9908-178 (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
�ti986 C53 . I/2(7777
Date' `��'E 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:
( ) 1,. 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 inder 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' compensatiori insurance carrier & policy no. are:
Cartier Policy No.
EMPLOMS iFlR;%T Ir. WCN 301204'
(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' compensa qn prprovisions ofSection 370, of the Labor
Code, I sh„�Ihfor w t, comply with Mose pro visio s , / , � �
Date: �— Si' Applicant
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 uthorize representatives of this City to enter upon
herabove-mentioned prope y for insp ction purpose's
.moi}” i b
Signature (Owner/Agent) Date_
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BUILDING PERMIT PERMIT#
DATE f %
! VALUATION LOT �17 TRACT, {
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JOB SITE �I
APN
ADDRESS
7&351 1'A1,MNG ROCK TURN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
WM C:1;1t "iLT.R
DBEf�'C th�IS�{l012'�fi Pt)�J.G �""�i1�iS"�Zl�"�I
18-151 TALKING KOCK
7741352 LENNON PT:.ACM $13
.LAA QIJMA C'.A. 97253
PALM DESl IRT - C.A. r.211
C;BLA 5115
USE OF PERMIT
2001. AND101k CP
P00"L PA, AND'V UN A.IN- Al. ARMS/11 At'R3k si TALIb..t_': F TN PLACE AT' �
PRF P;f,<FW04 77144E "fiON. r
POOL MAYOR SPA 30,ibt3ii,00 LS
EYfIMAM CXXST OF CONST DgL=ION
30i00,00
PLANI4F.rX FEE, 17777.44-439-A18
CC) NST RU101'1Otf.FEE 1£11-WO.41.84)00 $284,50
till {.1,1XXIC Vit.. FM -- .FOOL -.101-000-421-M $24.06
EILEC"I IC;ALM -POOL. '14:1-000-42773.01};77 $45.00
PLQV1BTNG FEE — POOL MAO
• SUB -TOTAL ti0n`L+.7.i.XW'110N TkND .t'Ld1N CITE es -.
`) 43
LESS, PIM -PAID le"YES
a$-0.00
„fOTAI, PERMIT IT FD±.i 1% DDUE NCAV
$S6a.43
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
X11
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
I Underground Ducts
Forms & Footings
I Ducts
Slab Grade
i Return Air
Steel
i Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
i
Fireplace P.L.
Grills
Fireplace T.O.
i Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
'
POOLS -SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Footings
Bond Beam
Electric Bond
Main Drain
Approval to Cover
g �- 9lip
Equipment Location
Underground Electric
Underground Plbg. Test
Final-
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping _
I Plumbing Final
Plumbing Top Out
Equipment Enclosure
}
Shower Pans
, O.K. for Finish Plaster
I
Sewer Lateral
Pool Cover
Sewer Connection 1
Encapsulation
Gas Piping
Gas Test
Appliances
Final
'i 90
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
Finial
Utility Notice (Perm)
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TRADITION GOLF CLUB 760 564 2356 08/25/99. 09:27 :01/02 NO:619
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ARCHITECTURAL DESIGN REVIEW
August 24, 1999
Via Facsimile
760-777-7011
Mr. Greg Butler
Building and Safety r
MY OF LA QUINTA
78-495 Calle Tampico -
La Quinta, CA 92253.
Re: Lor 60, Tract 28470-2, 78-351 Talking Rock Turn
Swimming Pool Review
Dear Greg,
This letter will serve as ADRC approval for the above referenced swimming pool: This
approval is based on approved construction documents (Sheet A1.0) dated 6/22/98. If you
have any questions, please do not hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
78505 OLD Avow 52 — LA QuArrA -- CA 92253-1120 -- PHONE 760/564.3355 — FAx 760/564-2356
TRADITION GOLF CLUB '"'760 564 2356 08/25/99 09:27[5 :02/02 NO:619
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