0210-114 (RPL)LICENSED CONTRACTOR DECLARATION
ffirm under penalty of perjury that I am licensed under provisions of
*ha9 (commencing with Section 700Q)ofDivision 3 of the Business and
Professionals Code, and my License is in full force and e4ect.
License # Lic. Class Exp. Date
�. 52340 C5. B 1110
",'Date Signature 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).
( ) 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.
S c) I have and will maintain workers' compensation insurance, as required by
tion 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 ,,TATE, FU)4p Policy No.
(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 i
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.
r•
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.
re (Owner/Agent) Date
3
BUILDING PERMIT PERMT#-
DATE � ;- VALUATION LOT TRACT `
I
i 6
JOB SITE •�
APN
ADDRESS „'{ A
OWNER
CONTRACTOR /DESIGNER /EN 1NEER
JAWLryryFr1j
CAL MIMIC MOMS' .
4104R'NOw'.fri.A49.30.1
L?.�WDGn ►{.1m1~,C;r, #200
'L,,t Qulkm C ''.92253
PAUM T) R -T C A. 92211
C/60)322 -?82 CS. -L f 6219
USE OF PERMIT
POOL .Ps11YC" R 2VY A
SrlALLyP.`2;nt�N •' ,,'� T.
t�ty`Cq�IOUSP.A..qM.a��Ft.`iirtllS.gqtg�%A;�.F.i�vp`�pLS
73''�yC.aA7.CAp.-T-6?%.i4L.
.F.{l 9i ►"�b,t 1C1 UYa t�)I'RV 7•JY'�'3;-.1'f �'-�iM3 �J d6.0 1V�.+i 7A'T �.�AItF6�7.I�
Not
POOL,,A.1+dDKA 011.A 3koovlCIO l..S
PLAN CHECK FEE 101-000-439-318 r . $269.43
C OMSTRUC:T1013 FXF, 101-000-418-000, _ $4114.50
ARCRAN1C".ALFEM— POOL 101-000-421-000"' ° $2A.DO
91,M,°f`3'fICaA.t. FNa•,S — POOL 1.01-000-420.000
PLUMBINO irk'iZ POOL 101-000.419-(K)O,. $ht,lti'f
ni11JR- '..,TAL C.IJS:Vbild.8.61MP1 61 .i' D PL.k1N 4'.'T `�L...i:h.
$779.93
LESS :PRE -PATI) IFIZE5
MOO
RECEIPT
DATE
E
BY ��
DATE IS1AL �
/NSP OR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
r. { 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 Pibg. Test
FVLA
Gas Piping
L 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
/� 05 14
Gas Piping
Gas Test
Appliances
Final
/: jf3
COMMENTS:
) f ✓� ��
I
C�J r -ter.
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)
SENT BY: PGA WEST RESIDENTIAL. ASSOC, I; 760 771 5iM :
PGA WEST TW
RESIDENTIAL ASSOCIATION; INC.
October 8, 2002
(21'-10-02 9:55AH; PAGE 1/1
James Griffin
54-700 Riviera
La. Quinta, CA 92253
Dear -Mr. James Grilli);
Mr. Don Adolph, Architectural COmmittee Chairman, has ahprc.,ved your plans to build a pool at
54-700 Riviera. Please note the R►liowing:
• The Homeowners' Association will not he responsible for any damage to the wall next
to your property lime; therefore we recommend that you instal l' a planter or strip of grass
aiong the wall at the property Iilie to .protect the stung, from mowing damage,
• Dainaged lawn area needs to be replaced with sod.
• Hand rails cannot exceed heiglit of adjacent wall
• "fhe new planter wall must be structurally independent of the existing property line wall
and will need to be sealed to prevettt�rnt}istUr,,.-
Any electrical wiring exposed duan' g constr�ictiop must be teported to the H.U.A.
We reserve the right to rwtke a final instiection Of this chwige to make.sure that it matches the
original. request- An approval is based only on.t%�e aesthe%ics of your proposed plan and should not
betaken as any eertific: ation as to the construction worthiness (jr structural integrity of the propose!
Change,
We appreciate your cooperation in submitting this request for approval. if I may tie of fwther
assistance, please contact me at the H.O.A. office, (760) 771-1234, Extension 15.
Sincerel
Kelly Galliard
Operations Manager
cc: Architectural Comtnitt"'
P.O. Box 1060, La Quinta, Califomia 92253, Telephone 760-771-1234 FAX 760-771-5125