0012-115 (CP)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
614611 4 C53 03/37nc
[Date`®' 00Signature of Contractor
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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 ofthe 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.
(IV 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.
W.C1.1.IAM:f13URO 1143. .. Waal 1"i NI-01'
(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' compte'n`saiion provisions'of Section 3700 of the Labor
Code; II fp hwith comply�with those provislo!�
Applicant---�"^� -°
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety,
for a permit subject to the conditions -and restrictions set forth , on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above -mentioned pro I erty for inspection purposes.
Signature (Owner/Agent) R� Date
BUILDING PERMIT PERMIT#
DATE VALUATION, LOT I1f3l l ka TRACT
JOB SITE
ADDRESS.
APN
e
4.44901/2 AVENMA 0.MPOON
OWNER
CONTRACTOR/DESIGNER/ENGINEER
K6'T, DE3EkT 5,0:£t.7.'., WC:.
MCINITMP00�.�° 4%SPAS
49-499 EMW- XOW14R
P.O, BOX 1791
1A Q' 1.i1+TT,A,. CA 92253
1.,•P. QU1TITA CA 92233
(760p,S0.35$s C,T 4. 1945
USE OF PERMIT
POOLANWOR VA
SPA ONLY (NY, CCDR1`# R, 017COUR1' 9)..4,I', AR:MSIBAR'RIORS ISMAIJ, BE
tad' p1.Af'E,E�`Y 1�R 1'I�i?' "E'Eft I4,I;iI�' r."`tlt�l�i. POOL W.UIPIM.ENT
KNC WSURR TS'NOT INCLUDED IN ` HIR PEPIM11T.
k't7OL ANIVOR SPA 1000. LS
FMMIFID O0v1' C)rl com' MUC111101!1
.f1�KJi1Zi.0 i
PmtArr Tf : StRI T gARY
PLAN CHECK FEE 101-000.439-318 $76.05
C.ONSTRUCT10lq FEE 101-000-418-000 $I j t 00
'MECHANICAL FEE • POOL 1017000-421-000 $24,00
F
1L;.FCTRIC,AL1s'EE --."POOL 101-000 420-iQt1(1
Pi.•C1MBRIG FEE_ POOL . 101-000A419-000 $i`7,09
SUB-leWAL C6NSr1-R CJ10R D PI" CH=1
=�139.05
LESS PRE-PAll3 FERS
MOD
TO'I'A1.PSTFURDi1ENOW
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
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
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
— f/
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 (Berm)
_
01:41 PM FORREST.K.HAAG.ASLA.INC 949 719 0564 P.01
'! EC-1:,-2000
( ) KSL DEVELOPMENT CORPORATION
55-920 PGA Boulevard
La Quinta, CA 92253
Chevis Hosea Tel: (760) 564-7146 Fax: (760)564.7131
Jim Waples Tel:(760) 7774834 Fax; (760) 777-4878
Mark ROsbottorn Tel:(760) 777-4853 Fax: (760) 777.4878
PROJECT ARCHITECTS:
( ) SOUTH COAST ARCHITECTS
13 Corporate Plaza, Suite 210
Newport Beach, CA 92660
Richard Hiroshima
Tel: (714) 720.7022 Fax: (714) 720-2045
( ) MCI.ARAI�TD, VASQUEZ &PARTNERS, INC.
695 Town Enter Drive, Suite 300
Costa Mesa, CA 92626
Ernesto V"ez
Paul .'Lalie4d
John Bonnici
Tcl: (714) 549-2207 Fax, (714) 549-5297
CIVIL ENGINEER: `
{ ) MDS CONSULTING
17320 Redhill Ave,, Suite 350
Irvine, CA 92614
St:snley Morse Chris Bergh
Tel: (949) 251-8821 Fax; (949) 251-0516
Desert Office (760)771-4013 Fax: (760)771-4073
LIMITED DISTRIBUTION:
{ ) ROCKY MURATA LANDSCAPING, INC.
6130 Grenada Avenue
Cvpress, CA 90630
Rick Mtuata.
Dennis Spalti .
Tel: (562)921-3210 Fax: (562) 921-9670
Forrest K. HaaASLA, Inc,
Landscape Arogitecture 4 Land Planni .1254 N. Coast Hwy, ng
LagUna Beach, GA g2b51 .
Tef: 014cl) 376-90(,& Fax: (94q) 376-906-7�
Project Number: 101/003:100
i
CITY OF LA QUINTA
( ) Building Department
P.O. Box 1504
78-495 Calle Tampico
La Quinta, CA 92263
Mark Harold ;
Tom Hartung
Tel: (760) 777-7015 Fax:(760) 777-701 ]
( ) Contmunity Development Department
Stan Sawa
Christine di Iorio
Tel: (760) 777-7125 Fax; (760) 777-7155 .
ELECTRIC ENGINEER:
( ) COVE ELECTRIC, INC.
77-824 Wildcat Drive
Palm Desert. CA 92251
Ron Cove; Larry Bojkovsky
Tel: (760) 360-0036 Fax: (760) 360-7895
TITLE 24 CALCULATIONS:
( ) FOUNDATION ENERGY
27660 Marguerite pk y. , Ste, 124
Mission Viejo, CA 92692
Benito Ramirez
.Tel: (949) 348-2414 Fax: (949) 348.2409
( ) SANTA ROSA IRRIGATION DESIGNS
44-385 Camino Lavanda
La Qainta, CA 92253
Ruben Villegas
Tel/Fax: (760) 360-5976
C: W)fYicc PrujeciallCSLlReson HotdkReson Homm\rOutin$lip,wpd
P. 02
City of La -Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
61 _i qo /Z,-
Project: 4 1/2 AVENIDA OBREGON
PROPOSED SPA @ LA QUINTA RESORT (COURT 8)
Applicant Contact: JIM WAPLES: 564-7189
Application / Circulation Date:,
Community Development Department
Christine di Iorio, Planning Manager
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Greg Butler, Building and Safety Department Manager
Health .Department
Fire Department
Schools Fees Paid
Date
Date
Date
1211112000 JGJ
Date
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Date
Date
Date
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