9908-179 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
' C`iapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in -full force and effect.
License # Liic.. Class Exp. Date yySS yy�
� VLIl C33 `I dV 2011
GDate ° i��` 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).
O 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.
(1C) 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:
Policy No.
Carrier • •
i t IPL.OYER i FIRST' T: • . V�!+Ctd 'SG k2tD3-2.
(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 ?8 00 of the,Labor
Cede, I(sliall forthwith comply wit h those(iprovi i n�s�', .
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penaltie's 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 ceitify that I have read this application and'state that the above information is
cor.'rect:- I agree to comply with all City, and State laws.relating to the building
construction, and hereby authorize, representativestof this City to enter upon
the'above-mentioned propCrrty-forpnspection purposes.,
Signature (Owner/Agerit) �i�'""'/" bate
PERMIT#
BUILDING PERMIT��
DATE VALUATION $40,09Q.00 LOT TRACT
JOB SITE 734"Z TALKING ROCK TUI
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOHN RICH
R013ERT A.Tk mkrowr',t-T Poor CO�fSTl'tucm
78.562 TAL,k,.rl*1'! a� ROCKI r ?h' &�3 ;
? 2 L3�� NON PLAC f#3
LA QUIN'TA CA 9M3
PALM DESERT CA 92211
760)3^S9yG!yy
t,5115
USE OF PERMIT
POOL AND/CIR SP.A
PO(YXISPA ANT) FM14TAIN- ALARls.43GAIMARS SHALL M TN PLACR T.
PRE PLASTER [.I+ SPE f 101`L
1'i➢OL AWOR SPA 40,").00 LS
'R 010N
F,3`d 9A4ATR1D C0!T OF CON'S"
a&9l df 13.13(9
PERI UT FEE .S1:iMNARV'
PLAN CHSCK FRE 101-0004-39-318 %'427. 18
CONSTRUCTION 101 -000.418 -OW $349,50
N fSCRAMCA'L FET, --POOL. 101-tflr 21. -000 x:4.00
ELECTRIC:M, FEE -- WDOL 101 -000-420-NO
.PL.LTM8r. C4 .-- POOL 101.0(10419 -OW
r
KT8-1WAL CC3NMRI.K"."I ON AND PLAN. CHOCK
S;o72.�i8
LESS .PR-E-PAIDI PLEB
$0.00
'i'07'MI NVIRMIT FEES UVE NOW
1'
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
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
Q
Footings
Main Drain
!
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
/
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
Sewer Lateral
O.K for Finish Plaster�—
Pool Cover—
Sewer Connection
Encapsulation
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 6.760-564.2356 08/24/99 15:21 :01/01 NO:612
y
bra �tion
ARCHITECTURAL DESIGN REVIEW
August 24, 1999 Vrw Facsimik
760-77.7011
Mr. Greg Butler
Building and Safety
CITY OF LA QuMTA
78-495 Calle Tampico
La Quinta, CA 92253 ,
Re: Lot 36, Phase 28470-2, 78-562 Talking Rack Turn
Swimming Pool Review.-
Dear
eview.Dear Greg, .
'This letter will serve as ADRC approval for the above referenced swimming pool. This
approval Isbased-onapproved construction documents (Sheet A1.0) dated 9/28/98. If you '
have any questions, please do not hesitate to call.
Thank you:
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
• L
pc: Jeff Lohman (via ft st lass maitJ '
78505 Oto AvENuE 52 - LA QuINTA - CA 92253.1120 -- PHONE 760/564.3355 Fm 760/564-2356