0102-097 (CCOM)LICENSED CONTRACTOR DECLARATION
•I hereby affirm under.penalty,of perjury that I am licensed under provisions
Chapter 9 (commencing with Section 7000) of Division 3 of the Business a
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
_f36rt$',? ��;'
Date 1 " r ° Signature,of Contractor
' OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that l am exempt from the Contractor's
License LaWfor 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 o=lusively 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 -3 t -L-• - &1 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.
006rD'E"f11c°�$3.42iCr.S¢'f7aiA6M3
(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 the a provisions.
Date:,. w r Applicant r C.ux. ^�..
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.
ing and S ty
IMPORTANT Application is hereby made to the Director oPsih
for a permit subject to the conditions and restrictio
forth o is
application.
1 IAN t;i"W19 PTIE
1. Each person upon whose behalf this application is madwhose
request and for whose benefit work is performedany
permit issued as a result of this applicaton agrees 13
AI, �
& hold harmless the City of La Quinta, its officers, ag nI
Any permit issued as a result of this application bec mwork
is not commenced within 180 days from date
fpermit,
or cessation of work for 180 days will subject p
r
ch person at rpu��qtt II, ilid�Ffihif� •
s an employees.
es n
issuance cQiTet(�fiLA
mit to cance116tlb1it+ICE
BUILDING. PERMIT'
VALUATION LOT
JOB SITE
ADDRESS
OWNER
."tit artmN mus,1433R 4"IVWMAN AV:)i $ SSW 100
0RPSGE CA 928086
USE OF PERMIT
PERMIT#
CONTRACTOR
324 ;,;t� t:t::+1t,41? M4 P,.YCEA POOL BUIL?J2�' G (LDT C)
r;�..A.i ACE i' AFt,P'ORT
0102^097 TRACT
APN
RJI 110BBS &a st UnWt�r.t":a�(�. S, LLC
55-96 1= GAS?'�,VD
LA C,�13I "l,A. CA 92233
(714)633-1260 C-SVe 5487
324 OD SF
UINTA
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 forinspection purposes.RECEIPT
Signature (Owner/Agent) ""`�J✓�" "'� Date
brr.,�.f.Wl�l-E.d t±.l. &�.,/A17 '�Lti'd• °((�SC�yy�yy"yr��yyh��i;;SAee4yylA((�;�. TT w
3
TOM -0 MUAff ;MS Dt1E .ESO •
:rt
DATE BY
$7:39.97,
$(,00,
S739.9'7
1 IAN t;i"W19 PTIE
191.000.439.31SC.'C11dS`
RUCTION FEEMECH1NIE
AI, �
1Q1-000.4.21-000
$34,"
X3-,'SC'9`F ICAL li'3 t
$OI -WO -4 0-000�'L�Ji`I�S1WO
VEY,+
1011.000 419-000
V..02.00
GMADINO HEY,
101-000-423-000
$20.00
b'P'tt31�C4.�i1OVOIA FEE - COM
100.000.241.000
$1.33
ART IN >f�4 BLIC !.LACE n - t.' OM3 701-000-255-000
$31,° 3
I�en:LiOpEp i�Vfpl�t; T nn
"x.4,01
UINTA
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 forinspection purposes.RECEIPT
Signature (Owner/Agent) ""`�J✓�" "'� Date
brr.,�.f.Wl�l-E.d t±.l. &�.,/A17 '�Lti'd• °((�SC�yy�yy"yr��yyh��i;;SAee4yylA((�;�. TT w
3
TOM -0 MUAff ;MS Dt1E .ESO •
:rt
DATE BY
$7:39.97,
$(,00,
S739.9'7
INSPECTION (RECORD
OPERATION
DATE
INSPECTOR ; '
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings �T�
Underground Ducts
Ducts
_ ,
Slab Grade ��
Return Air
Steel
Roof Deck n_�/ ?
