0009-233 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that lam licensed under provisions of
kphapter 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
or, 112f,
Date ,�` _ ,Signature of Contractor r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) '1, 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.
( J. 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.
STA,T9 FOND 6�G•f�4-a�U11Ui%�-D4r .
(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 Section 3700'of the Labor
Code, I shall forthwith comply with those provisions.
Date: ,a Rr :. 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, 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.
Signature (Owner/Agent) . r ! Date
BUILDING PERMIT PERMT#
DATE/� �'} VALUATION LOT (W9-X_k0 TRACT
JOB SITE
APN
ADDRESS
} MUMM
&04912-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
9(y(TrAU;i N MT.") I=
CA L,;S�'OxiM1 ''OOT,.'- & WAS
-
Q60)340-9000 (J'S'L. 455
USE OF PERMIT
)OL ANDIOR SPA
N
flUiS1BA t.P. XR.S SKALL 14 M
91 ACR AT PRF PI£.Ao�ik' R MOOPEC.`TION.'K.)O1,,EQUIPMENT INCILCfSM-f h'
NOT INC L,)JDF0 IM THIS PERMIT
POOL ARWOR ZPA I'S
unAvla D con oar cOn;S° 1C1'd:'noi;
18
MAN CG3i1;CK FRE 101-000-439-318
CQ-N3TRUCV01Z FEE. 101-000-4.18.000 �t�t►.tt!!
Y1&CW! A'Pat0AXA A -- POOL 101 -0 00-4 Y2F�dPg
10,ECiRJ A1.; 101-000 420-000 $44.00
FC. UMBINt31PRE nn ool, 101-'000.419-000 $27.00
SUB- M9'AL (;0A+1fFRUC710X .AM RT,d.W CIMPK
S393.00
%Tss : °Ti1S A gt . +`3
$0,00
.10TAL M.3m FEES DUE,
RECEIPT
DATE
f
E LED
INSPECTOR
INSPECTION RECORD
v 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
POOLS - SPAS
steel
Electdc Bond—
BLOCKWALL APPROVALS
Set Backs
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Final
PLUMBING APPROVALS
Underground Electric _
Underground Plbg. Test _
Gas Piping
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
Gas Piping
Pool Cover 17
Encapsulation
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G'.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM i-ACCOLWING
Charles and Bike= Smith
790 Spring Canyon Plsce
Ide%tury pads, CA 91320
PHONE. NO. : 769 776 5112 Mar. 26 2091 08:50AM P2
PGA WF.ST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282. LA QUINTA. CA 92253
(760) 776-5100 FAX(760)776-511i
,R e: 90-512 Riviera - Ar-bitecnual and I.att bWe to add Casita
,ear Mr. a Mrs. Smith:
The AwbOctu al Committee and the Landscape CoraWtce have reviewed your plans for the addition of a
spa, Patio decking and awl latrdseWng at their meetings on March Ir and With 10, respedivdY.
The Architectural Committee unanimously approved your PIanS as subMitti &
Review by the Ceanmluee is only for general cmftmsaa with the architectural gudelaws. It is the
MWCM*Jbty of the owner to fully understand and Conform to the arrlfiteMnd gide inea"my ether
an
trot all are toted during review. It is also ft owner's fa r spo req
to fia msting conditions. The Committee's decision with regard to project design will be final. 'lease refir to
tt►a Awbbectuml Rim for all required R*aduals.
The ape o mmttW approved your Plan with the ooMMM that titere are 20 bougaiai`illea bu*a on
the play that are somewhat questionable. As an mno-,an they all in the nun? In some,PIRM in the
coramx*. the bakes are not doing nearly as weU as the vines.
'_t is required by the Association that you obtain a 90 day warranty on shrubs and a one -yea womanly on
aces.
Please contact ltapmet Villareal. supervisor for Valley Gardening Service at 760/399-1844 and Carol
-OW, the Assods m► Manager, prior to any irrigadon modifications associated with this change. Upon
completion of changm please contact Carol Puller. Damage to the landsespiag, ie., dutubs. VOM Rowes
and turf is the responsibility of the contractor. The landscaping must be brought back to its original
-ondition when the project Is completed
Approvals given by the Architectural Committee are good for only sur months from the date on the
approval letter. Alltr that time a now application must be submitted.
Upon wmpledon of your pxgpct, please complete and return The Notice of Completion of ArclutoMral
Change.
If you have any additions] questions or concerns, please do not hesitate to contact Carol Wier. Association
Manager, at 760/776-5100, Ext. 20.
�im�erely,
tiGA WEST U RESIDENTIAL. ASSOCIATION
For the Architectural Committee
For the Landscape Committee
:.arol Fuller
;Association Manager
M Board of Directors
Unit File