0108-304 (RPL)/ LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
ChapteP 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
e•3 s" " C,1101-ur C.8 10131 /tea
Dated Signature of Contractor -
1 X0
414
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.lhe-following. declarations:
() I have and will maintain a certificate of'Conilant to self -insure for workers'
compensation, as provided ,for- bi'18,0 0h X700 of the',Latior Code, for the
performance of the worlrfor which this permit is -issued.
II_have and will, maintain workers' compensation insurance, as required by
Se Ion 3700 of the'Labor, Code, for the performance of the work for which this
permit is issued. My :workerscompensation insurance carrier & policy no. are:
Carrier Policy No.
STATE, COMPENSATI
(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 Section370 of the Labor'
Code, Ilforthwith comply with thos provisiFi's.
Date: shall�� Applicant �. ..
t
Warning: Failure to secure Workers' Compensation~ overage is unlawful arid
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Sec '
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building1pe
afety
for a permit subject to the conditions and restrictions set fohi41 ,(
applicafionm.`, l
1. Each person'�upon whose behalf this application is made & eacon at
Whose request and for whose benefit work is performed under or ITY
any permit issued as a result of this applicaton agrees to,& shallemnify�Fll
& hold harmless the City of La Quinta, its officers, agents and oyees.'.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propertfor inspection purposes.�•
Signature (Owner/Agenj) Dat ✓'
BUILDING PERMIT PERMIT#
GATE �• ^r1ALUATION LOT e�� •,iiz�a TRACT
JOB SITE
ADDRESS
APN
-
OWNER
CONTRACTOR / DESIGNER / EN INFER
M'R: Aa+il-g MRS. SC RAERF R
4dAU€+MTLk sa001Z & SPAS (101, Vit" C01
80.089 RIVIMA
74725 3J0141 DRIVE, ,31Jr-rE. OA
LA. QU3V.C',f;. CA, 922.53
PIAL L:fJUM C:a4' 92260
(7601340.9000 C'IZ-14 355
USE OF PERMIT
P'C? 1,.A).r1VOR WA
f''C3t?t.�"�i3'd .A.Y�wb c,:l,P,•50.19ff:3!•�'1P.1$,l�1T` 4�� k1t3.A.iA Pf.�.;.".I;IW31,�e.fs.,�!'.
4�. I. , I31! Rra 3. C:: A°! :�1�1 • � i :tl�l I1+I PIa: ;� ft Ai, POOL EQUIPMhNT
x"001iJ MWOR. 20,PV0.00 1."o
T NS fA SE'S` rl? cosrr OF CONSI-C ucam.."i
PLAN C`XACK FEE iold000-439 338 Sian
CilR+i:;"f ''�UCTION,11 Of -000-t 19-000 $258.50
MECHKH YCAI, ME% POOL 101 -000-4-21 -ON) S24,00
&Lf1f.C' PJ CAI, f EF, •,, POCIV: ' 101-000-420-M.0 $45.00
3 0 2001
OF�O�INTd STI ITYi'�P. CO:ts$VIR-_:#t�'ill'ilii'A'P..D.PLA141�t�1:1`.l�t'X
$522.:53
ANCE DEFT. �.: LIM MM -PAIN RIMIS
$0,00
RECEIPT
DATEBY
DAT
E
INS E rR
r INSPECTI6N RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs i 1
Underground Ducts
Forms & Footings. I
Ducts
Slab Grade I }
Return Air
Steel I I
Combustion Air
Roof Deck ];
Exhaust Fans r
O.K. to Wrap I(
F.A.U.
Framing i }
Compressor
Insulation- i I
Vents
Fireplace P.L. I I
Grills
Fireplace T.O. I I
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall':.
Exterior Lath I I
Drywall - Int. Lath I i
-
11
Ii
I;
Final
Final i }
POOLS -SPAS
steel — J _-
Electric Bond
BLOCKWALL APPROVALS
Set Backs I I
Footings
Main Drain
Bond Beam ; t
l i
Approval to Cover _
Equipment Location
I }
}!
Final I i
f'
PLUMBING APPROVALS
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
Electric Final
aste Lines I I
Heater Final
Water Piping I I
Plumbing Final
Piumbing Top Out i
Equipment Enclosure
Shower Pans I I
O.K. for Finish Plaster
Sewer Lateral I }
Sewer Connection l;
Pool Cover
Encapsulation
Gas Piping }
Gas Test I {
Appliances
1 r
1 `
-
Final 10
COMMENTS:���-
00
-
%
I!
]
Final IIAW
Utility Notice (Gas) #
ELECTRICAL APPROVALS
If
Temp. Power Pole; f
Underground Conduit
Rough Wiring i I
Low Voltage Wiring I
Fixtures I {
Main Service } }
Sub Panels I I
Exterior Receptacles
G. F.I. • 11
Smoke Detectors I I
Temp. Use of Power
1 I
I I
Final }
Utility Notice (Perm)I
FRAM . h)NRRCH . FHr. N7. • %@77765112 Aug. 23 22C31 02' 29PM P1
August 16, 2001
Mr. Philip Schaefer
4101 S. Tacoma Wav
Tacoma, WA 98409*
FOA WEST IT RHS1D1. ,tiT1Al.., ASSOCIYMOti, 1tiC
RO, BOX 1_8' -'..LA QU1N'1'A, (.,A 922>
(76()) 776- 100 FAX (760) 776-511
Reference: 90-089 Rivicra, Ira Quinta, CA
Architectural Chanes Rrxluest — Ad.dation of Barbecue, Fool and Spa
Dear.!",Ir. Scha4,,rr,
The Archite turai Committee reviewed your resabani?ted plans tc add a barbeau�-, pool and spa a: its
August 14, 2001 meeting :vtd approved your plait:; with the understanding, based cn a conversation
between Ca701 Feller attd pat from Californias Poo! S, that tlti wall height nor tho water feamre exca -,d 27" in
height. Plcaee resubmlt a drawing showing this measurement.
Review by the Cemnzinee is only .for general conformance with the :arrl>;tecrural guidelines. It is *he
responsibility of the owner w f-alh, understand and corOom to the arciiitecturai guide, Lnes criteria whcth:r
or net all deficiencies are noted during review. It is also the owner's hall responsibility to field. verify ail
c�isting condi ior_s. i ne Cotrunitiee's dooision with rcgatrd to project desiera will bo flal. Pleasc refer to
the Architectural' Rv1c3 for all required submittals.
Pl;,asc. contact Raphaa Villarcai, 34arvisor fo; Valley Gardenia- S rviC� at 75(',/399-1844 and Carol
Fuller, the Association Manager, prior to any irrigation r:ro4i.l:r�atians associated wiLh this change. Damagc
to the Iandscaping, i.;;., shrubs, trees, flowers and turf is the responsibility of tic contactor. The
landnaping mast be brought back to its original coruiition w•t cn thproject is eompteted
Approvals given by the Architectural Coaunittee art: good for only six months from th;�, date on the
approval ietter. After tcut time a new application must be subm itrrd.
Upora`complotion of your project, please complete and return, The Notice of Cenaplction of F,.rchitectural
Changw
I'Pyou have any additional questions or concerns, please do not htsiuce to contact Carol Fuller, Association
=^.ia.nager, at 760/776.5100, Ext. 2C.
Sincerely,
PGA WEST II PESTDENL MA ASSOCIATION
For thc:Arcbite'.:turai Committee
Caro: Fuller
Association \,Tanager
cc: Board of Directors
Unit File