0002-222 (SOTB)LICENSED CONTRACTOR DECLARATION
I her ,hy,affirm under penalty of perjury that I am licensed under provisions of
Chap3l 0 (comnnncing with Section 7000) of Division 3 of the Business and
rpi`76sionals Code, and my License is in full force and effect.
License.44 Lic. Class Exp., Date
Ufi� 31/J;r,�.'
fate -� /V � Signature of Contractorp
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 exe pt under Section B&P.C. fo t is�t;on
9�e Signature of OwrSe�
WORKER'S COMPENSATION DECLARAION
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:
Cartier�Policy No.
,Ri:, ti,O21419-9131-0
�.-3w,..��..
(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: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to .the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize reprep �toi es of this City to enter upon
the above-mentioned property for it et�ooip poses.
Signature (Owner/Agent � Date ti
�! (4.1,
BUILDING PERMIT
PERMI;I#��€}G-lzt
DATE VALUATION 41,d[i0-00 LOT
237 TRACT,6152.
JOB SITE 47-52.15 VIA irEi3KI IMSA
APN . 64.33,47;(-8M
ADDRESS
-OWNER-'
CONTRACTOR /ADESIGNER / ENGINEER
pp 77
1. i- i kl%P h ia'0 MA.af_
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,vA a% 'A '1 .0 ti *L: ir.�3�A,,
724,'.9 S#::I'1 4U,D NVAY
7Z1929 S:1 `!'WALRD WAY
PA1 M 0H8_6KT CA 92260
RA.1; M Dbl'SERT' CA. 92260
Ci31.,ft 4277
USE OFJ,��PERMIT
�� nn �$ p�
4.13 NE',11kAf, 801,JI_)1f (J
V ALUA;i XO"ev
1,ii3v.ilii 1.,14
VUNS'!RUk:!'I0N k'HE 30146 W-418-000 �wi.uf3
S;1i$- "t-�1.�41, CON f } jfc: "F'!t li+l 11'7 Pf: hi c rel C"3 ,
$44 t1fD
LESS PU PAID FEES
$0,00
Y'MAA, 1'9+:;Ir:tbA I' A+'1± CS .1)DE,, Nd; W
S54.00
RECEIPT
DATE
BY
DATE FIN LED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksWiKUnderground
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.Q.
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
Approval to Cover
Equipment Location
Underground Electric
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
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)
82/14i2M 12:38 7607733225 R G CONCRETE INC AND PAGE 01
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,q6(.>:G� 3.44 . , l•� cry 9.�.:
A R£-INSPECTIONFEf OF A3��
WILL BE CHARGED'IF?HE APPIta
PLANS AND 108 CARD ARE NOM
THE SITE FOR' A SCHEDULED .9 14
INSPECTION. '
.NO EXCEPTIONS!
FROM
FAX N0.': 7607712140 8- 2000 05:46AM P1
IA °
April 4, 2000
TO: Mr. Mike Bergin FAX: 568-978"
Michael Bergin Construction
FROM: Rich Lane
Chairman, Architectural Committee . �/
Lake La Quinta Homeownas' Association
;'Subject: Solar panel approvil '
Dear Mike, t
"Tbe solar panel installation on .the home of,Bob Schlick on .Lot •237• at 47-525 Via
AMontessa is approval with the following stipulations:
• The panels-will be the terra cotla-like color as provided in the'sarnple piece of
panel given the Committee for review.
• Tile cap pieces provided the committee for their review should cover all the
sed _
--� - expo manifold.P'VC=piping-(f
c All exposed plping should be painted to match either the roof tile or the sides
of the home's stucco walls, whichever is most appropriate. A
I will notify the city. Thank you for your cooperation.
In regards to your concerns for the outside lighting design and specific , light fixtures,
please comply with the HOA September 1998 Rear Yard Lighting Policy (attwhed). The
' Schlick's rear yard lighting will be seen by at least 20 lakeside homeowners, plus all ;
evening boaters. Note that the HOA discourages, but does' not prohibit, "post type '
fixtures." Regardless of what We Of fixture wg wt that light globes be either shaded
do%%Mard._fr,osted or both. a„d the bulb MMebe the lowest hAnimumnossible.
Most homeowners on the lake follow the HOA lighting policy and are very respectful Of
their neighbors. They ensure that their lights are not an infringement on their neighbors:
Unfortunately, some do not. Their lights are too bright and they leave them on beyond
midnight. `
Y Best regards,
Rich Lane