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i' 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
1556126 C53 HIC r_8
Date/) IM Signature of Contractor
OWNER -BUILDER DECLARATION
w 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.
( ) 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 STAT I+ COMPI+NS.ATI Policy No. 046DO6162
(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,,l shall forthwith comply with those provisions.
Date: Applicant if de
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 applicator 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 propyfOr inspection purposes.
Signature (Owner/Agent)h J' _ // Date, j 1)""i 7u /
PERMIT #
BUILDING PERMIT
�_�.��WOO
VALUATION LOT TRACT
�.�� ar/ii17• �M,�i. +����, 5
JOB SITE
ADDRESS117i1it0�ih�:
APN -
OWNER
CONTRACTOR/DESIGNER/EN (NEER
124F. t, "ON, M7.JNAUGH
CAL.IMRNIAPOOLS & EVAS Crag? 1•kM r01
80.670170W,ai
7472:5 JONI DRIVE- Ot:12'1` #,N
1,P. C3UKrA CA 92253
PAILMIMERT CA 92260
�?f�t�}4A•9000 CI.i� 00355
USE OF PERMIT
:PU£)l SP.eh; 03Q,(ANSI .G>2.&f995)..S d� !? S` BJ.00 X WAi.i.,
CITY S'J',A'Fj'!?ARD. A4AR.M8d0,,ARA-1RR5 SKAU DR IN K.A.CF. AT
POOL: MID10 SPA ;n,000.w 61
5 F11. WALL 5.00 L•it'
F.�. n,/.,KID COfrf Or, CONSI.d•4.YTiv1101V .22,1(JW'.25
pJC.yey3
PLAN CHWX,).r. 101-000.4399 3 18 9140.
CO"NS'!'32i1C'l::Lpw FEE 10.000."" e-000 x $234.09
MR41.'"gSAyysiiaWppAy* L FEE.., Pool L�� $211.00
' O;.hr�:.i.-!'A'bi �17.Ai.7-•�irdii y✓. dn
ioL yl1"gi0"4V"000k
FLU MBM0TFF.1I 111c at, 101-000-.419.000
DEC 2 i 2001
F'r
' *11 A , C4:yWSMI7f.` ION AWD 3 %M
YXIDD PRA -Mb Ms $0100
.F.SyA.rt'L m -ma N .i.�'L+d:s.�q;4aw 1p1 �4.Tetkr
RECEIPT
DATE
f )*1 f
BY +ir
Jc
DAT A1�
�J (/
IN E T R
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 Unes
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
�1
Set Backs
Electric Bond
_
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
a
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 ---.AF
Gas Test
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:
J Ji.
FAIRWAYS ASSOCIATION
December 26, 2001
Linkira
80-670 Hermitage
La Quinta CA 92253
Re: 80-670 Hermitage
Dear Mr. Linkim,
41
At the December 17, 2001 meeting of the ArchitecturaMandscape Committee, your
addition of the pool. deck, spa, and barbecue was approved. If additional landscaping is
added you will need to submit plans for approval.
If you have any questions, you may contact me at 760-564-3858,
P.O. BOX 13710, PALM DESERT, CALIFORNIA 92255 - Tel. (760) 776-5100 # Fax (760) 776-5111
entail; pgawest@inotiarchgrp.com