9909-203 (RPL)In
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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
598681 3 07'31/20(
pate Signature.of Contractor 11.4 wwo�
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.
V) 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:
Cartier Policy No.
(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 Califomia,._and agree that.if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, hall _'rthwith comply witl,
p y _ provisions.
Date: Applicant t
Warning: Failure to secure WorkersCompensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section -3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and.Safety
for, a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application -is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void'if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I. certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby author .e -representatives of this City to enter upon
the above-mentioned prop for inspection purpos .
i gnature (OwnedAgent) Date r
BUILDING PERMIT PERMIT����1�
DATE VALUATION ii; �.C3I)3y,f1R9 LOT TRACT
JOB SITE yj}ED��4�1 UAE��r�I
ADDRESS
APN -
OWNER
CONTRACTOR / DESIGNER / ENGINEER
JOHN' OMMERON
RMIURTAINSWORTi-i P001.
78-561 1.AE3:1C. QN- DRIVE E1AS •
'74857 LENN01 V3
LA QIJKFA illi 171253
PAUI t ESHIWr CA 102711.
(160)Q+M--4593 C'f31_ # 5415
USE OF PERMIT
POOL iANDA""k :iI° k
k"OC)LiSPAONLY, tAi:AkG:` ,rw'!AARRQ(4:1 :SfiP1,U. DF. �.tti tj�>S-t'I,t�:a`tI^Si
MCA. ANP�ADk SPA 2-11.006.0 1. IS
L'.►TdlN,GA,Y,bf,D CTIAST" Ok•" CONSTRUCTION
RU4.VTION
9��UK4Jii.�il1
{">q!;Il7L'L11 dI + Rj, �.f jbi MARY
pil. IsCf41x14{.FEE If11-t21 -439-318 W1'
tY'i"$I'rtf14-Ino!4FT i01_411TO-=tIfiom
NTE:i(ATI.!•lNICAl.. MZ[ -, POOL 101-000-4211-0m ��t.a2t1
tit:& `• EXIc:AL l -T,,% -- Fi.KA-, +(7 i tJ.Oft
I•'LOktrIPINt:a F FL- M-V'A 101_000_4t9_010 327JX4
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SUR :1�(; 14111 C -0t 4IST ).! 1',:,1 f,'kh1 AND PLAN (711k's I
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'11.11;
RECEIPT
DATE
BY
DATE FINALE_D
INSPECTOR
)IN 1
I�JS'�ECTIOO PJ REC�RC�
OPERATION
DATE'
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHAN CAL 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
BL OCKWALL APPROVALS
Steel
POOLL.S e SPAS
Set Backs
Electric Bond
p
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
--�
PLUMMMG 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
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)
COMM MEKS:
rl.
TRADITION GOLF CLUB 'x`760 564 2356 09/23/99 10-:4615 :01/01 NO:905
(Tra ifio n
ARCHITECTURAL DESIGN REVIEW
September 22, 1999
Mr. Greg.Butler
Building and Safety
MY OF 1A QUINTA
78-49S Calle Tampico
La Quinta, CA 92253
Re: . Lot 6, Phase 28470-1, 78-561 Deacon Drive East
Swimming Pool Review
Dear Greg,
VW Paeaimad
760-7"-7011
This letter will _serve as ARRC approval for the above referenced swimming pool. If you
have any questions, please do not hesitate to call.
Thank you.
Sincerely,
Christina J. Dores
Architectural Review Coordinator
/cjd
pc: Johnny Hinojosa (via hand delivery)
Kdsti Hanson (WOW
78505 OW AvD= 52 - L+,QuKrA v-- CA 92253-1120 -- PHotae 760/564-3355Fix 760/564-2356
NSWORTH
Pool ConstLL
74852 Lennon Pl., #3, Palm
(760) 568-45
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CITY OF LA QUINTA
BUILDING & SAFETY Dj T.
APPROVED
FOR CONSTRUCTION
DATE By
A RE -INSPECTION FEE OR $30
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULEP
INSPECTION.
.NO EXCEPTIONSII
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