0108-049 (RPL)4
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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
`�'r�rofessionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
y4 i
4't'2 C53 9 L6? 1161
4 -Date- " L Signature of Contractor-� t�✓
"
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:
(r) 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.
,�wFhave and will maintain workers' compensation insurance, as required by
ct(on 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.
(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' compensationgprovisions of Sectio 6700 of the Labor
Code, I shall forthwith comply with those rovisior r. !
,)a't'e : ;'."•- Z 6 1 Applicant Y Iz"Wi A, `F
b• r
'Warning: Failure to secure Workers' Compens tion 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 author ze representatives of this City to enter upon
the above-mentioned property 6r inspectidpn purpose
Signature (Owner/Agent) Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0.0•.049 TRACT
$24,108.7.5 16
JOB SITE
APN
ADDRESS
55406 I�.ffn.10OY17 M
OWNER
CONTRACTOR / DESIGNER / ENGINEER
30VIOLFS1
CAI JFOR.1+%u1. E" OOLS & wAs s;;i OP w4A1' Col
55-666'RAEVY.RR '
74725 JO1V1DIRTYX W= #A
1,A,(,l:3xT.A. CA VM3
PAT.NIUP;� C��' CA 92260
CYOO)S40-9000 CF3LO 355
USE OF PERMIT
POOL AWYOn Wil'•'A
x?�3t'.�Y.r' F�.M1�3kYf,�,A'is1517�1<.'i3•1�9�. �LsaR.r°Vfal€�iLT•Y��it;'.42�'i SE,f.�iY<G 13�; II>i
PLACK AT PRE-PLAISTUR rNIMIRC'F'MR. 5 UR OF Y FF1I0H OLIOCK
1100L AANWO1r• SPA 24,00.0 10
5 PIT. WWI 5,00 LF
7f4mARy
FRE1.01-0004:49-?I8 $1"rM
C10711STPUIC17CR PEE 101.000-418-000 $743.00
A3 4 •A43iO t.#19.1. POOL 101••000-421-000 $2A, OP
Y 1,,$?'.2:`i'iVH.'',A . 1XZ • .P0 -1, $45.00
PLYJMBR.40 POE - 1100L 101.000.41.9.000
PRE-PAMMS
$0100
AU .-:2 2001 ., :SSM TFEENDITE NOW
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cul*ar,�
c!rt off;
RECEIPT
DATE kJ /
,r
BY`�
id/
D T FINADe-N Lor
INSPECTOR
7::]
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r-01- 1
Y.Fy•,
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS - -
r 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 Plbg. Test
Final
Gas Piping
QQ y9
PLUMBING APPROVALS
Gas Test.
U'
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
JUL-31-01 TUE 1:01 PM PGA WEST HU FAX NO. 75D 554 2329 P. 2
i
FAIRWAYS ASSOCIATION
July 31, 2001
Mr. and Mrs. Arnie Weisler
55-786 Brae Burn
La Quinta, CA 92253
Re; 55-866 Brae Burn
Dear Mr. and Mrs. Weisler:
The purpose of this letter is to inform you that all information, which the
Architectural/Landscape Committee requested receipt of prior to the commencement of
any work on your pool at the above referenced address, has been submitted and approved.
Therefore, you may schedule the pool construction at any time.
With reference to the casita, the Architectural/Landscape Committee is still requiring a
deposit of $10,000 unless all work is performed subsequent to the completion and final
inspection of the pool.
Should you .have any questions regarding these matters, please feel free to contact me at
(760) 564-3858.
Very truly yours,
Bobbie Gaffney
Association Manager
P.O. BOX 13710 - PALM DESERT, CALIFORNIA 92255 • Td. (760) 776-51.00 - Fax (760) 776.5111
Mail- p9awc6k@monarchgrp-eons