RPL (0109-167)57218 Medinah
0109-167
LICENSED CONTRACTOR DECLARATION
I he affirm under penalty of perjury that I am licensed under provisions of
a0t, 9,(comTqncing v Section 7000)'of Division 3 o the Business and
Professionals Code and , myLicenseis in full force and effect.
'
CD;. M License# -', Lic. Class Exp. Date
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`514 WNA:'
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Z r, a Signature of Contractor A/ . -
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r-- 0 F- 0 OWNER -BUILDER DECLAR I
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LU LUI hereby affirm under penalty'of perjury that I am exempt from the ContreiCtor's
co License Law for the following reason:
Z 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).
1, fas owner of the property, am exclusively contracting with licensed
*contractors to construct the project (Sec. 7044, Business'& Professionals
Code).
C0 O I am exempt under -Section B&P.C. for this reason
U-)
N Date Signature of Owner,
0 C\I
< WORKER'S COMPENSATION, DEC
LARAiION
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0 G`LO I hereby affirm under penalty of perjury one of the follow ' ing declarations:
0 1 have and will maintain a certificate of consent to self -insure for workers'
X Uj compensation, as provided for by Section 3700 of the Labor Code, for the
0 _J _J performance of the work for which this permit is issued.
_J <
< 1, have and will maintain workers' compensation insurance, as required by
0Section 3700 of the Labor Code, for the performance of the work fo r which. this
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LO permit is issued. My. workers' compensation insurance carrier` & policy no. are:
Z
Carrier Policy No.
wavemnlow
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< (This section need not be completed if the permit valuation is for' $1 00.00.or less).
I certify that in the performance of the work for which this permit is issued;
I shall not employ any person in any manner so as to,bdcbme* subject to the
workers' compen
sation laws of California, and agreditlat,if"ll should,bd`ciome
, -- e
subject to the workers' compensation proVision6,,oPSecti6n-3700.of &labor
Code, I shall forthwith comply with those prov(si6rig..
Date 4 ^;Applicant—
Warning: Failure to secure Workers Compensation -coVMr$ is, unlawful and
.?I e .
shall subject an employerto 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 Directorof Building and Safety
for a permi.t 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.Cuinta, 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.
.1 certify that I have read this application and state that the above information is
correct. I agree to comply Nith_ all City, and State la s relating to the building
.construction, and hereby authorize re,p"reselAtatives of this to enter upon
the above-mentioned property for ins6lec , tidh purpos,es-'--
Signature (Owner/Agent) —Date
4
:-BUILDING PERMIT PERMIT#
DATE LOT' 0 TRACT
VALUATION 67
JOB SITE
APN
ADDRESS
57-218 MKI)INAH J
OWNER CONTRACTOR/ DESIGNER/ ENO IN EER
101) 4 & CALWDN' F00U., DTC.,
17
51 _211181.4101DUIM go nlum M, lzntw IP3
LA QIDIWA ItMCHO 2vJM,%G.17 CA' 92270.
(7fop3l -0860 (MLO 3735,
USE OF PERMIT
P 0 Q f , . W.XOR ',.TPA
KIOIAP.A. )dA.WW,_VetAFRM?k1S 91W -L BE IN PLACE AT PRE-P"..-A-111TER
INST EXIF014. POOL PAUIPWWT RINCUOSURE, NoT fmc-LumM
0
VAIXIATK*11'. 30,000.00 Ls
F.91DAMD C05:T(YF C0NT_f9U(7,n0X
PLAN CHECK Fral
101-000.439--318
$194.93
CONSMUCTION PVT
10 1 1 R-000
WCHANICAL 1 -it E POOL
101-000-421-000
SAW
%LA=RJC.Pa,
PLUM9,11140 F-I&F, __ POOL
161-000.419-000
1 1
D b%
SEP 19 200101
CITY
OF LA
QuINTA
FINANCE DEPT.
SUB-11Y)'AL (01AMMIJOY AND PLAN'MEM
USS MWMID M.CTO
TUM PU(BrIfy PIKES DUE NOW
RECEIPT DATE1BY NALED INSPECTOR
T7 T67
7z,
t
INSPECTION RECORD
OPERATION DATE INSPECTOR
-
BUILDING APPROVALS
Set Backs
Forms & Footings
S.ab Grade
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
Fireplace T.O.
Party Wall Insulation
Party Wali Firewall
Exterior Lath
Drvwall - Int. Lath
OPERATION DATE INSPECTOR
MECHANICAL APPROVALS
Underground Ducts
Ducts
Return Air
Combustion Air
Exhaust Fans
F.A.U.
Fans & Controls
Condensate Lines
COMMENTS:
I Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
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
COMMENTS:
I Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underaround Conduit
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
u
L 0 RE L T WORK SHALL BE PLACED A
M OE 2' EL WEEP SCREEDS.
OF LA UUIN IIA
G & SAFETY DEPARTMENT.
