0108-160 (RPL)LICENSED CONTRACTOR DECLARATION
I "reby ,af kp, 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
C'5 3yy 0
Date �_ Signature of Contract orrAYAM�
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 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 Policy No.
STATE VOID
(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 shill for�tthwith comply w)thdthos rasions.
Applicantvr9 . r� �..�
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. f
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 r p dcties ntatives of this City to enter upon
the above-mentioned. property for ins eon purposes.. 1%
Signature (Ow-eP genfi +� Date
BUILDING PERMIT . PERM T#
DATE J VALUATION LOTTRACT
JOB SITE � o'
ADDRESS
=APN
:0-290 VISAk CALICO
OWNER
CONTRACTOR/DESIGNER/EN INFER
W.STFR MOL -3
48-29.9 VI.i�S:N CAT..vCID
B-:'�?tUKf 1 i 5
lj.., 92253
3?.?F...VI IESEL'Iff CA 9226
USE OF PERMIT
WM..1WDlORI&
}'OWSR
K)OLAK'r0OR SPA 20000 112.
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yY7����pppp���pp FRE,ARY
3�f.. I CHE011` �� 1-1 w000.439.31 8
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t'ilf[°+Lw� aAlICC4!w.!1'ET+e. Or a: 101=•000-121-00
ELF,C";'RICALMO. '4 POOL
"mutomn 1'1:p..,. poo's,: ' • 101-000-4, i 9 -DCO
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AUG 16 2001
CITY OF LA QUINTA
FINANCE DEPT.
'UMI-W.VAL 69,N�=�YMOW AND PLAN CIM -4
Ian 14E.P.
70)"AL rElfAlff TITAN DUE NOW
W%98
RECEIPT
DATE
By �t
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
OOLS-SPAS
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
Sewer Connection
Pool Cover
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)
,s
11gecort
nUagj ment
August 10,. 2001
Dr. Daniel Sherman
Bobolink Place
Los Angeles, CA 90069
Dean Dr. Sherman: '
The Rancho La Quinta Architectural Committee has reviewed your submittal of landscape,
hardscape, trellis, pool, and barbecue plans for your home in Rancho La Quinta at 48-290 Vista,
Calico. The Committee decided to approve the plans for your pool and deck You may proceed'-
on that aspect of the construction.
It was also the decision of the Committee that the balance of your plans need to be re -submitted.
as follows:
1. A top view of a barbecue is shown on the plans. Pleme submit barbecue details
(elevations), plus tile color to be used.
2. The planter beds (those areas not being sodded) are very large, and the Committee is
concerned about the amount of exposed dirt. Please re -submit the landscape plan,
adding additional plant material in those beds.
3. At this stage, no aluminum patio covers have been approved in Rancho La Quinta.
The Committee is concerned with damage that golf balls could do to the aluminum. 1
am doing some additional research on these covers, and will report back to the
Committee with my findings. in other words, a decision on the pa=io cover you
proposed is on hold at this moment.
I appreciate your attention to the above, and ask that you have new plans witL corrections, etc.
back to me not later than Wednesday, August 15, 2001. The re-subrnitted plans will be reviewed
at the Committee's August 22, 2001 meeting.
Sincezely,
Garygrog, Propert Manager
Mastet Association for Rancho La Quints
a- : Dr. Sherman. via fax at 310-550-6363 ,
Grey Wolf Enterprises via fax at 760-200-1698
Master Fools and Spas via fax at 760-776.5889
Professional Commmity.Management/ Desert Resort M=agcmcrt
Post OfceBoz 4772 - Palm Desert, CA 922161-4772
73-55U Alessandro, Suite 5 -Palm Dessert CaliforWa - (760) 345-1161 - F4X (76)) 346-9918
tt -.
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08/14/2001 .10:17 7765889 MASTER POOLS SPA PAGE 02
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