0110-056 (RPL)H
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LICENSED CONTRACTOR DECLARATION
Thereby 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
Da tgy r� Signature of Contractor^
,f �.
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.
(�) 1 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 STATE CCINIPHNOXF1 Policy NO. 046006169
(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 becgme
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: * - Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful an D
shall subject an employer to criminal penalties and civil fines up to $100,000, i'
addition to the cost of compensation, damages as provided for in Section 370 u
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safe
fora permit subject to the conditions and restrictions set forth on his
application. -_
1. Each person upon whose behalf this application is made & each peYson at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancel: ation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for invaction purposes.
1.<
Signature (Owner/Agent),% �`I y %"y� Date'.
BUILDING PERMIT
DATE N rypy VALUATION S24,WW LOT
JOB SITE
ADDRESS 8.915 Wjank0 �
OWNER
NifM ISAA S
a0-915 fidER31ir. TT
1:.;P,. o"} :M11'A CA 922,53
USE OF PERMIT
POC91,AND102..SPA
}'Sr9OLAT1.F3 OR, SPA
PERMIT#
TRACT
APN
CONTRACTOR/DESIGNER/ENGINEER
VALM DEMIRT Cdr. 92V60
(760)340.9000 MW
NANO 1.8
XSEWATRD COW OF CONS"alRV07,0I11
p.):Mlaf FRE 19UM CA
PLAN CHWK k1, l 101 - 00-439 1f$ $€$7,0
4;ONS sRUC IM Me e '101-000-418-000 $x,43.0!)
MEdHA ITCi1L VF .. POOL "' 1.9I —fir,} -421.000 $24,00
F1,.MMM,A1,PRE, –}OOL 101-000-42--000kla
101.4900-419.000 $rNo
OCT 0 4 2001
LAQUINTA
BUD. -TOTAL CO.VS3.0,111MON "D PLANOU", ", CU.M; PIM -PAW MRS
RECEIPT DTE/j, % 0 rr f BY I DATE FINALED INSPECTOR
$496.9
$0100
$4%.95
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
TDATE
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.
Fireplace T.O.
Grills
Fans & Controls
Party Wall Insulation
Condensate Lines'
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
POOLS - SPAS
Footings
Main Drain
Bond Beam
I Approval to Cover
' Equipment Location
Underground Electric
Underground Plbg. Test
Gas Piping
/�/ l!/i•
Final
PLUMBING APPROVALS
Gas Test
' Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Sh6werRans
O.K. for Finish Plaster
Sewer Lateral
Sewer connection
Pool Cover
Encapsulation
_
Gas Piping
Gas Test
Appliances
Final
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
Final
Utility Notice (Perm)
ay: r•oe•. i c:vj!i;^ -:rj 4 1 J uh-r r rea; -u•vi i 1 :..:rim., r'•9ye 1 11
OL"T- 3-01 WED 10.55 Ay PGA WEST HOA FAY K0. 76[- 554 2329 P,
FAIRWAYS ASSOCIATION
October 3, 2001
Mr. & Mrs. Bryan Isaacs
P.O. Box 1708
Blue Jay CA 92317
Re: 80-915 Weiskopf
Dear Mr. & Mrs. Isaacs,
Today Mr. Chevis Hosea, cheirman of the ArcUccturat1ardscrape Committiec
your plans on the following conditions:
A. You will need to submit the landscape plans and deposit bef
that work .can be started.
B. The pool equipment neem' to be screened.
If you have any questions, you may Contact me at 760-564-3858.
Sincerely,
. 9
oDonn arLtisccio
'on Manager
t-;
P.O. BOX 13710 • PALM DESERT, CALIFORNIA M55 • TO. (760) 776-5100 • Fax (7 0) 776-5111
r email: pgawcaf(1 mauarchgrp,com