9605-109 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty -of perjury. that _.j:am licensed under provisions of
Chapter 9 (commencing with Section 7000)_;f Division 3 of the Business and
Professional Code, i,nd my License is in full force and effect.
License # Lic: Class Exp. Date
�656128 C53
Date 'i 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.
( ) 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!ssued�; My (workers' compensation insurance ca���erg& po��c f no. are:
Carrier 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: ADDlicant
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-aays 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 fordnspectiorrt;purposes,: —
Signature (Owner/Agent) ��" i./� -' Date
BUILDING PERMIT PERMIT # CONTROL#
DATE q VALUATION LOT 964115•uw TILT .33-61
S15.I14H).00 _
JOB SITE APN
ADDRESS 56-".5 itiI1'liERA
OWNER CONTRACTOR / DESIGNER / ENGINEER
S W131.3 CAI,11:0fMIA POOLS & SPAS
16&605 RIVIERA. 41,910 BOARDWALK NA2
LACHANt'A PALM DESERT CA 422(4)
ft 19)3407 9000 C:RIN 355
USE OF PERMIT
I",A, Al`11 10R. SPA
11001, £1Nf) 911A
1?,tN.CK� LS
ESTI�•�>tt1.'1.'EM COSI' OF CONS'1'iti;E:"i'i:f3N
PLAN CTiEXX FfT 101-0(X)43`019 10 5.'-V)
IC -01 N 'IST 1itsl,:1•10KFEr: got -(i00-11 $1Q.00
ittlIXIIANICtU FE -- POOL 1.01.-000-421-000 124.00
ELR( RICA.)', M -- fK )OL 10I -=)-420-0(X) $45,W)
F'f,'UhG1NG i�T; -- Pool. 1014011-419-000 $27.00
SUBTOTAL CONS". (JC 11(.*)N AND PLAN C_'IIECK
L155 r ItFi-1'A41)1 EIS
LAI
IU
I
y
RECEIPT I DATE
l'f _ 3 #11.01 T%Ilva i ti r rlr^l� 1)11, I4, i'%%YTV
1
BY I DATE FINALED
INSPECTOR
Is'(31)ti. m
$363.30
$0.00
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Picks
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Ste-,%
Combustion Air
Roof Deck
Exhaust Fans
OX 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 Pibg. 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:
PGA WEST H RESIDENTIAL ASSOCIATION, INC.
P.O. Box 1282 • La Quinta, CA 92253
June 5, 1996
William Strub
Landmark Partners
1515 South Victoria Road
Lilydale, MN 55118
RE: PGA WEST II Residential Association
56605 Riviera
Dear Mr. Strub:
Per our conversation, you stated that you have obtained the necessary approval of your
neighbor, Mr. Baumann, for the location of your pool equipment. Please forward said
approval to our office so that we may complete our files.
Therefore, the pool installation is approved by the Architectural Committee, subject to
field verification during construction, as set forth in my letter of May 24, 1996.
If you should have any questions, please. call me at (619) 360-4161.
Sincerely,
John H. Handel
Association Manager
cc: Board of Directors- . r. .
Architectural Committee Chairman
_California Pools
\\monarch\users\suzy\pga2\strub-pool-06-05-96.doc
al
.0