9906-023 (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 usiness and
Professionals Code, and my License is in full force and effec
License # Lic. Class Exp. Date
C53 i t; fit/ Gi
Jo Signature of Contractort'
OWNER -BUILDER DEC ARI IT
I hereby affirm under penalty of perjury that I am ex I pt 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 issued. My workers' compensation insurance carrier & policy no. are:
Carrier - Policy No.
>>"r,t1 F'C'.IdC1
111111012 9S
(This section need not be completed if the permit valuatio is for $100.00 or less).
() I certify that in the performance of the workKf 3 hich this permit is issued,
I shall not.employ any person in any mann . o as to become subject to the
workers"compensation laws of Californl and agree that if I should become
subjt t • the workers' compensatio rovisions of Section 3700 of the Labor
Code, I, s all.. 'th comply witFVt fis tr vi ions.
Date: l Applicant 1
Warning: ailu to secure WorkersC mpensation coverage is unlawful and
shall subject an employer to criminal perVies 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 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 authori" epresentatives of this City to enter - on
theababove-mentioned propert or I spection purposes. G
Sig" nature (Owner/Agent) r Date `(/'/�►'! 1
Y if i
t
PERMIT #
BUILDING PERMIT,,-�►
DATE } VALUATION�,01fU,tH1 LOT TRACT �..
JOB SITE!s 6'_iU iii V J 1(A
ADDRESS
APN — —
OWNER
CONTRACTOR / DESIGNER / ENGINEER
N, I.'k! ffII.I.ON
faAMILY 4'OO S CONMIXPION
90-224 RIME -RA.
33300 AVENI.fDA R.&MIRE%'
I.A. t tUINTA CA 42253
LA QUINTA CA 92253
f7(.(1►5G43(5i t,K4 2893
USE OF PERMIT
f'13t..Di AND/OR SPA
J10%)ILiSr'A/i3IQ - .AJ AFU.,,MDARRIERS h4U C BE .IN PI,ACF, AT
ftE-.ftA,Y'i'hR 1NSPECrION
POOL A:N13r41t SPA 21,W0.00 I.S
E,NTI.i1+WE D COSTOF CONYfRUCTION
1.I►ITi;.f1:!
P ERfi 1T FEESVIMMARY
1,11, AN C:"HEUK F& I.01-000-4.19-318 5140.40
r.ONST tx-rION#'IT,. t•nnA-4!8-nnn fatf.nn
,1%U;CI1AN1CAL.C.IE--POOL iOI-(?DQ•�W1.-fltlf) �2�.s1Q
J -VEX,--POOL 101-000-420,-M S45,00
l?L(J1blBiN4J FM -- F*r)OL 101-tHV-419-000 :V2 YIIO
R �
rt
M113-TO-TAl, Ci3N''IRI.T.MON AND PLAN Cf?VCK
$452 40
LESS 'PRE -PAID FEES S
SI1.00
TMAt. PErfiMVI' VEMS 1DOE NOW
�4:5R.aN1
JUN 0 71999"
-TrY OF LA QUi9NTt
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
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
OX to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 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 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
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
Ttmp. Use of Power
Fi;hal
Utility Notice (Perm)
COMMENTS:
' `APR -28-99, WEU
D
4:3� Dyl MONARCH ii:��1�P FAf: INO. 619 776'5I11.
April 28, 1999
Mr. &,Mrs, David !-Tilton
4430 Shepards Lanc
La Canada, CA 91011
P
S
PGA WI ST1I h'.:P^;Sl.ial :I�1TI�\L ASSOCIATION, NT.'.
P.O. BOX 1282, LA QUIN TA, CA 92253
(760) 776,-5100 FAX (760) 776-5111
RE: Architectural Change Bequest for installation of pool, spa and bar-becue
Dear Mr. & Mrs. Milton:
The Planned Unit Development Architectural Committee has reviewed your request
installation of a pool and spa at your PCA WEST home. Based on the fact that you have
submitted the required Construction Regulations, Agreement and Covenant Running
with the land, Application for Architectural Change, Conditions of Approval and
Disclaimer and $500.00 deposit for the barbecue the Committee is pleased to inform you
that it has apprcved your request as submitted.
This approval is good for a period of six months. If construction is not begun by
October 29, 1999 you will need to submita new application.
Please have your..contractor contact me when work is complete so ttrat we may arrange
an Inspection and the refund of your performance deposit.
Sincerely;
For the PUD Architectural Committee,
Carol Fuller
Association Manager
CC: Board of Directors
Unit File