17 777-1012
INSPECTION REQUEST UNE f
v 777-71 S3 ,
Owner KEN & ROBERTA LO_ 1SQFF' ----
contractor
Permit Number01.09- 67
POST ON JOB IN CONSPICUOUS PIACE
INSPECTOR MUST SIGN ALL APPLICABLE SPACES
JOB ADDRESS 57-218 MEDIN A
POOL/SPA. ALARMS/B,ARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION. POOL EQUIPMENT
ENCLOSURE NOT INCLUDED
_----- nATV INSP-
fWTING STEEL
MAIN GROUND SYSTEM
nnni fun Pi 11UNING
ROUGH E
..l r
BONDBES
SIGNED
uuTIL ABOVE HAS, BEEN SIGNED
DRYWALL INTERIOR
EXTERIOR LATH
POOL PRE PLASTER
POOL FENCE b GATE
SEWER SEPTIC TANK
FINALS •
ELECTRICAL
PLUMBING -
FINAL GAS TEST
HEATING - A/C
HOUSE NUMBERS
JOB COMPLETED
TEMP POWER
ABOVE APPROVALS DO NOT INCLUDE RIGHT TO
TURN ON UTILITIES OR OCCUPY BUILDING
M Ark,
PGAWEST
September 17,2001
Sep. 18 2001-Ng P1
PGA WEST Ir RESIDENTIAL ASSOCIATION, IINC.
PO: BOX 1282;, LA;QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-51.11
Mr. Kenneth G. Lonoff
57-218 Mcdinah
La Quinta, CA 92253
Reference: Architectural Change Request - Addition of Pool 8t Spa
Dear Mr, Lonoff:
The Architectural Committee reviewed your revised plans for the addition of a pool and spa at its
September 11, 2001 meeting. The application was approved.
Review by the Committee .is only for general conformance with the architectural guidelines. It is the
responsibility of the o*ner to fully understand and conform to the architectural guidelines criteria whether
or not all deficiencies are noted during review. It is also the owner's full responsibility to feld verify all
existing conditions. The Committee's decision with regard to project design will be final. - Please refer to
the Architectural Rules for all required suba&tals.
Please contact Raphael Villareal, supervisor for Valley Gardening Service, at 760/399-1844 and Carol
Fuller, the Association Manager, prior to any irrigation modifieatious associated with this change. Upon
completion of changes, please contact Carol Fuller. Damage to the landscaping, i.e., shrubs, trees, flowers
and turf is the responsibility of the contractor. The,landseaping must be brought back to its original
condition when the project is completed. It is our understanding that there will be no additional
landscaping as part of the application.
Approvals given by the Architectural Committee are good for only six months from the date on the
approval letter. After that time a new application must be subrtuttul.
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
In the meantime if you have any additional questions or concerns, please do not hesitate to contact Carol
Fuller, Association Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File
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CAS o(. 1.ee d r ® m
CAL -NEVADA
POOLS
, MARK TOUV
70180 THUNDER ROAD -
RANCHO MIRAGE, CA. 92270
PH 8310860
LIC. # 777601
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VICINITY MAP
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- ,toes
N
` U S P/tom
I W r4e /I/ I N
L0& CIAT
-
POOL SIZE / • 5r x re; th_ 3 x x
Surface Area ~ +f
Perimeter q
EXCAVATION Access
Grading
Dig From ' a, L-te.a
Obstacles
(l
Walls Removed ' S, • a 4
/
Replaced c/
Misc.
PLUMBING Filter Tpc • CIvILT
Size J
Pump Jn Sizet
Booster Pump
Skim Run — Main Drain —
Ret 3
FII Line 14 ✓ • r Purifier
/.I ,-r ,2 t Lo --r `=
Auto Cleaner 4 L w't /d. 1. S
Htr Type Z 4k2 S Size q 0 -0 0 c'r
Gas L/F l gy
FOUNTAINS -PRAY HOS—WATER EFFECTS
Type /1% v
Size—
Plumbing Length
Valves
Booster Yes/Nc Type
Size
Misc._
STEEL GUNITE Eng
Sur -charge
6' RBB 12' 18'
Step Risers
Spa Wall Width__
Benches `
Love Seats
Spa Dam Wall / 2•
Notch
r
Misc.
;
ELECTRIC Total Run L/F l !ry
FberOphc NO:
Remote R 5 ^4
Spa y buvtl
Misc.
TILE W/Line# 4t •2 S
Coping L t i
Step 8 Bench Tile#
Misc—Glass—Etc
A R -INSPECTION FEE OF $30 - DECKING SgFt ..5 q Type 5 4 •i Color COvTv(
'MILL BE.CHARGED IF THE APPROVED _ Nat Concrete SQ Ft Cantilever 3 _-
B CARD ARE NOT ON r•. D.O.D. OF Step Risers
PLANS AND )O
THE SITE FOR A SCHEDULED ' ,
, ,Misc.
CITY OF LA OUINTA,
11
INSPECTION. Z SPA Size 2 Area 15Y PerZ
NO EXCEPTIONS! BUILDING &SAFETY DEP-( Pump 5.. . t Blower _ Spillway,
APPROVED I 3 Jets -l- l ►r . - r Step L LightLJ
r, Misc.
FOR CONSTRUCTION ► INTERIOR FINISH M Color
a
Q 1 .rTG C Other iU r 4?c IL 0
DATE dl i q .; o a Z'
.a, OWNER to fence pool area and install self closing and self latching gates per code. P
NOTE: No dirt will be removed, retumed or graded after day of excavation. OWNER kc j
Designed by NOTE: Relocation of equipment pad will result in additional cost to owner.
? b; NOTE: Fill pool immediately after plaster (follow instructions). Do not use rubber hose. ADDRESS 7
not turn on pool light when pool is empty.
KERRY R. K O E H N L E I N NOTE: Do
PHONE 360-00 2 NOTE: Wet down concrete shell at least twice, daily for seven days after shell is installed. CITY D.. SOLD BY DATE_
I have reviewed this plan and hereby a prove total.plan & pecifications. PHONE (H) 77/ 7 c{ L( (W)
_.
`% -9": : I:a . DRAWN BY DATE
ATE CUSTOMER SIGNATURE
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