9806-085 (SIGN)LICENSED CONTRACTOR DECLARATION
•f 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code). J
() I am exempt under Section B&P.0 for this reason
./Date 6/1 e✓ Signature of. Owner X r? t
WORKER'S COMPENSATIOW'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).
( ) 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, Ishj� 11 fo hwith 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 f
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 6uilding
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property;for' inspection purpose .
./Signature (Owner/Agent) Ya" 1ADate �+
b
I,.. PERMIT# CONTROL#
BUILDING PERMIT
ddd
DATE `, 1 �lJ f VALUATION . LOT TRACT i
(i 1
$.1,000.00 '�
JOB SITE
ADDRESS 78-605112 VIA FLORENCE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
,LAKE LA QMNTA Hf N111Zi N",, ERS ASSN
OWNER' 8UTLDER
47790 VIA.fARDIN
LA QUINTA. CA 911253
CBL'#
USE OF PERMIT
NIONUTENT SIGN AT INURSEC t IDN OF CALF -0 BAY AND VIA FLORENCE.
VAJ.UKr10N 1,000.00 LS
Li STIM ATC(l) COST OF CONST.'RU'CTION
1,I)OO.Im
PERM [ FEE SUMMARY . .
PLAN CHFICK FEE 101-000-439-3111
CONSTRVICTION FEE, 101-000-418-000
Cti
SUB-T,%AL CONS�"1'�i C -TION AND PLAIN CRECK
193 4:LS
SUN 1 U f,rss PRE -PAW I-
%O.t;a
Y�` ,,fo AL PrmNif(1 FEES DUE NOW
S41.25
. ✓ �� O l
i' t1 r
RECEIPT
-"LED
INSPECTOR
w�•
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
f
Approval to Cover
Equipment Location
Underground Electric
Final
Underground Plbg. Test
Gas Piping
PLUMBING A PROVALS
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:
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)
LE _COPY
c7;1
F1
�..= 78-495 CALLE TAMP,.ICO LA OUINTA, CALIFORNIA 92253 — (760) 777-7000
FAX (760) 777-7101
TDD (760) 777-1227
May 27, 1998
Mr. JM Roberts
Lake La Quinta Homeowners Association '
47-790 Via Jardin
La Quinta,-.Calif. 92253 r
SUBJECT:Sign Application 98-421 for Lake La Quinta t
Dear-Mr. ,Roberts, {'
The Community Development Department- has approved your request for permanent
subdivision identification signs at your project entries'at' the intersection 'of Caleo Bay
and Via Florence and Caleo Bay Drive and Dulce .Del Maras submiaed. The approval
'is.subject to-the following conditions: r }
I. A building -permit from the, Building and Safety Department[' shall be' obtained
prior to any work beginning.
2. Approval is subject to the enclosed plans. '
3. Any lighting of the sign shall be ground mounted and comply with City Dark.Sky.,
Ordinance. All new Light fixtures .shall be submitted to Community
Development Department for approval 'prior.to installation.
Should' "you have any questions, please call'me at (760) 777-706•
Very truly yours,
JERRY HERMAN
COMMUNITY DEVELOPMENT DIRECTORS `
STAN B. SAWA
Principal Planner
sbs
• " enclosure
c: Code Enforcement
Building and Safety' Department
WAILING ADDRESS - P.O. BOX 1504 - LA OUINTA; CALIFORNIA 92253 -
c:Utr app sa,98-421
CITY OF LA QUINTA
SUB -LIST
CONTRACTOR
D����-1 �v���
ADDRESS 4120
VSA JAO.o,,�
OWNER L—kILG
1-k QujoZp, i ()A
JOB ADDRESS 78-6,05'h-
VAR FL�e-e-�et
This form shall be posted on the job with the Building Inspection Card -at all times in a co "yicuous place
It is the responsibility of the General Contractor or the Owner/Builder to monitor the sub-contractors.the
are on this list are the same persons performing the work. Any changes to this list must be approved th
City of La Quinta Department of Building & Safety Belix to work being performed by a changed sut
contractor. Failure to comply will result in a stoppage of work and/or the vo.dance of building, permit.
CITY:
SUB=CONTRACTOR'S
TYPE OF$TATE
WORI4ER'S
BUSS;:INE
TRADE
NAME
LICENSE
CONTRACtOR'S
:COMP `NAME/
LICENSE
it ENSE
C
NUMHR .ON. FJLE_
;NUMBER/
NU BER
EXP; DATE
GRADE/
A/C -12
EXCAVATE
PIPELINES`::.
C-34
CONCRETE/C-8
FOUNDATIONS :
ASPHALT: ::
A
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B
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MASONRY.
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ATE �uuP I i 49
096- -
351c9 ti /Lha
PLUMBING
C-36
FENCING
C-13
LANDSCAPING
C-27
POOLS
C-53
OTHER
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