0203-219 (RPL)H
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LICENSED CONTRACTOR DECLARATION ry
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
6515128 C,53 MC C-8 i 1.1�1r31sQi
DatefT 7 Signature of Contractor
dv
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:
Carrier S kTH COIdiPENSd3,'1'f Policy No. 0460006116810X
(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,r Q
Date: Applicant / it-� ,/s' .F
"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.
ff J F! F
Signature (Owner/Agent),. �• r'` �e�-� Date-- • z
BUILDING PERMIT PERMIT#
203- 119
DATE ` i VALUATION LOT TRACT
JOB SITE 1
APN
ADDRESSlrjii��i
i
„
OWNER
CONTRACTOR/DESIGNER/EN (NEER
. Al DIOR MRS. MY(THES
4. UFC-)RUi-AP06LS SPA8 (TOV, M.Wi�
n-6'55 C I '.UM) WT R
LA QUI 1% (+a 922n
:€� "S�M :C3E;"MRT CA (42260
060)343),9000 COIN# {DU355
USE OF PERMIT
POOL, SPA, F311Q (AT41 ztt-1995),20 LAR S' 81.=K WALL,
C1TySplfDtRD, AL&RKt,11113 kR 1 p`AIJ, RE IM PUCET
PRE ?LASS i Effi. D')3 ;PEC CIN.
5 Ff, WALL 20.00 LF
POOL A14()€OR SPl1 72,06-'e.0a LS
EFTIIM07D COST OF COM1". il'i.'.i2'0V
224A)9,90
PkIMIr VVE SUMMARY
PLA14 Cf WK FEY, 101.000-439-31 S
C074STRUCTION FLOE 101-000-41 R -OW
Ir`IEf.H"ICE' LFSK-- POOL 101-000-421-000 $2441)
:".'i,):C'1R1CR.1.,ME•-POOL 101-000.4120-000 $45.`o
i�l'at!�i�INO i�F -- nC�QI✓ kCtl.«04f)-4i:t..00C� E2"r.t°h
.,f
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�A)yi•�1,ftY�� 1 It3�:1A`;Yip�
$48"/1.'t
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CITY �—
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RECEIPT
DATE
BY
DATE INALED'
INSPECTO
;f7-
INSPECTIO14 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
_ 2
Set Backs
Electric Bond
Foofings
Main Drain
— Z�
Bond Beam
Approval to Cover
— y
Equipment Location
Underground Electric
—4 —
Underground Plbg. Test
Final
Gas Piping
—y —
PLUMBING APPROVALS
s
Gas Test
Electric Final
Waste.Lines
Heater Final
Water Pawing
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Q
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:
FROM : CALIFORNIA POOLS AND SPAS PHONE NO. : 7603465407
UV,dU/1f:: "Ll; lr'90 rat ;CU Z4b Hbl' 1; K !l
Mar. 22 2002 04:23PM P1
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- '.� �.'�. � � tiC � .� �h�3` �•w'Ca �� � '�, fir, ��^���^,* N"� '�� 'f7 tps,
Manch 20, 2002
Wafter & Kathleen Hughes
79-655 Comm StmeY
La Quint@, CA 92253
RE: Am++Iteatural Request
Citrus Course Homeowners Association
7"55 Cetrino
11UYI S 45
Dear Mr. a Mrs, Hughes.
This latter Is to eonfcrm, In eCCordanee with the Architectural G uidellnee; the Are itectural
Committee has approved your application for the pool, spa, waterfall, decking quartzite on
eXiS6ng decking and fountain.
When all work On the project has been completed, pleeaC notify ibis office in writing, so thEI :ha
ir°►provement Can be inspaabed and signed off by the Architectural Comms and your deo sit
can be returned to you.
Please contact me if you have any questions about your architectufal application.
Sincerely,
Architectural Rev►e Committee
Citrus Course H rs Association
By; Fran Wally, Association Meneger
P.O. Box 4772 • Palm Desert, CA 922e1,47T2
73-550 Alessandro, Suite 5 + Payn'DoSerk California + 760.246.11169 +,
Email; drmQ)drm8nternet.com + www:drminternet.eom FOX 760.346.9 3' e
N-, - ..1.