0102-049 (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 Sign ature`of Contractor
OWNER -BUILDER DECLARATION%.
I hereby affirm under penalty of perjury that. l 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).
( ) 1, 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 rarmit is issued.
V4 Ifhave and will maintain workers' compensation insurance, as required by
Seotion 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.
IML -AND 114 1.1'A M FW0908193R
(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.,
Rafe: Applicant—
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the,above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date_-'"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT (AW -049 TRACT
JOB SITE
APN
ADDRESS
f.,g)-PADVINT n.D014--TrA °S�:CAiL
-
OWNER
CONTRACTOR / DESIGNER / ENGINEER
80440 LAX; -VA QOM CPS AWL
7 2 509 0.AN GC>RGONIO
LA QU$N'iA CA '92253
RMG.710 f.Y£iRAOR CIA 92270
(760)34'12336 C IL4 Stif f
USE OF PERMIT
y, e)C),L, AND/0R 9PA
3at.`001, &S'P SHAWU, 114 IULA.0 .e4T PRE,
PLANER rN3P9C;TT0N,P00 EQUIPMENT 50dMi3;iF,itia„' 13 NOT Iiad",:i.,CTO)<,D
T)E7 1`Y•IT>3 i'1.!if.Rdli'1'
F001-MD/Olt SPA
XS,,W4A1`R.3.3 COST OF (!0NSTrs'.'UVA1T0 Tf
3 1225 1.1
:C.Cif"llFr�.1SF Af4•[L17. iJ 6.f.1�MA1lii:i.G�.%C 7
PLLAM C'•.13ECK FEE 3 014*0-439-31 S $10.38
C014SrR~;aCT1014 M 101-040-418-000 $X911.50
i� an1'S i4 3C' 1• CE1:% .. 'Pool, 101.000.4,21.000 33 AKI
EEO. TRICAL VIM,— POOL S IDI _00104111:10 -000 11GO
e�9
4
S t YB-Tti:I, 'A . COWS DRUC 0101 ' A M 0 PLAN C3DXY,
$586.98
1XIM-,
"0.00
'XI.,.'.AL Y1ERWI1, ]YETS D11 NOW
�:►�3�.�
e
RECEIPT
DATE_
BY-
DATE FINALED
INSSPEC
/f
,R
I,-
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
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
! Plumbing Top Out
Equipment Enclosure
i 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
i Rough Wiring
I Low Vottage Wiring
P Fixtures
Main Service
I Sub Panels.
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
i 2??;.3: a w .: 7605685986 BREEZE AIR PAGE 01
%195/2001 09:46 768-779-1370 FORTUNE WEST MGMT .PAGE 01/01
LA QCIINTA POLO .ESTATES ASSOCIATION
c/o FORTUNE WEST MANAGEAMNT
G. E. WMDLL COMPANY
73-900 El Paseo, Suite 3 (Rear)
Palm Desert, California 92264 d
(760) 3464432 FAX (750) 779-1370
www.fomulewest.com y�
February 9, 2001
CI�tyy of La Quinta
Building nVartment
Attention: Diane
78-495 Calle Tampico
La Quinra CA 92253
FA7: m-7101
RE: 80-840 VISTA BONITA TRAIL , r VIN) ARCHLIF-Mig AT ap
Leat Dane:
The Architectural &r Landscape Committee of the La Quina Polo Estates Assceiation
bis approved the plans of Jath & Gioia Kalvin, 80840 Vista Bonita Trail to build a barn and
hi,5taD a pool in their back yard.
Thank you for zeclui= evidence of the Associarioa's Architectural approval as is
reaaired by the CC&R's for all La Quinti Polo Estates property prior to issuing any city
approvals that may lead to cousarocrio%
FOR THE BOARD OF DIRECTORS
LA QuiNTA POLO ESTATES sIOCIATION
Gary Wiedle, P( --AM, CCAM, AMS, CMCA.
r E" '17ST MANAGEMENT
.. , .. .1„ �� L. ,AAMC ,
cc-
Joe Cake;', President, La Quina Polo Estates, FAX 568.5986
�7 S / Rock Water Feature
10'0
Overhang
811,681f SPRMOS
P.O. box 1046
Rancho Mirage, Ca. 92270
(760)341-2336
S140f#cE
sates
1883
CITY OF LA QUINTA -
BUILDI•NG & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION
DATE c—:21-- 4 '---0—-4. —
4
A RE -INSPECTION FEE OF $30*" ---,
WILL BE CHARGED IF THE APPROVED
PLANS AND JOB CARD ARE NOT ON
THE SITE FOR A SCHEDULED
I SPECTION. � X,•S�,�c,�
Existing House NO EXCEPTIONS! L /