9906-207 (RPL)LICENSED CONTRACTOR DECLARATION
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
(V W Professionals Code, and my License is in full force and effect. t,
`License # Lic. Class - Exp,[Date
r-- Ci� i , 6,X128 C53 �,�" 10/31/20t
oZate' `° '�� ' Signature of Contractor
Zo O- rll�
r- H C:) OWNER -BUILDER DECLARATION
W d I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
Z O 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).
x• C () I am exempt under Section B&P.C..for this reason
N Date Signature of Owner
O•rn
U Q 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:
Carver, Policy No.
S'1'At,? T'1 N"D 046-99-0005 10S
(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
worke/,rsltoccthe
mpensation laws of California, and agree that if I should become
subje workers' compensation provisions of Sectioni 3700 of°the Labor
CofJe; I shall forthwith comply with those provisions. �.-
[nate: r' ," % ,1 ./ 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 property for inspectionf-6urposes.
$ignature (Owner/Agent) ,• -^ Date
.P
BUILDING PERMIT PERMIT#
DATE VALUATION �;� ����,�(i LOT TRACT
JOB siTt .14-913,181VIERA.
APN -
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
R:114�; •I .ISG
C� k.,PnR.N'1.AP 0 00LS &SFAS
.54-913 IVa RA
74-7215 JONi k7IUVE; HA
%A Q31tN't: k CA 92253
wv ryt m.,s a CA 92260
(7610)34(1-9(1(9() CB1,4. 355
USE OF PERMIT
YCI>$)1...A1uDiOR SPA
f 100 r%ND SPA ONLY - A1.ARMS / 13,ARWAS SHALL Bt- 1N PI ACM Nr
Pfd,1 1..ATI'1:"fZ..fN.SPKC:';I10 N
POOL AMEXOR. SPA 17.900,00 LS
a�,.
F WA ED CONT OF i�S��+"�"�3t��"°�FIO r
1`�, N,0.00
ti'u;RMIT FEE SUMMARY
i --LAN rHEck l n to1.000_09: 3118 $1,'1.85
CON -;'1: rt(j IMO N EV—Z. . IN -000 -4,18 -MI) 81 %Afo
W-01AN"1CUMTTs.-,r,;10L IOJI ?010421.000 's.N.00
E i'C.:t'f2.1t;A1 S^L,i!~ -POOL 101-0.00-420-000 WkO
P[U PNiBN01<E<tPOOL .1,01-000,,419-000 V7.00
•
t. SUB-' 0T.AL COKs A1;.1C170N AIND PLA C111t' 7K a
� _ _ 'S4t)183
LESS 1'._,E Fl�.t�] FEES
x.30
flab`{'AL.1'1f:.9iNAUT 1.+`i;,:fN 011F NO
$407.85
17
lifr
,RECEIPT:
DATE
BYyI
DATE FINALED
INSPECTOR
INSPECTION RECORD
f;PERATION j
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
BLOCKWALL APPROVALS
POOLS - SPAS
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
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)
COMMENTS:
f: ROM : CALIFORNIA POOLS AND SPAS PHONE NO. : 7603465407 Jun.
beth UV: 'VH ^•'L-�I-1LZAL&VI_RL :1bEN -'�1;; /du /if b115; JUt1•'ea•yy 4 48�PA;.,
n
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
June 22, 1999
Daniel & Sandra Using
33 Lisa Court
Alamo, CA 94507
Dear Mr. and Mrs. Zeising:
29 1999 02:16PM P1
rage 1;1
Mr. Don Adolph, Architectural Committee Chaim= has approved your architectural variance
regnest to install a pool and spa at your 54-913 Riviera residence per tile. plan executod by Mr.
Adolph on June 17, 1999. Please be advised that the following stipulations must be satisfied and/or
adhered to.
1) Irrigation main "or light Waring must be moved if.necessary at homeowners
.expense. Irrigation or lighting in side yard caauat be connected to common area.
2) Approval is granted bused that the plans are corroct regarding the property line. If
the rear property line is not on location shown, the homeowner must take full
responsibility and must be mquirml to relucate pool.
3) Detailsof correspondenee dated June 2,1999 from California Pool must be adhered
to. .
We reserve the right to make a final inspection of this change ,to make sure that it matches the
original request. An approval is based only on the aesthetics of yo:9r proposed plan and should 11ot
be taken as any certification as to.the construction worthiness or structural integrity of the proposed
change.
We appreciate your cooperation in submitting this request for approval. if 1 may be of further
assistance, please contact me at the HOA olliee, (760) 771-1234 extension I S.
sincerely,
doyvcGatliard
Operations Manager
cc: Architectural Committee
P,O• Box 1060, La Quinta, California; 92253. Telephone 780-T71.12U FAX M-771-4125