0204-104 (RPL)^� LICENSED CONTRACTOR DECLARATION
1 hrzreby affirm under penalty of perjuFy 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
656128 �:�;� i.I'J� "Kt3 tl f
Date �" t 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
perform'a'nce of the work for which this permit is issued.
�p!il 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:
Policy No
Carriei :w�A'1 i�'S Pk3�I .F�'y .
!'I iJ��f7j3Q)61tiE•i111
(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 E
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 wit( those p(evions. � ((t
Date: ,; R f rApplicant pJI, Si91 1;FF
Warning: Failure to secure Workers' Compensation coverage is unlawful arid!
shall subject an employer to criminal penalties and civil fines up to $100,000, rr1?,
addition to the cost of compensation, damages as provided for in Section 37506
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth onIhis
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to '
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and'State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) , � � p �'a Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT O. !W4 TRACT
JOB SITE;
ADDRESS 78-170 CALVE LAIS Rt$.l ULAS"
APN
OWNER
CONTRACTOR'/ DESIGNER / EN (NEER
MARWARMORM
Ca gt' & �U-,.1.61
CALMNMIA POOLS &, SPAS CrOP MAW CO
e 4725 JONS ]AI' X, SiJi E NA
S -/ 70 S a s
L cA-- w i h +C%—) C,_ . j Z Z 5-3
5
PALM.x7��*M.ZT CA 922,60
(160)3404'fJ 0 =641 00355
USE OF PERMIT
POOL AMD/0R. 9PA
POi?1. ANf7 SPA. O"[v'L,'il'. 15 LP OF 4191.00X WAi.,I.. CITY STANDARD.
ATARMBlil./ .PERS SHAhL 8F IN MAW?, PRIOR TO P.REPLA. TER.
rNSP11?Cr1O`N. POOL EQUIi+1 ENT PERMIT.
P001, ANDIOR SPA I P,a001Jif LO
4 ..VP. WALL 0.00 Lie
EgMUTED COST, OF CONSYRUMTON
19,140M
PLAN CHECK FEF, 101-000-429-318 $1A1 111
CCb'WSTRUCTION MR. 10 1 _000-418-000 $301.00
MEC;HMICAt., IP •- POOL 101.0.00421,,000 lrgll.00
ZL Z CT1RJC.AL FEES :PObL '1101-000420-000 $4 AU
PURIBING FFIF -- PWL 1101-000-419-0100
iJ*
'N 15 Z�
CiTYCRAft
StM-IWAJ, a30NURIMMON AND I•LAW Cl<*.FXX k
$437_: 5
f LESS PREXPAIDMES
$0.00
TOTAL PERAnT MS DUE NOW
RECEIPT
I DY[I
BY yr %
DATE F NALED
INSPECTOR
flat;
INSPECTION RECORD
L 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
BLOCKWALL APPROVALS ,a
steel
POOLS = SPAS
Set Backs
Electric Bond
Footings =� _ 2
Main Drdin.
Bond Beam
Approval to Cover
Equip ent Location
v
- 7 - L
Underg?ound Electric
Underground Pibg. Test
Z
Final
Gas Piping
Z
PLUMBING APPROVALS
Gas Test
Electric Final
_ z
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out 1,
Equipment Enclosure
Shower Pans y
O.K. for Finish Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
—®
Gas Piping
Gas Test
r...
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:
1,
APR -12-2002 12:44 AM
II
P. 02
1�16 4't
Duns Gardens Homeowners Assocl sti on
REQUEST FOR ARCHITECTURAL. OR LANDSCAP9 MODIFICATION
Date of Appliatiaa ., , 0 • ° "
Nemo 4agg=At 4'fd^a1-1
Amapa 8 + C &=d-44
N IrA-
phone I-1GLI 44t9 -1;q04.
Duo Phone 6 -/? 17 7+;- '1` L -
MODIFICATION REQUESTED
t'scfG�►^46d � w �� .—( 1. 0 ��r��.%-�-� ���.a
Archltecttva0andsope approval is "queetod far the proposed modl&ertion Used above prior to any work
Fh:c�
cncing. Applicable drawings are attached and delineate the type of material said specifications. All
willbepermed by fioeasod, insured oonttt dm or by the homeowner doing their own work on
own property as a aver bidder. It is 111y understood that the appilc ont is responsible.6or obtaining
any and all permits associated with the improvements. All costa will be the 2W cent's responsibihty
bwludhgg but not lim had to irrigation linea, elecuical► A=e wKW soeaoe, end ptimi nsaterial, It is f zber
agreed flat ficttae tnaenta►anoe of the approved modifications and common areas, as tiny be required as a
result of said modification wW be at the ex xnn of the applicant and their sucoessars in iota ck The
appiimt agrees to hold hasmiess the aasoaiatioa ftm any damages resulting from the approved
modi8adom
SIGNATURES OF ADJACENT HOMEOWNERS ARE REQUIRED
PLEASE SU$MiT TO: VLTNA TDRaN
A ICET GARDENS
CO �E
78080 CALLS NOR11
LA QU TA, CA. 92253
REQUEST APPROVED:
REQUEST DENMD:
ARCF UC MAL R18VMW COAdIVg M2 DATED
caMlvaTTEE cogs; y ��
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