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9908-181 (RPL)LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chdpter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License5 741 Lic.Class Exp. D%/31/19! (/Date 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. (X) 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. STATE PUNP Policy No. 046-99-000'M34 (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 wo�ers' compensation laws of California, and agree that if I should become soject to the workers' compensation provisions of Section 3700 of the Labor ,e ode j'shall, forthwith comply with those,provisions /Date: ✓.� Applicant_:.,..:.. -.w r..- 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 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. (.,agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter nter upon thbove-mentionedproperty for inspection purpose`s_____ ture (Ownegt),'✓Date 5'11 gna. �1�!! BUILDING PERMIT ((( DATE t�J VALUATION ��i°!� LOT TRACT, JOB SITE i{g.b 13g`V[1lti.� APN - - ADDRESS OWNER CONTRACTOR / DESIGNER / ENGINEER LANCE MUELLER STENT, DODSON CONSTRUCTION 80-23.3 RIVIERA 7?011 COUNTRY CLUD DR, SUI FE F4 LA, QUIN A CA '922-53 PALM DESERT CA 922,60 (760)3464032 CBL# 1044 USE OF PERMIT PCIOL Ax' WOR. SPA t),IX & NPA Ali117' IIJ I `t SHALL L ISM, IN PLACfr AX PRlE P1. ASTER I.N-95' .C"I"ION. , PtXX Aids)IQR ,'.T:F'A '231000-00 LS MfMtTrt bl, COST OF CONSTRUC;TION 251000.00 AIEXl- AMCAL FEE — P001, 101-M-421-000 524.00 ELECTRICAL -- POOL 1.014X)0-420.000 $45.00 PLUIv1ETaNG F1+:E »- POOL $27.00 a1LAI+T C3•%cK rEF, 10! .000 -X139 -sl ei S163.80 CONSTRITCf'I'0N FEE 1014)0041.9400 5252.0 SilB40TAL CONS Y R UC:T OKAND PLA I CHECK $519.80 Pi, V LESS P21:'-PAt131�EE4 R so.; 0 AUG 24 TOTIkL PERU t' .VEES DUE NOW 1999: �i RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION 4 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 Hacks 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 Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Ctility Notice (Perm) Final COMMENTS: AI �d,,*.UG-20-99 11:15 AM DODSON POOLS Au0-0.2-99 09:3817 Lanre and Chloe Mueller CITY OF t_A 0! !1INTA t • AUG 2 0 RECD 7603410895 P.01 206-322-0264 P.02 TIGA WEST It RESIDENTIAL ASSOCIAHON, INC:, JEW �LIILUit�� Wt�l; u .rL Y PQ. ROX 1232, LA QUINTA, CA <i?251 l,�►clr tfm FAX (760) 776-`i I I PGAME '. kiy 14, 1999 Me , Dance Mueliel 115.135" Avc, Seattle, WA 96122-4411 Reference: 30-233 ;kivlera Arrmitlrtural Change Requent tr) Install Spa & Fuontain Dear Mr, Mueller: The Plarmed+ Unit Devftrnent Archite mal Committee at its July 13,1999 meeting has reviewed your plans ta.add a spa Hnd Fountain. The commi"tee has approved your request as suomlttod with the WI!uwinp Wnricatlon. rhe Association wd! not be responsible for the relocation of the Sumac should It vt survive. Regaiding the ir6gat�n maiitiQUOnS associated with this Change, your landscape maintenance contractor and Valley Gardening to coordinate these cnanges prior to any digging or excavation to ensure the existing Ones are properly rerouted and that therc is no interference with the computerized .rrigatlOn clock The property foreman, Miguel ValenzaMa, can be rearhed at 7501399-3!444, or contact tnea ASsoddtion Manager, Card fuller. ApprOv316 tive:n are §66d for only six months from the date on the approval letter, After *hat time 3 new app!icatk)n must be submitted, If pod have any additional questions or concerns, please do not hesitatee.ta contact Carol Fuller a Association ria-iage:r, A 760/776-5100, Ext. 20. 5lneetr@ly, PC;A-WF5- 11 RESIDENTIAL ASSOCIATION For the PLID lArchltettural CanrnitOee . - �.. •rte �....•-�-�.�,�G�._ - 1 Carol Fuller Associat& Marager rr! 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