0209-114 (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
-656128 C5 TxT ' q�-S I ,N1J2t
Date 9.f'' Signature of Contractor LI-�" `""
F/
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 3100 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 09TA1,V C.0 t F1h**.N2KtJ Policy No. 04600061ftT-01
(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' compensationdp . visions of Section 3700 of the Labor
'Code, I shall forthwith comply with thoseEprovisions.,�'
Date:'.' A+ 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, indemnity
& 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
Jhe above-mentioned property'Gr inspection purpo ds. i
Signature (Owner/Agent) Date
4
-�A'QILDII G PERMIT PERMIT #
•
9414
DATE VALUATION LOT TRACT
JOB SITE +
APN
ADDRESS�� E%� -J? iVnM1Q
_ _
OWNER
CONTRACTOR/DESIGNER/EN (NEER
11 ..+�wDfoR hits: o)fcm
CNUM ORRIA1)001.8 & H.P.A,41 Mr- vrA1CO.'
�S0-G 42 IYURT,IkMA
86- 100 A,VA . . ? 54
LA C wwrA' CA 92253
COAC'MIUA CA 92236
('7Gti)s� ^p222 L 00355
USE OF PERMIT
Ia0OLAXV OR 0A
PCIOXy.-SPA, HSQ (ANIR 77.E ,5&105), 51....F, a 13LOCX'WAIIy
CITY S7'A1v1D. IRD.MAitMSIRARPUh S TO BE IN .PF..t';E .AT PRE-PkAS7°.I?A,
INSPECTION. 1+,�5r}1P�r11E1+1T ,U�kdC1,4SL31t��4't�'.P 1Tv1'CL,td�'�1�.
J 1' r.. 4 AIA , i.§.Yi+ 1,,1'
POOT,,ANIVOR SPA 1p91m L,S
Kr 0. COS '�OSL1iai
10.449925
P.C.9hU"r yUYASyqY
PLAN C:F?WI ME' 101-000-439.318 UAW
C O NST1.,UCT1ow Bite 101-000-418.000 $199.00
NVCH A` IC.f 6 VE -Z o• POM 101-000-421.000 $$24,00
E.N,CYI21CAL, i VP, - POOL 1014M -42Q-000 Via.W
e'lIUM.i ING PLIr •• I?001e 101 �S10S� �k ! witt�S3 @ ,IkO
11f3p 1's:,,A, �I��.r:"I�
!�;A22.70
rZ,'5 FRU-PAM���S
$0:00
SEP 1 �OOZ
SE
�.;ci�ti �1�M NOW
CITY OF LAQUINTA
FlNMCEDEPT.
j
F
RECEIPT
DATE.4 r%
BY < r
DATE F ALE
INSPEC O
V.
INSPECTION RECORD
OPERATION
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
steel
POOLS - SPAS
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perris)
Final
COMMENTS:
l
FROM : MONARCH
PGA1V.E*,-ST- .
September 12, 2002
PHONE NO. : 760 776 5111 Sep. 12 2002 01:55PM P1
F)GA WEST II RESIDENT1A1. ASSOCIATION, INC:.
P.O. 13OX 1282, LA QUINTA, CA.92253
(760) 776-51 M FAX (760) 776-5111
Ms. Kim Grobeck
308Culet Drive
Danville, CA 94500,
Reference: '80-032 Riviera, La Quinta. CA 92253
Architectural Change Request for Pool, Spa, 1313Q, Countertop, Patio Deck Extension
Dear Ms. Grobeck:
The Architectural Conitnit= reviewed your plans for a pool, spa, BBQ, countertop turd patio deck
extension and unanimously approved your plans as submitted.
,7
Review by the Committee is only for general conformance wigs the architectural guidelines. It is the
responsibility of the owner to frilly 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 ArchilTeenrcttl Rules for all required submittals.
Please contact Javier Contreras, supervisor for Valley Gardening & Landscape at 7601776-6667 and Carol
Fuller, the Association Manager, prior to any irrigation modifications associated with this ehmige. Upon
f completion of changes, please contact Carol Fuller. Dantage to the landscaping, i.e., shntbs, trees, flowers
and turf is the responsibility of the contractor.. Tlus application is approved with no additional landscaping.
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 Q1e date on the
approval letter. After that time a new application must be submitted.
Upon completion of your project, please complete and remm The Notice of Completion of Architectural
Change.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller. Association
Mana.er, at 700n76-5100, Ext. 20. .
Sincerely
PGA WEST 11 RESIDEN rLM, ASSOCIATION
For the Architectural Committee
Carol Fuller, CLAM
Association Manager
cc: Board of Directors
Unit Filc
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