0111-069 (RPL)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 Exp. Date
4
Date # e p' 'E t i Signature of Contractor 11
4t
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 Signeture 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.
{(qj 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:
Carrier `� � INS Policy No. WN4043, 47JOI
(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 with th8selprovlsions. jJ
Date: t t t. r, t Applicant
_Warning: Failure to secure Workers.,, Compensation coverage is unlawful and
shall subject an employer to criminal nalties 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. j
rSignature (Owner/Agent) 1 1., _ . a. ._..w__ .-"". -(Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ��' TRACT
P t � ,1.� •.� 1
JOB SITE��4�}
ADDRESS �� CKB �141a:Cn��it 1.� TOT
APN
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OWNER
CONTRACTOR/DESIGNER/EN INFER
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LA C"Um h CA 92253
'P)V. M i EME . T CA 922:61
(760)360-6602 CIBI-0 1
USE OF PERMIT
POOL .tWMA PA
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PLAN "HM RZ 101-000-439-338 S29173
CON'STRUCTO ME 101-00 0-418-000 036.50
MEC HANT01IJ, FEE -- .POOL 101-000.421-000 $24.00
ZT XC1'DtdCAd., V — POOL 101 -000 -420 -WO $1:5.09
PLdUT44T3TrJO 1171, •- Pool, 101-000.419-000 �z7,40
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.SUE NOW
1.
RECEIPT
DATE ie°�
BY
DATE FINALED
INSPECTOR
..s
LwM
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
Footings
Main Drain
( ��
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
_
Underground Plbg. Test
Finan
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste tines
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
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)
raditio''n
November 9, 2001
Dutfield Financial �.
Attn: Jeffrey Hinkle
73-960 Highway 111 Suite 6
Palm Desert, CA 92260
Re: 786-42 Talking -Rock Turn,_Lot 40
Dear. Mr. Hinkle,
The Tradition Architectural Committee reviewed the proposed change to the approved
pool for lot 40 Talking Rock. The- plan was approved as submitted.
Thank you for your submittal and patience in our review of this plan. I look forward to
working with you further on the completion of this residence.
Sincerely,
Mindy Gutierrez, Property Manager
Tradition Community Association
PCM/DESERT RESORT PROPERTY MANAGEMENT COMPANY
POST OFFICE BOX 4772,,PAL\4.DESERT, CALIFOR,-,IIA92261-4772 73-550 ALESSANDRO, SUITE 5, PALM DESERT, CALIFORNLA, 92260
PHONE: (760):a46-1161 FAX: (760) 346-9918