0201-117 (RPL)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
Date 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).
(N) i, as owner of Ines prdperty, 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 re;'son
.
Date I. 14 'f "L, 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.
(This section need not be completed if the permit valuation is for $100.00 or less).
O 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 provisions.
Date: Applicant
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) �r\` ( �� Date
PERMIT N
%yB-JILDING-PERMIT -
DATE VALUATION LOT W01 417 TRACT
JOB SITE
APN
ADDRESS dd�� �y� ,gqAM��tly�p��-1��y �py b j
- - I4"s' 45 S_i,,.v,1, N.F.J1H 71(.E'i�.A.
n-44457,
.. ...
OWNER ^
CONTRACTOR/DESIGNER/EN (NEER
rj
BOB.VIXE,i7 �`. r'`
BOBE.'l'.YiM.L
'A8.8145 MEN M-1 WAY
rib"8'?Sw�'' W1T1T WAY 1
'LA QYMMA CA 92253
J_A,Q,1J,WL`.A c.:,lr'!, 9.225.3
-
(760)Z75-9400 CBW
USE OF PERMIT
POOLARDAYR8PA,
PS:lWSPA. AL.,A7. MS/6AP.t` ERS SHALL BE rNI PLACE AT
INSPEC RYA, 4 r„ . RISL
POOL At3,3Nok 5'1'A LY
4 FF. WALL Ll?
:�1�'�.�A"�`Si� t"'Q�'.�' �L� �:iD:1�i �"�.'ER�;7C:'1'.T>µ4�►��
3 %;6.P��.
PLAN N EHEC K i'� I. 101-000-439-318
CaN,``,"ilw'Li'CT1014 WE 101-Ci00-4l8M0= $14tlm
•s ECrt,MIGIAL FEE— );=004 ns3.000-A-21-000 `24.60
BL ECTI .ZriiL PE - POOL 101 w,00 S-42AI-000
PLUM -BI 10 FER --.POOL 101-00.0s,419-1100 %217.D0
JAN 2 4 2002
WYORAQUI
a,� �y^ c.y��
SIMAl,ff��''ff p� K qy�����r�.�ry+�y� pp�y� PL
t7�..M-' V'.e AlorC�SAtla7T'X:�.4f Li.1.201 dGt`+D Pi.��.GV t�.�"il;.tl�w.C4,
�(f .y !+,
$113-�.60
LESS PRE -AID F1.1:0
$0.00
': " PIAJ, k1M . "!lt"WN DMER VW-
vxl%._
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond —_
a
Footings
Main Drain6 � S
Bond Beam
Approval to Cover
Equipment Location
Underground Electric Z_ —
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
Gas Piping
Encapsulation
Gas Test
Appliances
Final
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)
COMMENTS:
' FROM :DILLARD RESIDENCE FAX NI.
745067 Jan. 09 2002 05:48°M 131i1
M py 1tt� 76-495 CALLE TAMPICO
OUINTA, CALIFORNIA 92253
TELEPHONE (760) 771.7
AX (760) 777-7011
OWNER/BU
INFORMATION
Dear Property Owner:
An application for a building permit has been subrr
your name listing yourself as the builder of the prePcrty
improvements specified.
For your protection you should be aware that as "0
rilder' "'you are the responsible party of record on such a
permit. Building permits are not required to be sign,
)perty owners unless they are personally performinE their
' own work. -if your work is being performed by somt
cr than yourself, you may protect yourself from possible
liability if that person applies for the proper permir
r her name.
r
Contractors are required by law to be licensed and
by the State of California and to have a business Tense
_
from the City or County. Thcy are also required b
put their license number on all permits for whicF. they
apply.
If you plan to do your own work, with•the exceptic
iuus trades that you plan to subcontract, you shoild be ,
aware of the following information for your benefit t
action: ;
If you employ or otherwise engage any persons oche
turimmediate family, and the work,(including materials
and other costs) is $200.00 or more for the entir
c, and such persons arc not licensed as contractees or
subcontractors, then you may be an employer.
If you are an employer, you must register with the 5
Federal Government as an employer and you are subject
to several obligations including State and Federal
rax withholding, federal social security cues, worker's'
compensation insurance, disability insurance costs su
ploymcnt compensation contributions.
Thcrcmay be financial risks for you if you do not cat
iese obligations, and these risks arc especially serious with
. respect to worker's compensation insurance.
For more specific information about your obligation
edetal Law, contact the Internal Revenue Service (aad, if
you wish, the U.S. Small Business Adminscration).
; specific information about your obligations under Stare
Law, contact the Department of Benefit Payments ar
ivision of Industrial Accidents.
If the structure is intended for sale, property ownc
re not licensed contractors are allowed to perform their
work personally or through their own employees, w
licensed contractor or subcontractor, only under limited
conditions.
A frequent practice of unlicensed persons professi:
contractors is to secure an Owner/ Builder" building
permit, erroneously implying that the property ov
aoviding his or her own labor and material persorally.
Building permits arc not required to be signed i
rty owners unless they arc performing their own work
personally:
Information about licensed contractors may be obt:
contacting the Contractors' Stare License Board in your
community or at 1020 N. Street, Sacramento, Califc
l4.
Please complete and return the enclosed ownerbuil
ication form so that we can confirm that you are aware of
these matters. The building permit will not be issue,
to verification is returned.
