RPL (0310-325)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, and my License is in full force and effect.
License # Lic. Class Exp. Date
779365 ABHIC �,,r 0.5.d'31/2
Date •f " ��' �'' Signature of Contractor .44,�— `!��'
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.
( ) 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:
Cartier j,TATE Foil.) Policy No. 1684dti�-«itf��
(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,provislons of Section 3700 of the Labor
'Code, I shall forthwith comply with those provisions.:
Date')` ;Applicant
Warning:
provisions,
Date: :
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,irispection purposes.
Signature (Owner/Agent) •�'✓a's% �'� Date
PERMIT//p
BUILDING PERI�A
b� jy,gg
G/e7D 1U".�La7
DATE , pp ,/yy,,��►►yy ,,j�q�•VALUATION mmyy�,T��poA ��••��99 'LOT'.i _ TRACT
. b�la�7Al��r, tbJr�l,�l7�e4JV � •.
JOB SITE
ADDRESS 7•C3�4 :E�a�
APN 71 1-+ 511 V40
.OWNER
CONTRACTOR / DESIGNER / EN INFER
idf�a'1� �'11F¢.It�'1E 3
CANYON VIEW POOH
54.1084.1di!*'1:1t)N 37Ph
2.95 R TAMAT�,1,at,`121)
3..AC7L A CA 922,53
PAX.MVIM G-8 OA. 92262
(M)778-2700 C31,14 2931
USE OF PERMIT
POO A'Mi0?2:SPA
P001, SPA (33)'30-(44XSI Z223) AND 6 L111' OF 4" WALL, 0RC0 DBTAIL
V ALL.O.iRARRJE S0 MUIST BE IN PL.lit;E.MOR TP I3R&PLAUER
Y1+t5PifCT' N.
POOL. ANI IOR SPra. �a,OJ�r./@/L�t z
4 rT ALI,
XIMMA.TM FOOT OF CONMUi`'I`POH
l� t�"ktMIT FEF 6'IlN3MA R
PLAN CHECK M 101P000439-318 $140.40
CONSTRWrm rn 101;,000--418-000 $116.00
MtCRANICAL.,;RE •- POO;, 101-000-421-000 .. 924:00
ZJXPU'TRIC.AL F -WE b. P.001 101-000-42d} 00 $45:00
1�l ibt 3 1 13 F$1 -PUS&d " 1.01-000-4,19-000 $X1.00
#
OCT 3 l 2003
L i CITY OF LA QUINTA
FINANCE DEPT.
SUB— Od AI COMMi3'C:€ ON AM KAW CI3.Fd.,CY
$452.40
LF35 PJM-P.� M
$0.00
lvrms .T�rwxff';ti' ms Dug NOW
$452AID
RECEIPT
DATE �
BY = "
DATE FINALED
INSPECTOR
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
0. 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
POOLS - SPAS
Steel
Set Backs j
Electric Bond
Footings N, I
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 —'
i•
Final
tility 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:
CMUSTENSEN RESIDENCE
57-484 Merion Dr.
La Quinta CA 92253 Nicklaus Gate
D)I\IBNSIONSk POOL SPA
Lenglb: 31'0 71(
Wid4: 17'0^ 7'op'
Stufice Area: 388 SF 38 SF
PeTiroelee 88 FI' 23"r
Depth: +3V'roSVI 42"MAX
Derwo,
Courd.c: SD 5F
SM.'Gravel: 426 SF
mbin::
6xtr, Spa to Equipment: 30 LF .
Raised SpsaB3patswlrkvalue: YES
De&ated Vac Llae: YES ,
Gas Line Extra: N/A
Gas Line ft BBQ'Fite Pit: 12D'
Spa leu: FIVE BACX JETS
Decca
Omaha Tan wfsalt flnlsh: 450 SF POOL CAP @ RAISED SPARSD BUFF
Cantilever Edge: I1] LF
3- Deck Drales (per1F): SO' (SLEEVE ALL V1,&JMRS)
'Step Riser (per LF):. NIA
DwWall: Stacked sranespllhvaywlQZTitspa sidles(everpool)
RaisedBoadBeasn: 4 20 LFA+12",BAQCSIDEOFPOOL,v�2; 1�'r�
UmkellaSleeve: KIA -
TUerBtopek .
BaskTileGroup:- ]11LF67GROUP ]OR2TILF
'Qaarbite6" Waterrme: 30 SF
VA -
Tile Raised Acew: 21) SF
Meamtav: -.
