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9810-078 (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 239947 C. 53 a 161100 Date k'A 9 �7 Signature of Contractor`? B 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 & Plufessiulldls 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 heby affirm under penalty of perjury one of the following declarations: ( have and will maintain a certificate of consent to self -insure for workers' comlYensation, 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. `', (101 CJfy„ Fit CL) Td'�°y"�13 6 If") -3 (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' compensatio provisions of Section 3700 of the Labor Code, I shall f hw'th comply with o t p isions. Dater 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 re esentatives of this City to enter upon the above-mentioned property for ins,ettion.puip;7rj"ADate SignatQte (Owner/Agent) 'r tor . BUILDING PERMIT PERMIT9NIWO178 CONTROL# DATE VALUATION �>jjr(#,f'LOT TRACT 84-30- 4.30_ J ADDRESSOB SITE a1T-. :! RIVIERA APN M-461-029 OWNER CONTRACTOR / DESIGNER / ENGINEER ltrA,F.,TEI', PCHAR111ARN & NAN HAPlSEL MtAMTR C OO:L,S 56-3,15 R.1VIE PA. 13-555.i-Lli,#M.AY 11I LAQUINI'A CA 92253 PAW !)USERT CA 92260 uoE or rcnMIT RJOL AN.i CA SPA P00USPA, A1.e9, IMSt73tiR.i UiRS 31-FAJ L F313- IN AS PRE-PLASTUR. 1NSFii i;'.i'10N t)i: L lorj),OR 3PA. M,90.00 LS ESM%AYaF Ui a OF i:ONS IMi a 01 , P .RA T FET SUll MAk.'t K, AN CHECK FL4f 101-000-X139-3:18 $123..85 rT NSTR1JC'rFON FLEE 'Inn-(M-41P,%IW tlfig,Mi F List: 1'IZII'.a1f., l i so I�t7C�7: 101-000-120-000 y 34S.4U 1P1 UMBIN10111'.F P00-1.. 101-000-419-000 PO f OCT 0 9 1998 �JTY OF Lia QUINTA t A L �a S# 1#x.•'4(TrAI., C -(,)hl `"! RUC."g0N ANl) MAN CIVECK IJV S5 I, ,SS RRE-PtU13 FET,S $0.W TO'N'AL P11MMIT 1"'3:lEN Dili? NOW ��6117.1i.5 RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR . BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms 8 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 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 i Final Utility Notice (Perm) ne�eivea VCI-d/-V6 IZ 4! OCT- 7-98 WED 12;30 PM PGA VMST. October 5, 1998 "from 619 776 511f 4 MASTER POOLS COR? page 1 MONARCH GROUP FAX N0. 619 776 5111 P. 1 t PGA WEST II RPSIDENTIALASSOCIATION, INC. P.0. BOX 1282, LA, QUINTA, CA 92253 (619) 776-5100 FAX (619) 776-5111 Mr. Chuck Mansel 56-345 Riviera La Qulnta, CA 92253 RE: Architectural Change Request for instatiatlon of pool and spa Dear Mr. Hansel: The Condominium Architectural Committee has reviewed,your request Installation of a pool and spa at your PG weST home, The Committee is pleased to inform you that It has approved your request with the following condition: 1. Please provide stamped set of final plans with the selected pool contractors license numbers for the Assoclati©ng flies prior to beginning this project. 2, As previously agreed, you are to be responsible for all land'scaping maintenance associated with this change. 3. Please contact valley Gardening Service at (760)399-1844 to coordinate any irrigation changes. 4. Your approval Is god for a period of six months, If work.is rot completed by April 5, 1999 a new application will be required. Please have your contractor contact me when work Is complete so that we may arrange an Inspection and the refund of your performance deposit. Sincerely, For the C lum Architectural Committee John I Monahan Association. Manager CC Board of Directors Unit File Ir i