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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
Date
? a 96 053 C10 D 3 5 10431121
Signature of ContractI.or
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.
(r) 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 SY'ATF k D Policy No. 1$55,12-42
(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. ✓,.',f�
Date: 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, damages4s 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, indemnity
& 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. �g
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
03W-OD7
DATE VALUATION LOT. TRACT
JOB SITE
ADDRESS so-46scrraip. C wr
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
. & NOW]. IAW.1�' 4M HUS 1✓` I'H
:9URBIX, SPR -T Ga
80-465 CM)AR CREW
?1509 SAN GOR.GO131
LA. (;iTa]jnm CA 92.253
RWCHO 1Wl'E`IAGE r`,Rr. 9 2 V0
('7(50)341,3336 CSLA 5486
USE OF PERMIT
POOL Akl.D/tart 1 PA
PODU P)k,, 12 LF; 5 HLOC WALT, Cli"'ir' STANDARD.
ALARNiMk3ARId.11:RS SHALL B9 IN PLAC>;AT PR&-PLkcJTZR INSPECTION
5 FT. WALL 12,00 Lir
POOL At DICT t SPA 3:2,341.00 LS
P .7iMATE1) COSI" 0T' CO3NST1?U0n'QN
3216M.80
PLAN C;IMCKFEE 401.000-439.3)8 W7.60
CONSTRUCTION FFZ 101-000-418-000 304.50
MECHANICAL FLE -- POOL 101-000.421.000 $24,00
I.L.E T ICAL IN= .. POOH 101-000-420-000 !fit S.tz�
PLUMBING F&E • POOL 101.000.419.000 $2',00
kJ "1�.`F+UC1',ICWA :PI -WI CITCV
W7,60
�� ..
LE0 PRE-1'AID FEES
$0.00
2Q03
r?ILTN'NOW,
CITY OF LA CUINTA
DEPT
&597M
INANCE
RECEIPT
DATE
t i
BY
It
fj7E FINAEpi
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INS
TOR
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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
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
Appliances
`
Final
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:
July 22, 2003
Mr. & Mrs. Lawrence Helseth
4115 St. Andrews Drive
Reno, NV 89502
Reference: 80-465 Cedar Crest, La Quinta, CA
Architectural Change Request — Pool and spa
Dear Mr. & Mrs. Helseth:
The Architectural Committee reviewed your plans to add a pool and spa and has approved your application.
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 approval is granted with the.
understanding that there will be no additional landscaping.
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.
Upon completion of your project, please complete and return The Notice of Completion of Architectural Change.
If you have any questions, please do not hesitate to contact Carol Fuller, Association Manager, at 760/776-5100,
Ext. 20, or Cathy Clark, Assistant Manager, Ext. 18.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller, CCAM
Association Manager
/clf
cc: Board of Directors
Unit File
1 +18" SDa & Bond Beam I
L
A
W
N
Block wall around
equipment stucco
to match house
Block Wall r
_quipment O
Location
I�
SPA B'x8'
3.5'
Deck - Almond Biege
•
sassy 0
�sp�rn00 9�&s.
•
1 (2) 2' Sheer Descents I
Plaster - Tahoe Blue Pebble Tech
Tile - 6" x 6" Earth Tone Portabello
5.0'
3.5'
POOL 28'x 12'
Lawrence J. Helseth
80-465 Ceder Crest
(Nicklaus)
La Quinta, Ca 92253
(
Golf course side of
raised pool and spa
bond beam stucco
to match house
Lawn
All Landscaping and
drainage Existing
4115 St Andrews Dr.
Reno, Nv. 89502