Spillway 6 FT QUARTZITE STACKED
WIF-511L- • WA
EJBQ 10 (SEE ATTACHM DETAIL.) �/ G(Jj�IVC�
VuVPIL WA
emdriess: NIA
Aeoeas Wall: 2= wMo.0-
Egoipmenl Wall: 4' B X &W
PainVStuDcwPlager- STUOCOEXT. BACKSIDE OFSPA
Wuiie Pool Pfister. YES - -
PebEkPoo1: 141A
Rauiomeot:
PUDIF HAYWAJ0NORTH9TA3L 1.5 HPCIROSPA
PLimP: N/A
Filter: HAYWARD 300 SF CARTRIDGE -TYPE
Hexa HAYWARD4i0kKJULD-NOX
Controller: POOL BOSS REMOTE DFy.MOUNT
HeywardNivigtor. VA
PaolLiPW ONE4Gr1WATT
Spa Li34rt: ONE 1 GELWATT
Purification System: SALT SYSTEM. - (AQUA -RITE)
Wap" Feawre: Custam cascade iVwjde fii RBB (2)
Lesadseane: SEE SEPARATE DETAIL
PstloCtwer NIA
Feneine: NIA
.MISC. SPBCLHICATIONS: ALARMS & SPRINGS PER CITY CODE
Bsyrr is tmsre that onl represeemdon or t3pyewrrnm by eikber Putt' Is mat blodhg
riles: ENslled sod s(pcd by boyo and s<arr.
PIA
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sao net @ SLS" I
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straw exterior
live spa fats ' ,. -.-decking
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RESIDENCE "- - I.:
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57-064 MERION PI L
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CONTROLLER
51urwALK
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U;7 +t�
bobcat access
GATE
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sleeve all Planters
o
` set wall -distance
t0 allow for access'
760-778-2700 760-3�0-3667 FAX . 2295 East Tamarisk Road Palle
REMED 9/23iO3 I
CITY OF 1AQIJI TA
BUILDING & SAFETY DEPT.
A. PR'OVED
F R STRUCTION
6 D
C •B ense ] 5 m
m
--------------
W
10/29/2003 13:31 760-320-3667
i10/1y/1b03 7.1:23 - 776511.1
-fi- -A WEST,
October 24. 200.1
'$ .iSAUNDERS ENG PAGE 02
MQNARCH PAGE 01
• POA WEST 1I RESIDENTIAL ASSOCIATION, INC.
p.o.- BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111.
' lvl's,hitoda Clu'istensen ' .
6114 La Salle Ave_ !# 162
Oakland. CA 94611
Reference; 574184 Merion, La Quint&. CA
Architectural Change Request - Pool, spa. batbei;acAandgeaping
i. Dear Ms. Christensen:
The Architectural Comifttittee reviewed yens revised plans fot`die tidflitaon of a pool: spa, barbecue and
additional Ifutdseaping and approved your application pending a swund adjacent neighbar comment form;
we are please to inform you that the fbnu was received on Octobe, 22, 2003.
Review by the Committee is only for general conformance will, the architectural guidelines. R is the
responsibility of the owner to fully understand and oonlbrm to the architectural guidelines criteria, a'liedrer
or not all deficiencies are noted during review. it is also the onmcr's fail responsibility to field verify all
existing conditions. 17he Committee's decision with it gard to proiect design v611 be final. Please refer to
the AmWteettnl Ruled for all requited submittals.
Approvals given by the Arcbitecttual Committee are good for mnly six month, from rile date on the
,,4 approval letter. Tf construction bras not commenced within six months after tilt project approval 031c, a new
application must be submitted
Tim Landscape Committee has the following comments.-
Your
omments:Your contractor must vrarranty the troes for one year and t Ire shnrbs fbr six months,
• Plow contact Javier Carrlrrwas, supervisor for Valley Oudening & lAndscope at 760/776.6667
and Carol Fuller, the Association Manager prior to any irrigation tn05itic2tions associatod with
this change. Damage to the landscaping, i.e., shrubs, tyre!,. flowers and turf is the responsibility of
the contractor. The landsc-.apir g must be brought track to its original condition when the project is
completed.
Added shrub and turf irriMon Should be on separate oov rols due to over -seeding in the Pall.
Upon completion of ,your project, please comp' lete and return Thi; Notice of Completion of Archilcctl n, I
Change. t
Tn file m=ime if you have any additional questions or conceals, please -do not hesitate to cobtact Carol
Fuller. Association, Mana goo, at 760/776-5100; Ext. Z0, -
Sincerely.
PGA WEST 11 RESIDE"AL ASSOCTAlTON
For tho Atrlritectural Committees
For the landscape Committed
Carol hiller, CCAM
Association Manager
cc: Board of Directort..
Unit File
t