0104-284 (RPL)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
Date ' F� `'t Signature of Contractor r. w fF FV AJ P
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).
() I am exempt under SectionB&P.Ctfor this re ; ,
Date e � 4-01 Signature of Owner �� � ki�,: '
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 Policy No.
S'I'A7F, C,O#ItPJ3NfyATI fAC� . M
(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.v
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 author)ze representatives of this City to enter upon
the above-mentioned property fdr inspection purposes.t
Signature_,(.Owner/Agent) x Date 4ngf4i,
{ 1
BUILDING PERMIT PERMIT#A�
DATE VALUATION LOT TRACT,'
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JOB SITE
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ADDRESS
47-615 ilW..fd0.?1.6., =A
_
OWNER
CONTRACTOR DESIGNER EN 1NEER
1Tq-TR I'qAVG
aAMM.iVYA V001 & IVAS 0a.1-`M,Q 4 0y
7$453 P01KM_HA.F1,A(%
74723
PALM D12MR-111 CA 0.21260
PALIA DT001-T .11-4A 92260
V60)340-9000 CBL# 355
USE OF PERMIT
P11005, A)MOR BRA
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P001BP.& P9,kAPsp;(,".tJVf2n 3?f+BENNC,E RX0 CAL
.&LARJAMAR SUS SIMS,A, OF, ITS P1,,A 0,K A't PPM-Pw3Tg11 ion.C.TION,
POOLfQUIPHILI211" 1040,10;3t.7PtE fHC.Lt1T)X0.
MWLAWDIOR OPA 91."9109 LS
r
R41,f MATED W9F OF CONNIKU M. ON
191500M
PLAII CHUM KeE 1.01.000.439-318 Nmisi
CONS`J.RtICTICTO T+KF: 101-000-418-000 42n,60
MEC"Y-I. £moi! CAL 6"F1L, .. POOL 101-000-421-00-0 $24,00
&LZell 91CAL =- PO 0L ' 101-f 00-42tl-.000 145.PM
( '� I. TMAC I1:P2:GTC"1' 011.sA�}Ty 1�I" VIFIFTIC
V,37,55
(i�11 LF20 0M, , 41 U) JKERV
$0.00
"All 1.11-
KnUT.IrMs DUE., NOW
APR 2 6 2001
CITY OF LA OUINTA
FINANCE DEPT
BY
DATE FINALED
INSPECTOR
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k,!"f •.It ;1.
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
Footings-01Main
Electric Bond
Drain
Approval to Cover
Equipment Location
�
Bond Beam
Underground Electric
Underground Plbg. Test
Final
PLUMBING APPROVALS
Waste Lines
Water Piping
Gas Piping
Gas Test
Electric Final
Heater Final
Plumbing Final
Equipment Enclosure
_
(�
Plumbing Top Out
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Gas Piping
Pool Cover
Encapsulation
_ _� –�
/p Z
v— —�
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)
Lake. La Quinta
Architectural Committee
April 18, 2001 _
To: John Lang
47-615 Via Montessa -
La Quinta, CA 92253 .
From: David Thorns
Chairman, Architectural. Committee
Lake La Quinta Homeowners Association
(760) 564-5049
Subject: Swimming Pool
' Dear. John
The Lake La Quinta Architectural Committee is pleased to inform you that your
proposed swimming pool has been approved. The pool and or infinity edge_
reservoir must be five (5) feet clear of the back edge of the lake concrete
edging.
You are further required to submit hardscape "concrete" plans and planting plans
to the committee for their review. - Plans must be approved prior to installation.
Best regards, CITY OF LA G?lJIR1TA
Tl�BUILDING & SAFETY DEPT.
!v,
PV
Dave Thorns
FR CONSTRUCTION
DATE 11�j BY
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