0309-063 (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
47 55S 1 -1 - AB MC
pate4 .s Signature of Contractor"7`
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 r
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 ST,4.TE FLCHD Policy No. 044.074x19-10
(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 provisions.
Date:c/''% ,' dr', "r 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)'- {,-y� Date `✓ ✓ .�°" .
BUILDING PERMIT PERMIT
DATE .-,VALUATION LOT: � � TRACT
JOB SITE
ADDRESS 47.-2.25 WaHWC_`r0N 81raXl'
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I_A"_ Fi?0) U WF., MR`S,1NC
d�kl «v"� �. C0�1 i�:�►.Cr"J �t�*C�, L2;�C:.
PO BOX 4378
15-501 LITME MORO NG0 FOAL
PALM Dk;URT l'"A 92261.
D&S,Ut T HOT 9 -P -R ', CA ' 922,Gd
(76V)251.-5454 CMU 762
USE OF PERMIT
400 LF RETA1.WIiNO'WAL1 L, 3';-d' R,ETAlNf2+161),A.U-YN(".3-'t i.,.+ R PhAOR.CO
DIT..M.P&RAPPROVED PRECISE 01RAPIN P6. AN,
6 FT. WALL
MWA'tLI D COFf OF t'£>.t ST'RUMON
i(►, .fir
9Pu suAfivu3ry
C ONST ltiiCTKIIN FEE 101. -0%f4l l S..• 000 $117,00
N
t'1 '
� � • • CO wt CTC.`sl'-) AMD T" G'kTF(15C
�1 �i.fst7
3 M -PAID FM
MOO
.r nLc 1.)U iVoW
SEP 05
17M
2003
/J/ _.
CITif OF L.A QUBNTA
FINANCE
DEPT. -. .
RECEIPT
DATE v- �; +r
BY -' 1�F
DAT FINAED
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
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 L .
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:
CDD o
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
LAKE LA :QUNITA HOMEOWNER. ASSOCIATION
C/O . J &-W MANAGEMENT
P:O. BOX 1398 PALM. DESERT, CA 92261
(760)'568-0349.1
FW'EP C�C0�9C.�,iSeptember.2, 2003.S-.4;0
j COACITY pOFLAOUuINT A i
UNIN QEV.ELOPMENT
Lakefrorit.Investors Inc. --� °EPARrMEEEEEE_NT
A7610 Via Montana
'La Quinta, Ca 92253
Dear Sirs:
.The Lake. La Quirita Architectural. Committee ( B. Reynolds, B. Schilick and B. Rosker)
tf met on August 29, 2003, to review Tract Plans for the annexed (7), seven lots.on Caleo
Bay Drive submitted by Owner:,Lakefront Investors, Inc. 47601 Via Montana; La Quinta,
Ca 92253. Lakefront Investors was represented at the meeting by Moe Hoffman and
+ Norm Slaughter. ---
The plans submitted to the Committee were reviewed and discussed. The design for each
lot home was examin_ ed along with the plan, layout and pad location on each lot.
Lakefront Investors submitted material consisting of Sheet AO Cover Sheet;. Sheets Al'
and A2 Elevations; Sheet A3 Foundation Plan;: Sheet -A4 Foundation Notes, General.
Notes, Building Sections and Truss Profiles; A5 Floor Plan; A6 Roof Framing Plan: AT
Construction Details; E1 Electrical Plan; M1 Mechanical (sic) Plan, Title 24 Compliance;
- P1 Plumbing Isometric, Gas Piping; Cl Grading Plan Information- . and: C2 Grading/Site
Plans..
The Architectural Committee hereby -approves the plans as submitted: Landscape and
dock review is not included in this approval. Owrier.will submit those plans ata later
date.
The Architectural Committee of the Lake La Quinta Homeowner's. Association.
specifically roves nstruction of those Retaining Walls set forth in Plans C1 -and C2. ;
Ben Ros er
Chairman, Architectural Review.Committee .
HOA Board Member
12 Lakefront Investors Arch