0309-066 (BLCK)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
77'18}9 xi a 04!30/2(
Date ` y • r 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:
( ) 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 13I)ERTY MUTUAL fir Policy No. IRA292.i?I447130I2W
(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 those provis'ons.
Date: -� Applicant419W ✓_ sr� �� y,�.... . �.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100;000, in
addition to the cost of compensation, damages as provided for in Section'3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) el!& � � ���-^-� Date 0 91t6A.2
J �
BUILDING PERMIT PERMIT#
00
0309-W6
i
DATE W1102(y. VALUATION LOT TRACTJOB
SITE
ADDRESST•w�•,����n�910eiX�i}!
APN d t
OWNER
CONTRACTOR / DESIGNER / EN (NEER
73^121 F141)WAPJ G#:10`0 '
73.12'1 FREb Ak I NG#100
Ply. ,DR -SE -M CA 92260
PAL M Dn$_3%T CA 92260
(760)6.74.91699 Ck3L4 -4832.
USE OF PERMIT
33 LF. S' SI0_NA O tL' .9LOCK 'WALLS, I3ER SA..2003.722, ORC.0
SYSTEM, iSIGN BUILT AT JEFFERSON ST, RNTRAUCE, 2 510143 AT
1i'Z 50 RINTPU"CE
S Fill WALL 93.00 L
FS'MYAM, COST 022 CON91RUC"iZL)i41
CONSTRUCTION PO 101-000.4180000 $2.4.00
•:Sl�'f3�.�►ULrCON'. TRUG°i ®Ai fid®Pf"G"F� :'I .
9.Q4
ZS DXJE HOW
ME
SEP 1 1,2003
CITY OF LA QUINTA _
w:tt�e�e�CE gEPT.
RECEIPT' I-4
D'ATE'"—�—
BY AT FI _&K
j�
SPECTOR'
0
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
Final
Gas Piping
PLUMBING APPROVALS
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
Pool Cover
Sewer Connection -
Encapsulation
Gas Piping
Gas Test
Appliances
-
Final
COMMENTS: �-/5- S
-
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i
P.O. Box 1504
78-495 CALLE TAMPICO
LA QUINTA, 'CALIFORNIA 92253
September 10, 2003
Mr. Lee Dotson
Toll Brothers, Inc.
73-121 Fred.Waring Drive, Suite 100
Palm Desert, CA 92260
(760) 777-7000
FAX (760) 777-7101
s-MPIz' 'To f,#,z C-t-vo
b 3oq-v"
Ref: SA 2003-722 (Mountain View Country Club)
Dear Mr. Dotson:
S� �1vi✓ S7>- —
The Community Development Department has reviewed your request for a
the installation of two monument signs for Mountain View Country Club at
the Jefferson Street and Avenue 50th project entrances. The request has
been approved subject to the following conditions.
1. This sign permit is for three non -illuminated monument signs (one on
Jefferson Street and two on Avenue 50' only). The signs are approved
per plans on file with the Community Development Department. Should
the applicant want to install a monument sign at the Avenue 52 project
entrance, another application, fee and plans must be submitted for
review and approval by the Community Development Department.
2. The sign letters shall consist of 2 inch deep can letters painted matte
black and stud mounted to a low monument wall. The maximum height
of the sign area shall be limited to 2 feet high and 11 feet -four inches
long.
3. Obtain a building permit from the Building & Safety 'Department, prior to
installation of the sign.
EWl
Mr. Dotson Page 2
September 10, 2003
Should you have any questions or need additional information, please feel
free to contact me at your convenience at (760) 777-7068.
Sincerely,'
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTOR
MARTIN MAGANA
Associate Planner
c: Building & Safety Department
Chron file
41w
C�
24"
11'4"
8,9„
.Mountain View Logo painted mage black
2" deep can letters, stud mounted to existing wall.
Approved by: Date Reso �
D Planning Commission
• City Council
G] -Community Dev. Dept. a
InitialsN/l -----
Case No.
VExh' it " ^----
ith Conditions
P.
11'4"
8,9„
Mountain View Logo painted matte black
2" deep can letters, stud mounted to existing wall,
A VE 50
j^j J
PA