0010-271 (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 afiii my License is in full force and effect.
License # Lic. Class Exp. Dafe
pate . _ 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.
( w) I have and will maintain workers' compensation insurance, as required by
Seaton 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.
SMATE Pg3A1) rFA1 t�9L0fii8��1�:�,p�
(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
C e; I shall forthwith comply With those provisions.
Date: ? 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 phis
application. T
'1. Each person upon whose behalf this application is made & each personat
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
ove-mentioned property for inspection purposes.
,Signature (Owner/Agent) r- ' { . Date L
BUILDING PERMIT PERMITp
DATE VALUATION LOT �� (}_?,�� TRACT
JOB SITE V
APN
ADDRESS
id^iJ 7Tii .lf.R `�' S��vE1t
OWNER
CONTRACTOR/ DESIGNER/ EN (NEER
101 .l9ARR
MOMNIAP00LB & WAS
79-8501M MA
74-725 JQNIDRIVE-, #A
LA QI�'.€1�'9.A CA 9225.
pAXM IYM EWr CA 92260
(76t8)''a�bi -9000 C.SLO 315
USE OF PERMIT
.PO (IT, p�++OR y� p
...
POOti, & SPA ONLYYA,l. ARMSliZ.AtZRJERS S"LL BE IN PLACE AT PRF,
PLASTYR )NSP13i C 1Ot+1,P,00L EQUIPMENT MCLOSURY,ISNOT t"CLUDF113
IN THIS 1>isRM1'1'
POOL A14DIOR SPA j �%Stit ao 1's
X�A/dCOST 02? CJd612J M✓S?N
$;�ry�7'T07Ji'LJFW
P Md•1 MMMAKy
PLAN aJECK ME 101 -OW -439 -SIS SMAI
CONSTRUCTION 7.99- 101-000-418-000 $171.00
WMC1,MNICAl,YBE--POOL 101.1000a1121-:00 $24.00
11.WTitICALI • 110G1,. 101-0%4"0-000 $45.00
PL1}M&M.0 RE - POOL 1011'0041-419-0100 valor.
sN
SOB-TW'AL".CDN :".9'�uc-IrI`�..CON Mu" PL.,f9W, f r N:
$376.15
1,03 M -PAID l�k'. ;�
PAID6
$0.00
_ ; . QCT 31 2000
fid'► QU,` _i!_'
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
Slib Grade
Return Air
Steel
Combustion Air
Ipof 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
�1
Final
Gas Piping
,_36
PLUMBING APPROVALS
Gas TestElectric
Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
_
]]
����p/o
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
Final
Utility Notice (Perm)
,k
October 25, 2000
Mr. & Mrs. Eugene Darr
79-850 Riviera
La Quinta, CA 92253
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, .CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: Architectural Change Request for Pool/Spa Addition
Dear Mr. & Mrs. Darr:
The Architectural Committee reviewed your revised plans for a pool and spa addition and
approved your application as it was resubmitted.
Review by the Committee is only for general conformance with the architectural guidelines. It is
the responsibility of the owner to fully understand and conform to the architectural guidelines
criteria whether or not all deficiencies are noted during review. It is also the owner's full
responsibility to field verify all existing conditions. The Committee's decision with regard to
project design will be final. Please refer to the PUD Architectural Guidelines and Application for
Change for all required submittals.
Please contact Raphael Villareal, supervisor for Valley Gardening Service at 760/399-1844 and
Carol Fuller, the Association Manager, prior to any irrigation modifications associated with this
change. Upon completion of changes, please contact Carol Fuller. Damage to the landscaping,
i.e., shrubs, trees, flowers and turf is the responsibility of the contractor._ The landscaping must
be brought back to its original condition when the project is completed.
Approvals given by the Architectural Committee are good for only six months from the date
on the approval letter. After that time a new application must be submitted.
If you have any additional questions or concerns, please do.not hesitate to contact Carol Fuller,
Association Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File
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