0111-286 (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, anal my License is in full force and effect.
License # Lic. Class Exp. Date
Date _w ,'2 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:
( ) 1 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
Sectioh. 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.
STATS C011f.1�;€r`I�T�k4�,f 1 W14006163
(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 sous to become subject to the
workers' compensation laws of California, and agree that if I should become
subject to the workers' compensationfprovisions of Section 3700 of the Labor '
Code, I shall forthwith comply with thase.proylsfo S. gt, 5.
Date: -� , Applicantr.,,`'T d
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. 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 property for inspection purposes. j'
i+'1 r
Signature (Owner/Agent)�< �" d- ?Date '
BUILDING PERMIT PERMITp
DATE VALUATION LOT�+� "' TRACT
JOB SITE
APN
ADDRESS 80-490, RIVD:'7"'.A
%fix-Q)3SBD-wa
OWNER
CONTRACTOR/DESIGNER/EN (NEER
1.`+,t CIAM, lis 1. .4. f i
CAL .UF'ORKA P001A .& SPAS Cft, P MAN C01
CM -416- MAMA
94725 XXX VRrVT ,, T1T),E'M
:A QUNITA. CA V253
; KIM DER .tT CA 92260
(760)340.9000 MIA (10355
PE�R�•MIT9
USE OF PERMIT
p qDp{
POOL r4tNTJ SPA /86Q1ALAMSJR t;;t-'.; F1ZS $kB,€sLA,6P, 01 PI..P.CY, Nr
j 11,!_7,..KAcg`kER S:�CSPROTit,9K, 3 TU V I$WCK W ALLL,.CI')'Y,q.T,(%.i1tiAtlD/
P0l'7].. F4, U1P XXW. T 1W>;:,I.03URZ 140T 'tNCi.rc 11 T) IN THIS PEMIT.
P0Of, A14D/ORa SPA 21,000,00 LS
.l�ylux"•MUf. COST OF C(M5".0.'�'rJMMY1
211108:
Wa"1.ANIC AL FEE -- T'0, 1:. 101 _000-421 -000 $24,00
ME,CTR'tl':ALF, — VIM, 101 -OW -420-000 $4100
PLf fiMi73:4,•90 F _%,P00S, 101-0010 419.000 $27.00 .
vt.tw(:tl t IC Srk'sf' 101-000-439-319 `$'446.25
rJL�1�lu`7'R.1,1�,"I'?CJh_1?�T( 1 t33.�tiC^t�-r I�yfSt� 3"��SI�ZS
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DEC 03 2001f
�,.7 i'.��^MTi' 1 CONvxx.RICT(MOaN AND Pi,AU,n CUPJ`: C1
�,y"•'�i �,.� e
IMIS RYM-PAW YT -B's
$0,00
TOTAL Vii°. +''ES' 1 TE NOW
$467,2
RECEIPTt'
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
I 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
POOLS - SPAS
BLOCKWALL APPROVALS
S
steel
Set Backs
Footings
_
//I6/ Z �,(��
Electric Bond
Main Drain
���� 6% �/►
Bond Beam
(�/��
Approval
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
Sewer Connection
Pool Cover
Encapsulation
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)
rT-1•n•F� .F,.r�5ai.
' �MONI:RCH FAX NJ :'760 651??. Nov. 27 2001 02: 53PM P 1
PGA WEST 11 R1.SII'')1:NTIA1. ASSOCIATION!
' -P.O. B0 1282, LA Ql1INT4, C:A
(60 776-5 ► (Nl FAX (760) 77f
Ma
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Novctrtbcr 26'2001 l ' '•
_
_
Dr. Clark Kvistad
19102 94' Avenue West
Edmonds, WA 98020
Reference: ' 80-496 Riviera; La Quinta,JCA 92253 '
Architectural Request - Poo' Spa, BF3Q, Docking
'
Dear Dr. Kvistad:
The Architectural Committee reviewed your plans at its November. 13, 2001 nlcctitg to add a pool, spa,.
harbecuc and decking and unanimously approved your application, with the unders:.euding that there will
he no additicnal landscaping. , r
Review by 1116 Cotrnnittec is onIv for general conformance with the archlleclurtl gutdclires, It is the '
responsibility of the owner to ful } understand and conform to titcc architectd' rat guide lincs criteria whether
or not all deficiencies are noted during rcvie•.%-. It is also the owner's full responsibil.ty to field verify all
existing conditions. The Comrrittec'S dccisicr. with re -;:rd to project desigtr will FK !ir,al.' Phase refer to•
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the Architectural Rule: for all required submittals.
_ Approvals given by the Architectural Ccalmittcc are good for only six munths from ahe date on the
approval letter, Afler that time a new application must be submitted,
{
'
Please contact Javier Contreras, supervisur for Ve114 Gardening Service at 760/399-:844 and Carol huller,
Qtc Association Manager, prior to any irrigation rn6difica6ont associated with this clange. Damage to the
landscaping, i,e„ shrlbs, trees, flowers and turf is the responsibility of the contrac-or. The landscaping
must be brought back to its original Condition when the'project is completed.
completion of you project, please complete aftd return The `oiicc of Completion orArcliitectural
UponChange.
♦
• Chante r -
G
If you have any addiiianfal questions or concerns. please do not hesitate to contact Ca wl Fuller, AsioJaiinn
_
Manager., at, 760/776-5100; Eat. 20,
3
- c
t _•
r
, PGA wF..ST 11 RESIDENTIAL ASSOCIATION i`
For the Architectural Colntnittcc
Carol Fuller
Association Manager '
- - cc: Board of Directors' r r
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Unit File
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