Very truly yours,
CITY OF Ll QUINTA
DEPT. OF BUILDING AND SAFETY
78-495 G1(e Tompico
La Quina, CA 9225
1
(760)777.7012
60) 777501
r
0 ER'S SIGNATU
/DATE .
$57� W -A
-
PROPERTY ADDRESS
gaol- /l�
' PERMIT NUMBER(s)
Jan 23 02 11:01a P,.1
SIARLICHT DUNES
HOMEOWNERS ASSOCIATION
APPLICATIO LAN DSCAff-MGBCAB-QMAffR0-YAL:;
N
DATE: I{ I
OWNER'S NAME: NONE: �i�O r �"T_
PRop TV AddRESS: -M _ ? l 5 t�?
ModifICATION REQUESTECI: :Le 5 1 t T GL's {
(REPAINTINCj Of HOUSE dOES NOT RE91UIRI dRAWIN(f5 SubMiTTEd OR PERMi'T5)
To: ARCHITECTURAL /LANDSCAPE REVIEW COMMITTEE
YOU ARE IIEREby AdViSEd TkAT TIE ABOVE WORk i5 pwpcAEd ANd APPROVOd i5 REQUESTEd. ATTACIiEd ARE dTRAWiNgS '
TO SCAIE MINIMUM 118„ = I') of THE woRk TO bE dON( ANd TYPES Of MATFRiAI5 TO bE USEd ARE INdICATEd ON:ikE
dRAW;NCTS. WE UNdERSTANd TkAT BuildiNCT PERMITS fOR SOME MOdifiCATIUNS ARE REQUiRF.d by TkF- Ch), OLb
OUINTA ANd TWT TILE COSTS Of TIiF PERMITS ANd THE RESpomibilirY Of ObTAINiNq PERMITS ANd SUBSEQUENT
iN5PCCTi0N Will bE bomf by TiiE APP11CAN1.
WE AC!CNowt-dqE TiAT All AppROVEd CPANgE5 iN'TkE ORiCIINAI.dESigN Will bE AT OUR EXPENSE; T:LQT ANy dAMACCE'iO
OR RELOCATION Of EXISTING, SPRINVER SYSTEMS, LiNdEKROUNd UTihES, bUildiNq STRUCTURF ANd EYTER.•OR 1ANdSCA0INq * A
' TO OT.kER dAMAGE TO Assbr!ATiON pROPEnn' RESUITINGC FROM THE CONSTRUCTION AN&OR iNSTAIIAT'ON Of TiESE
PERMITTEd iMpROVEMENTS Skal1 bE AT C'AIR EK;)ENSE.
WE ACkN'OWIEdtiE A SECURITY DEPOSIT Of T nw-�Z�/i1 _,SONE of T4E TOTAL COST Of T11E PROJECT IS
REQIiREd TO COVER ANy dAA1A4E TO ,LCE COMMCN AREA OR CIEAN,Up NECESSARY fOR TkE COMPIETION Of TkE PROJECT.
DEWiT AMOL',NT Will bE dETERMI-lEd by TIiF. ALC iN RELATION TO ThE EXTENT Of rkE WORk. TkE dposiTMUST bE
SubMITTEd pRiOR TO COMMENCEMENT OI x'ORk- AfTE'R INSPECTiON Of Tk COMpIETEd pROJECT by TkE ALC, TkE
dEpOSiT Will bE REfU.NdEd If Ali CCMPONENTS ARE RESTORF.d TO ORIGINAL OR BETTER CONdITiON.
"NOTE: CONSTRUCTION/INSTAIIATiON Cf RF.QUE--TEd. ANd AppROVEd MOdifiCATIONS MUS-. bEq�N WIT ,,i 45 dAy's Of
r RECEipT Of WRITTEN APPROV4I ANd sAid M110d.'fIC:ATiONS MUST bE COMPIETEd WITkiN 90 dAys of 'AiRi-IFN AppROV'AL
PRIOR TO COMMENCEMENT OI PRCW-rd M0KI1fiCATION, PIEAsE SUbMii WiTi THS ApPliCA7iON CONTRACTORS INSURANCE,
BorAd ANd Copy Of LICENSE if OTIkFR Tkav HOMEOW-7CE1 iNSTNKA601N. FAiIURE co, (y WiTk TkESC OR"Of TIE
ABOVE SPECifiCATIONS Will RESUIT iN TIE NJIlifICATiON Of T CUM NTSANd BSE EN. APPROVAL TIiEREOf,
` OWNER SIGNATURE) '1/ ,
-MAiliNq AddRF-%:
ZAZuwTA 'A^5z-T53
PkaNE # dAyS X6 7 r .n 66SEnd Tu: EVENINC,S '
PERiONAIIzEd PROPERTY t0gMT.
689!0 AdEIiNA RUAd
CATNEJRAI.GTy, CA. 92234
,ATTN: ALC �ommirr E. ~
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Ti IE ABOVERf?U ' 65 EN REViFVEd by T ai C x d kAS BEEN: ( AD iE'd - ( I &NIEd ( I PE `•yw
O Q�
�CnvMENTS:
DATE REV - 'Ed: EpO51T AMO T:
A'ppRovc By:. _
ML-i1 4AVE.TWO (2) SICCVATURE5)
rte. ..