0105-145 (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
Peof,essi6nals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
*�aiSignature of Contractor
OWNER -BUILDER DECLARATjOW
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.
( ) 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 Policy No.
'RBUCYNT COUP INS '►YAMPIDUIP19P
(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 forthwit,, comply with those provisions.
Date: �^, ,# 'l tom:+` f F Applicant,,. •,..;..,., ,»x r:..mm�.M« tea:-��:y
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,above-mentioned property foKiinspection purposes.
nature (Owner/Agent)
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ()1(&.145 TRACT
JOB SITE APN
ADDRESS
1 ITAI M RIC C119 " XIMIN 770-3(n,0,31,
OWNER I CONTRACTOR/DESIGNER/ENGINEER
`3•YfffC.i'X K9MC11A.U44 CARUJILA P001'W C014tM t .13C. CION, IAC,
HEAVFRTON OR /9"?008 P.r`Cfr.M iSIWRM'r CA 92761
)360.1%02 CD70 1844
USE OF PERMIT
POOL &. SPA CYN'.;<.'r'•A7,.,di RWYB.P.RPURS SM;t L BE W PIACE AT PRE
PLASTER DI PWTIOUPOOL RQUIPME?+ T ZNC1A%UR-X IS OT INCLCfMD
it TI-MTI-M PERMIT
P001,,AWWR ISPA
m%000.00 I.S
X-71UTAMI) COO` OF ?C 01'gM%rC110Kv
PLAN CHECT 1q�19 I01-000>439.3101 $MI0
COINLSTYtIXT1014 )FEE 101-006-418-000
I 'EC 3A�iZCi�1..E�'F; . -• POOL 101-000-471.000 $24.00
RLEC'U'.RI>u.OLFEE POOL 101 -OW-420-000 $45.03
fr<Is010100 i<TE — POQ14 101-000-419-000 $27.00
8 UB -`�'t LAL C ON9IRU =0)q AN D'PLAN C1MC:`IC.
TOTAL M(Wr ynrls DUE. NOW
RECEIPT I DATE / / . I BY
"17.05
INSPECTION RECORD
'PPERATION
DATE
I 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
s
Final
Final
BLOCKWALL APPROVALS
steel
POOLS - SPAS
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
I Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
j Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
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)
Final
COMMENTS:
s
I
March 22, 2001
Tradifion
ARCHITECTURAL DESIGN REVIEW
Via facsimile
Ms. Nickie Gormley
Building and Safety
CITY OF LA QUINTA
78-495 Calle Tampico
La Quinta, CA 92253
Re: Dutfield/Stout Residence
s.
Lot 48, Tract 28470-2,_78-591_Talking Rock Turn}
Swimming Pool Approval
Dear Nickie,
This letter will serve as ADRC approval for the above referenced swimming pool .(copy
attached). If you have anyquestions or need additional information, please do not hesitate
to call.
Sincerely,
.Christina J. Dores
Architectural Review Coordinator
cc: Mossimo Giannulli, (via first class mail)
Ross Stout (via first class mail)
Geoffrey Henkle (via first class mail)
C' My Doc WADRC\Dudfidd46012P-L-pd
78505 OLD AVENuE 52 — LA QuiNTA -- CA 92253-1120 -- PHONE 760/564-3355 -- FAX 760/564-2356
J' x 8' SF f A'
TURAL STONE SPA COPING
(RAISED 6" HT)
NATURAL STONE PAVING SET IN TURF
•
16'x 40'
SCREENING DODONEA VISCOSA (HOF
NATURAL STONE POOL. COPING.
(RAISED 6" HT.)
FOUNTAIN JETS.
e • rrir.l �r
M WIMMII
MTW