9911-069 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
1�!"rlapter 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
w;sI, C53 , e. r'3112.ii(
Jr
Pate y"� Signature o' Contractor e* ��+
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, foi 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:
Cartier Policy No..
"ON OLOYC' 11,1C.14 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
workerompensation laws of California, and; agree that if I should become
subject to the workers' compensatiorrpryovisionsSof Section 700 of the Labor
C�offe, I shall forthwith comply with t j ose provisions.
Date: +� ,AiIrpplicant
t
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
Constriction, and hereby authorize* representatives,, of this City to enter upon
thee�above-mentioned properrt77o_ iinspection purposes.'
gnature (Owner/Agent) S �'h Mli Date �1
`BUILDING PERMIT PERMITV
J LOT TRACT
DATE, VALUATION �`
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SITE
ADDRESS 784Ai0�r,16�ir�l►U7N_RN
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OWNER
CONTRACTOR /y�DESIGNER / ENGINEER
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52-482TALIKUAdGROCK'1U ...
748V1,:1:'P�•,�+ON PLAC� #3
LA. QCi1'WI'A. CA 922+3
PALM .UCS XC CA 92211
(764),%849.93 C3T,; 5115
USE OF PERMIT
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41L,A.(X Paf:PRE�PI,:ASTE t€.INSPEdc: °I.V fit.
P001kAND,'aZ SPA X. 000.00 LS
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P, REW ' FE�+;.StUACMA;RY
PLAN CEfiSi X FOS 9176:48
Cljd�i"t'iZt `t"f'If 1d IT -w-, !01 4,M-41 R4M $.1271150
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$0.00
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RECEIPT
DATE
BY,
DAF ALED
INSPECTOR
I
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
Set Backs
Footings
Steel
Electric Bond
Main Drain
C
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
PLUMBING APPROVALS
Gas Piping
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
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
(((
Gas Test
Appliances
Final
COMMENTS:
tZ f/ab�
- G
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
FbQuies
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
. EDITION GOLF CLUB 760 564 2356 11/16/99 11:.06 :02/03 NO: 518
s6 .
qradiffon
ARCHITECTURAL DESIGN RfiviEW
November 16,1999 . -
3 via Facsimile`
760-777-7012
Mr. Greg Butler
Building and Safety
CITY OF LA QUINTA ��-
78-495 Calle Tampico
La Quinta, CA 92253
Re:.` Lot $2, Phase 28470.2,-x-2=482 Talking Rock Turn
Swimming Pool Review
Dear Greg,.
This letter will serve as" ADRC approval for the swimming pool at the above referenced
address.' A copy of the pool plan is attached. If you have any questions, please do not
hesitate :to call.
Thank you.
Sincerely,
.Christina J. Doren
Architectural Review Coordinator
/cjd
Pc: Kristi Hanson (via first class mail)
ctinroawwos.om.,.w
78505 Ow Avg 52 — LA Qu►NTA — CA 92253.1120 -- Nm 760/564-3355 -- Fax 760/564-2356
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