0105-260 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby'affirm under penalty of penury that I am licensed under pr visions 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
C33
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that lam 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. t
I have and will maintain workers' compensation insurance, as required by
Sfciion 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 ' 11tt . 1L pn� pp���ssryF IND
1/��ry� Policy No.
n'•A1r w�5`..i-,{:tbApCE INDf d` lY �:I7CW�ta
(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 t se p,rovlsons.
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, damage's 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 SafetykZ
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) Z
r..�' �=' Date'
BUILDING PERMIT PERMIT #
DATE VALUATION LOT..'1 TRACT
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JOB SITEI `
APN _
ADDRESS
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OWNER
CONTRACTOR/DESIGNER/EN (NEER
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BUBBLE WRM619
493-a NM40
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1A Q4VA1."i.dA. CA 92253
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ac/'A�'TCHO �JT.7d�. CYX -CA 92,2 7 0 `
('7611)341.2336 IMUM 5488,
USE OF PERMIT
DOM AND/ap: MIA
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P4ACRAT PDQ,ft,P,,LAS-ER.FMOPi!C'fl )41 POOL 'RID,01APM.EF't ENCLOSrJAR,
NOT .INCL'. UDIND.
PddC''L,ANrvORS:;~A 43,970.0.0 LF,
y
NS IPDIA11171) C0,113I' OF CONSTRUCTION
41 IOAX)
PLA9 NECK F`),L 101 •000-4i39.3;8
Ca RS`f'r; UCTION FETA $362.30
MECHANICAL ME 101.000-421.000 $24,00
RLEX"'M L M - POOL 101-000-420-0,00 $43.00
PTIT,1MBDIG YEE. •- POOL 101-000-419-000 177M
p2 ESS' P14Eaz�.�Ia.ERES
$0,01D
Mg) OW, A= 5+ ' .. �.16`nY Nry, WE NOW
IVFf�r,Ti�
CITY OF LA QUINTA
FII^ANCE DEPT
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'
RECEIPT
DATE
BY
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
0. K. to Wrap
F.A.U.
Framing ;
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O:.t
Fans & Controls
Party Wall Insulation -
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final -
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
Set Backs
Footings
Electric Bond
Main Drain
�•
Bond Beam
•
Approval to Cover
Equipment Location
Underground Electric
_
V
Underground Plbg. Test
Final
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
!L!V
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 Not (Perm)
COMMENTS:
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BUILDING & SAFETY DEPT.
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Cl -
of APPROVED
I5 r FOR CONSTRUCTION
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May 3. 2001
•
Ms. Eloise Strebet ` f `'.. f':* y brw •` -
48-687 Vista i'
aiomino 4" t
La uin CA 92253; • y � r � r, � _ , Y. ;
Dear Ms. Strebel Y ., t
-The Rancho La Quina Architcctural'Committee has reviewed and approved your submittal ol•
plans for landscaping, hardscape, pool/spa, and barbecue at your hone at 48-687 Vista,K
Palomino, with the followi ig'conditions: 1
- Queen palms must have minimum 9 foot trunk height -
Queen paps shall not block neighbor's established view lines.
- On the golf course property line, only lawn to match the golf course or a 12" .wide
concrete mow band shall be allowed within a 12" setback from the property line. No '
fl = plan.ters; including,trees, shrubs, or, grout dcover other than lawn shall be allowed in
t ` this 12" setback.
All worker to be done in accordance with all appficabl requirements C uirements of t i
governmental entities, including the City of La Quinta,'and in accordance with all Q
" Homeou�ters Association architectural guidelines and governing documents.
• ^ -: The owner drains to a properly installed drywell or,properly'mna.-Ded drain. tine and
buWer box located on their propert} Y , a ° M
t + • ..1�� a' t
When the above conditions have been met; and` the work beg-un is fii2ished, please fill out and,
return to me the,enclosed Votiee of Completion. The consultant will perform a final inspection r
r after receipt of that notice to-verify installation according tc+ the approved plan; end then your .
deposit can be processed fvr a refund: f r r r �.a ;
Sincerely`µ w. ;K
.,
te
17croy, Props Manager
Rancho La Quinta Master Association,9 y' i
Cc: Sent to Bubble Springs via fax at 341 2336 i-*
.,.
Y P.S. -'Your construction.delsosit check 219 in the amount of $2500.00 which has been held
pending approval of Your plans, will be deposited tomorrow,'May 4, 2001
Professional Community Managenhent / Desert Resort Management
Post Office Box 4772 • Palm Desert CA 9226114772
•, 73-550 Alessandro, Suite 5 • =Palm Desert, California
,,, 34 1161 • FAX (760) 346-9918 t`
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