0312-183 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licen"sed 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 J Exp. Date
611,463,1 C;53 9130105
Date ic�< 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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 INSCORP Policy No. IC;7000f13500
(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: 1LW Cr/'2 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 in�speectenpurposes
—Sigriatore' (Owher7Agent Date fir /310`�'�
r
- = PERMIT" -
BUILDING PERMIT
_�
DAit ' VALUATION LOT J � � TRACT
JOB SITE .%
APN
ADDRESS 49-3.91. VU CO3? QUNIADOR
OWNER
CONTRACTOR / DESIGNER / ENGINEER
64ti� �til�3t'Ci%1
1viGTPJ'fYRE PO OWE S1- PS
49.391 VIA CONQUNIADOR
P.O. BOX 1731
X:A' 71ati+lTi,. CA P2253
A.QT.i`TVEA. CA 92253
(760)360-3585 Cl 1,0, 194:5
'
USE OF PERMIT
POOL PROVO:E2 SPA
POOUSP.A. J. �L,A1LMV?BARRIVIU; SZiA LI, BE IN PLACE AT "T XFmPL P_ST1UZ
INSM'PTOR EQUiPMENT ENO, ,i),[ RENO i INCLUDED, BBQ UNDER,
SERAILAVE PERMIT
POOL ANWOR ORA L.1:
IM 00.11.7. O.L' .0O3NTiY J. Cl.6t\e AFL'47&N
1.s+yC7Vl..
��99��'',,y9��,����pp�,���yyvv yy;;0V�� (�q y� ydq:+113-..7.]JVCS6v1
S.l�:iK1fVl�B.r.�d..L'.I.e SYIJAI�rAbi.7: f
PL&I CH&O s FEW 103.000.439.318 $105.30
CO'NSTRUC ION WE 101.000-418.000 $162.00
M&C--HANICAL,"M POOL 101-000-421.000 $24,00
E±:LECTRIC.AL. Elf.? -- POOL 101-000-420-000 UtOO
PLUt+i?BWC11� 4� fi. -- Pool., 101-000-419-000 $27.00
SUB-TO%AL, CO1M'FWC'3: iO9 A1,M P1 kK CIMC K
$363.30
LES -PAM PRS -PAM XSES
Li
$0.00
{rr .r1,ud" I`I +' . ,S DTTF NOW
DED 31 200333
CIT'! OF LA (14WINTiw
FINANCE DEPT. _
RECEIPTDATE
% L ..
BYE-
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
Steel
POOLS - SPAS
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
2.
Underground Electric
"
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas rest
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:.
n
u
112/17/2003 20:19 7603469918 +,DESERT RESORT MGMT
PAGE 01/01
December 10, 2003
Arthur and Janice Martin
49391 Via Conquistador ,
La Quinta, CA 92253
Re: Pool/Landscape Submittal — 49391 Via Conquistador
Dear Mr. and Mrs. Martin:
The Rancho La Quinta Architectural Committee, with the advice of its architectural consultant,
has reviewed and approved your pool/landscape plans, subject as follows:
1. Shrubs are to be maintained 'at 30" height.
2. The Washingtonia are to have a minimum of 9'0" trunk height.
3. In addition to the brochures already submitted, please provide the elevations and plan
of the proposed BBQ (6 copies).
4. The sun deck` is to be no more than + 12".
You may commence the work. In the meantime, please submit six copies of the information
requested at #3 above. When the work is finished, please fill out and return to me the enclosed
Notice of Completion. The consultant will perform a final inspection after receipt of that notice
to verify installation according to the approved plan, and then your deposit can be processed for
a refund.
Thank you foi your patience and cooperation in this review process.
Sincerely,.
Tony Br6nner, Property Manager
Master Association for Rancho La Quinta
enc
P.O. Box 4772 Palm Desert, CA 92261-4772
73.5%Alessandro, Suite 5 • Palm Desert, California • 760.346.1161 • FAX 760.346.9918
Email: drm@drminternet_com • www.drrninternet.com