Combustion Air
Exhaust Fans
_
O.K. to Wrap / I
Framing 8��
F.A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. F
Fans &Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
_
Exterior Lath
Drywall - Int. Lath
s
_ `Final
Final ;L� I
—L V
Pools - sPAs
BLOCKWALL APPROVALS
Steel
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 /-j/�
Heater Final
Water Piping
Plumbing Final
.Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
_
Sewer Connection _z
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Q
Final/s---
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 IllkligI
Final"
Utility Notice (Perm)
�7�(lf'• '1 Planning App
1' ► " � Pub. Wlcs;4
H.O k Appy
Fire:Mar' affil
L Dept. App
Ag -Approval::
y
• y a
�
N
Ci of L a Q ui n to 1
Building ild
in Safe Div'
tY Isi
8 on
P.O. Box 1504 '
-Permit #::::' `' .: ><»<>
>`><>'
78=495 ,Calle Tampico -
[ ' ';<
La Quints, .CA 92253
0�0�. `.. >_
Building Permit :Application and TrackingSheet
eet
Project Address: 56 4300 t _� O
Lk 77'r
n .' l
• Owner's Name. `
A. P. Number:
rAddress. 5S U—
Leval Description:
City,ST, Zip: LA
Contractor. �t1 g>cJS^
: /� �—
Telephone: �� £ �_
/. —7
Address: ✓S-
Project Description:
City.ST, Zip:
Telephone:X.
X60 � -
5 �o
State Lic. # :
City Lic. #:
Arch.. Ener.. Designer)
l
Address: 2Le Co4A
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I ►�1 �1L17J t
C
City. ST. Zip:T-./ — C
42 ? 1
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Tel hone:
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Con stru '
cuo nT e: an I
YP Occupancy,
P cy
Sta ' r;
to Lic. . I�
Pro' ect e (circle e one
1 tYP ( New Add'n Alter Demo .
-
Name of Contact Person; �
ti ,
Sq. Ft.: 7Z
# Stories:
,Repair
# Units:
Telephone it of Contact Person:, ��0- �- I
Estimated Value of Project:
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�7�(lf'• '1 Planning App
1' ► " � Pub. Wlcs;4
H.O k Appy
Fire:Mar' affil
L Dept. App
Ag -Approval::
y
COMMUNITY DEVELOPMENT
_ PUBLIC WORKS
FILE COPY
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be. obtained. Please return this form to Nickie Gormley, Building and Safety
Department onlyqter approval. Contact applicant for resolution of conditions preventing or
delaying approval.
Project: 55-066 SOUTHERN HILLS
334 S.F. POOL HOUSE BUILDING
Applicant Contact: JR MAURO 760 564 5612
Application / Circulation Date: 02/14/01
Date
Community Development Department
Christine di Iorio, Planning Manager Date
Public Works Department
t
Steve Speer, Senior Engineer
Building and Safety Department
Greg Butler, Building and Safety Department Manager
Health Department
Date
Fire Department
Date
Schools Fees Paid
Date
Date
Date
_ COMMUNITY DEVELOPMENT
PUBLIC WORKS
FILE COPY
City -of La Quinta
Developers Project Approval Form
r
Prior to the issuance of Building Permits for the project listed below, .the following Departmental
clearances must be obtained. Please return this form to Nickie Gormley; Building and Safety
Department onlyafter ap, rp oval. Contact applicant for resolution of conditions preventing or
delaying approval.
Project: 55-066.SOUTHERNvHILLS • —1—Z,S ( ¢9
334 S.F. POOL HOUSE BUILDING
Applicant Contact: JR MAURO 760 564 5612
Application / Circulation Date: 02 14 0
Date
Community Development Department
Christine di Iorio, Planning Manager Date
Public Works Departme
teve Speer, Senior En ineer bate
Building and Safety Department
Greg Butler, Building and Safety Department Manager Date
Health Department
Date
Fire Department
Date
Schools Fees Paid
Date
06
PAn
l3'P' a
i\
MONTECITO A TPGA WEST
PLOT. PLAN.
MODELS
' - GOLF CART
ACCESS LOT A
PHASE 1 <.
•:tom',; ,,..:. ::r•d..Y:� �\p
PHASE 2
p PHASE 3 b ,
PROP. POOL LOTS ` 9
�z
:a 10
EXIST. POOL LOTS
2
GREEN BELT" -`y
1415
A RE -INSPECTION FEE.OF y; ':t 16
WILL E CHARGED IF THE APPRQV
PLAN AND JOB CARD AE,NOT ,{
�t N
ey /8 W
THE ITE FOR A SCHEDU
�,
INSP TION. - - . 9
NO EXCEPTIONS! ?r TRACT NO. ane
24
L� lJ IBJ ?s 43
CITY OF i`
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CONSULTANT:
MDSYDS CONSUL T/MO
W.., .1)SZD R.m:o w.nn, SJb ]6o h,4 a,-mi,� ` p 8:614 :AX a1�N6 /l/{Oi\ 1 ECITO
;A NO ENG44iE1NNG • SURVEYING 1♦•L - '" 1:/442-04/E1648Sf5/P-MILLS 11/16/48
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