permit issued as a result of this applicaton agrees to, & shall, indemnify U-05 k>R�PAM MIS
& 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 TOTAL i MAMID"ES TATE NOW
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/Mr inspection purpos s.
RECEIPT DATE BY + DATE FINALED INSPECTOR
Signature (Owner/Agent, Date,_.
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
POOLS - SPAS
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
02/19/02 TLB 19:35 FAX 760 348,$918
. i
* "ADMEN,
I,
P R,u
4tsert
ort
February 19, 2002
i
Lorraine & Doug Henderso I
79-785'Tangelo fes:___
La.Quinta', CA 92253
RE: Cltrus Course Homeo � ars Association,"
79-795 Tan elo--•_
�
Dear Mr. & Mrs. Henderson: {
This left eArchitectural' r is to confirm, in accordance with the Architectural Guidelines; the Arc i I
Committee has approved your architecturei and landscape request to install a fire pit, extend he
backyard decking and widen your planter bed.
When all work on the project has been completed,,,please notify this office in writing so thct be
improvement can be inspected! and signed off by the Architectural Committee and your dei !sit
can be returned to you..
Please contact me If you have any questions about your architectural variance application.
i rely, I
gnu Iahy I
Association Manager f
on behalf of the Architectura Review Committee
Citrus Course Homeowners Association
I
(
Professional Community Management.)' Desert Resort Management
Post Qf oe Box 4772 • Palm Desert. CA 92261-4772
73-550 Alessandro, Suite' Palm Desert, Califomia • (760) 346-1161- FAX (760) 346.9918
,
0002