RPL (0401-323)57111 Medinah
0401-323
LICENSED CONTRACTOR DECLARATION .
'I hereby affirm under penalty of`pejury that I am licensed under provisions of
Chapter 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
C5 N17 0
Date ! a' Signature of Contracto y1,
_ OWNER -BUILDER DECLARATION
r
I hereby affirm under penalty of perjury that'l 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. ,
( ) 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 ME'MIR Policy No.
(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: ( 1 %' ! 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 ffor`inspection, purps ses%.
Signature (Owner/Agent.) -S' k t '%C` Date ' j 3
.._ S. , BUILDING PERMIT PERMIT#
04014-4323 f
DATE 01173/210C VALUATION , LOT
TRACTJOB
SITE
ADDRESS wt^.YRa:.S Lerr
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
WOODY 0T"I' wI
MCCAULUM POOLS
5741;1 MEDWAR
82-702 C.',€ s7tLMOVIT.AVE.
LA Q1:MP A CA 9225'3
INDI i fyA' 92 011
(760"275.6403 C115'L* 6531-7
USE OF PERMIT
POOL ANIVOR SP A
RETdtplO yTFinEL Ol tc IIS 'TIip '5 3 ¢xPOOL TO.r X Ir7ty2s?5'.?>y9;;C IDEA^y7•LYJI .Yt dtlf4`¢Wg'dCL? AS LINE
1' V 6 W ^1E A -PP OV CiD A'JIPI.il.f'.NO3-9 : . iXJ i,Tft. 0 L 000 a 'Q V(.T".Clii.i<i'1 r1. _
POOL .BSNDIOI3 SPA L'S
EMMU & ID C~09f OF COV 1RUC'dION 9155M04)
:niff M ISMIM lCiAR'!i''
PLAIN (111= FL's 101.000.439.318 Mos
CONSTRUCTiON.FEER 101-000.418-000
PLUMBINO FRE -- C1OOL 10` rz„ .19.000
JAN 2 31004
CITY
FI FCE , ,•'
,
OU13-TOTAL CONS•PU'=ON, NT) }?Y.,AN M'J1W.. X $220.135
I ros $0.00
p r q' A £ ALT ¢ + r w s +t y : f
t4FlriidA7.t-K.E.iv.l.`. Xr d:.6 ES WE A7T'ow u%220.05
.r
RECEIPT
DATE `/,. O
BY
DAN FINALED
3 —2
IN ECTOR
I
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
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 Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
lei
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
Z
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)
COMMENTS:
fi karthlink.net ate Serio PGA WEST II RESIDENTIns Greetings AL ASSOCIATIONINC.
1:36:06 AM Pacific Standard Time` . P.O. BOX 1282,. LA QUINTA, CA,922S3
(764}7'I6 100 FAX (760) 776-51-11
And a bOagtmio' aroenerto. you too.F.
Mr. Woodworth Clum
P. O. Box 221220
Carmel. CA 93922
Reference: 57-111 Medinah, La Quinta, CA
Architectural Change Request -Fire Pit, Water Feature, BBQ
Dear Mr. Clum:
The Architectural Committee reviewed your revised plans and met with your contractor for clarification on
several issues and has approved your plans.
Re%iew by the Committee is only for general conformance with the 'architectural guidelines. It is the
responsibility of. the-owner to fully understand and conform to the architectural guidelines criteria whether
ex not all deficiencies are noted during review.'ft is also the owner's full responsibility to field verify all
existing vonditions. The Committee's decision with regard to project design will be .final. Please refer to
the Architectural Rules for all required submittals.
Approvals given by the Architectural Committee are good. for only six months from the date on the
approval letter. If construction has not commenced within six months after the project approval date, a new
application must be submitted.
If natural gas is to be used in your Ctrepit, the installation must be permitted by The City of La Quin and
ins ted.
Please contact Javier Contreras
supervisor for Valley .Gardening & Landscape at 760/776-6667 and Carol
.Fuller, the Association Manager, prior to any irrigation modifications associated with this change. Damage .
to the landscaping, i.e., shrubs trees, flowers and turf is the responsibility of the contractor. The
landscaping must be brought back to its. original condition when the project is completed. This application
is approved with the understanding th" t' diere will be no additional landscaping
Upon completion of your project; please complete and return The Notice of Completion of Architectural
Ctiarige. •
In the meantime if you have any additional questions or concerns; please do not hesitate to contact CarolFuller Association:M. manager, at_760n7C1-_SI00; E d::2.0„ .
.Sincerely.
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller, CCAM
Association Manager
cc: Board of Directors
Unit File
Thursday, January 01, 2004 America Online: Cur clums