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LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I ajn 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
656128 053111: " �'f, ',�.%���7,fC1;l
Date- �e Signature of Contractor -
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 COMPFNSATION 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.
^+rte )_.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 Policy No.
IrAl
(This section need not be completed if the permit valuation is for�$100.00 or less).
( ) 1 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, l shall forthwith comply with those rovJ s-io s. dl
Date: Applicant t� ..pfd, �) �'
�•sr l' v k'-4.v� r �
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. Eachyperson upon whose behalf this application is made & each persotrat
whose request and for whose benefit work is performed under or pursuant to it
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) or inspection p
,u;po§qs
Signature (Owner/Agent);y�"� -�' � �. � Date Ki
JOB SITE APN
ADDRESS
OWNER
D91 MIX5114ENT
CA 92253
USE OF PERMIT
TIM
a X, MINOR SPA
CONTRACTOR/DESIGNER/
C .fL.f'VJ .11,11A'C'2.%V+1'..S fAV 1"U
74725.10MINUVE, M. rl? AA
:I A EdiLAWWr CA' 92260
(7760)340.9000 C."r314,
ANSI Z.2l -fie ,1995 W,Ri`d'F11FY+:i'PURM
ALARWI 3ARJU=1711'HA ,.L OF W PIA CF JVr IyR&PI.A S't E R 1HRM7101.4.
POOL EQUC8'U1''NT WNC,;.LOSURE 140T 'INCW'LUDE.D.
FOOL A.NDIOR SPA
24,7$0-001,4
:W-°1'.1MA:,itED COST OV COf}dMUMON
PL44IN CI4)WK FFIX
WNST,43UCB'IUN RfIr
1110CHANICA1.1FEE __POOL 131.000-421.000 3'x4,00
p7; w,nuCAt.. MR -- POOL 101 -WO -420-000 $45.00
P3,U.R:3 i N0 f+'{M -- POOL 101-M-419-000 -419.0f,}0 $1.704
ID PLAV O..R
eIitvy-.i1Yi7p.~LVpCr vn
$�: � )
rAAR' 1.6 2001
RECEIPT DATE f` I ?f ,� BY DfyTE FjfLIALEDj� I INSPECTOR
24, 0,02
X0.00
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
7—
COMMENTS:
Final -
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main vvice
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM MONARCH
ati
FAX W_ 76P-77651!2
PGA IVE SM
FAIRWAYS ASSOCIATION
Mar. 16 2001 08:3eAM P2
I �h
March 16, 2001
Darryl and Janet Branstetter
55-802` Brae Sum
La Quinta, CA "92253
P-46: Architectural Change application
V
Dear Mr, and Mrs. Branstetter:
The Architectural/Landscape Committee of the PGA WEST, Fairways Association
reviewed the plans for the Pooi, Spa; Hardscape and Landscape at your Heritage
home at 55-802 Brae':Burn. The committee is unable to approve the plans for
the Hari:1scape or Landscape based on the. following reasons:
1. The Committee will need a'sample of the deck color.
2. The Committee will require -a more detailed description of the Landscape
that will be ln. M�Iled including the number and sizes of the shrubs and
trees,
3. The Committee: will require a lighting plan showing where and what type
of lights that will be used.
In addition thefiCommi;ttee would like to note the following:
1. The fountain pump must be screen from view from the golf course side of
the home.
2. The boulders behind the pool and the property line walls both are within
.the 5' setback and are subject to easement by KSL 'Desert Resorts, Inc.
XSL-Desert Resorts, Inc, will not be responsible for any damage done to
'those items during the maintenance or the. golf cbjjrse.
3. The irrigation system Installed mu ' st conform to the HOA's irrirrigation'o
specifications. Please meet with our contractor, Estate Landscape, to
,insure this is done. The telephone number to reach them Is (760) 776-
4. Since both names are listed on the Agreement and -Covenant Running
with the Land, both signatures must be notarized.I am sending a blank
form for your use.
BOX 13110, PALM DESERT, CALIFORNU492255 - TA. (760) 776-5100 s Fax (760) 77(,-_;111!
email.. pgawejA(,1,moasrcb(Vrp.c0M
. 41.
L. 1�
FROM MONARCH FAX NO. 7607765112 Mar. 16 2001 08:38RN P3
PAGE TWO
The Committee has approved. the portion of the application relating to the pool
and spa. Please provide the required plans and information to the Committee for .
its review.
If you have any questions, please do not hesitate to give me a call at (760) 776-
5100 ext. 24.
Sincerely,
FOR THE ARCHITECTURAL/LANDSCAPE COMMITTEE
3P WEST Fairwas Association
e`Davis
Assistant Association Manager
cc: California Pools
Architectural Committee
Unit File
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