0402-178 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
H - Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
LU Professionals Code, and my License is in full force and effect.
O =) M License # Lic. Class Exp. Date
I LU
65 Z8 C53 1 '0" 1'N
oZ � Datet5 Signature of Contractor✓_ ��� `✓�•
cu O. C e�
� U (0 OWNER -BUILDER DECLARATION
LU Uj I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ U) License Law for the following reason:
Z ( ) 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).
M () I am exempt under Section B&P.C. for this reason
N Date Signature of Owner
p N
C4
d Q WORKER'S COMPENSATION DECLARATION
o (r I hereby affirm under penalty of perjury one of the following declarations:
L Q ( ) I have and will maintain a certificate of consent to self -insure for workers'
X WLL compensation, as provided for by Section 3700 of the Labor Code, for the
m� Q performance of the work for which this permit is issued.
Q .L) '4(<rI have and will maintain workers' compensation insurance, as required by
O L) Q Section 3700 of the Labor Code, for the performance of the work for which this
a rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
?' Z Carrier Policy No.
°�D O STATE CCuPEMNY1 046-6168-20114
J (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
3 subject to the workers' compensatiprprovisions of Section 3700 of the Labor
Code,,L.shall forthwith comply with tho a %srovisions. �r
Date: Applicant �� /,I
-�
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 propeyfor, inspection purposes.2p
Signature (Owner/Agent) y' '
Date
13.01LOING PERMIT PERMIT#
DATE VALUATION 7 LOT +! TRACT
JOB SITE APN
ADDRESS
70-R-5MRY_1C' ' :'NkCTDQX MW
OWNER I CONTRACTOR / DESIGNER / ENGINEER
0MOR it 11410 r> WUS
LA yQ,ua` T.A CA, 92253
USE OF PERMIT
CA'ZZRINTIAPCJOLS tQ SPAS (D.'Yl)MAN
86 100 A NDSTUE 54
COAE:TM'Cai: A CSP,, 92236
C760)'398..9222 Mul 00355
1'17r3f..ESd A.. AL RMS/BA.i'�eUEV..S SF-PJ:.0 YJE IN PI ACEAT PRR,•Pi. ,STIR
EIS;SPEC:TIO.d..l?QC1tPMZHcf MC.LOSUR1', NOT .01CLUiDIED
FOAL ANi?/ORSnA
14,000,00 L8
T-WrMATED CtJ�t' OF rION�,'�k' M- t'EOIN
PYA41rf FRX SC1`MMA:C`'t'
No
NN CHECK FEE '101.000.439.318 S121,b
CONS•Cr7'13C.PION ..f.W. 10,11-000-418-000 8180.00
LIHC i.A:fQ1f:AI,Ii'E•T -- POOL 101.000-421-000 $24,00
EVEC I'MAL MZ- POOL 101-0.0-1120.1000 $45,00
P LUM'SINO FE -E -- POOL I G1 -000-4-19-000 M09
D Q �
FEE 0 2004
CITY OF LA QWNTA
FINANCE DEPT.
3U -TOTAL CO 1 R CT:[0N AND MAN C x�, M_
'LES;3 PRs-P.AW 17't M
M.85
,ftt)()
T' rAl. ?`ERM r XF"`1.Dim NOW Q7."
RECEIPT DATE BY / DATE FINALED INSPECTO
-;/- /�,l / i PSS'` ! �-.� a 5►
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
I INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root 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
-/—
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
- /—
Underground Electric
Underground Plbg. Test
Final
Gas Piping
fl
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
-z
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
LA QUINTA FAIRWAYS HOMEOWNERS ASSOCIATION
AVAIL PROFER17Y MANAGEMENT
P.O. BOA. 1032 .
PALM DESERT, CA 92261
760-568-2717
January 23, 2004
Mr. Greg McManus
78-855 Breckenridge Drive
La Quinta, 'CA. 922.53
RF,: Architectural Variance Request
Dear Mr. McManus:
Your request for the approval of a swimming pool / spa in your rear yard was reviewed and approved by
die Committee with the following conditions:
The followiw, but not limited to, requkements of the La Quinta Fairways HOA Rules &
Regulations and Architectural Guidelines, dated June 25, 2002, shall be observed (paw
and/or pwWaphs noted).-
1.
oted):
1. Genera! ,Rules, regarding conunon area damage, work hours and authorized access by
contractors (pg2, para 4, 10, 11).
2. Vehicles annd panUV, regarding conar dors (pg 4, para 4, 10, 11)
13 Architectural/Landscape Guidelines:
a. Para 3, Elevadon/Dnungasge (pg 9)
b. Para 4, PooWSpas (pg 10)
c.. Para 14, Common Area Obstrucizon (pg 16)
All necessary City permits must be obtained prior to starting the construction. Thank you for your
cooperation in dds matter.
Sincerely,
Cram Anderson
Project Manager
LA QUINTA, .FAIRWAYS HOMEOWNERS ASSOCIATION
AVAIL PROPERTY MANAGEMENT
P. O. BOX 1032
PALM DESERT, CA 92261
760-568-2717
January 23, 2004
Mr. Greg McManus
78-855 Breckenridge Drive
La Quinta, CA. 92253
RE: Architectural Variance Request
Dear Mr. McManus:
Your request for the approval of a swimming pool / spa in your rear yard was reviewed and approved by
die Committee with the following conditions:
The following, but not !united to, mquir mems of the La Quinta Fairways HOA Rules &
Regzdad'ons and Architectural Guidelines, dated June 25, -9002, shall be observed (page
and/or parWaphs noted):
1. General ,Rules, rrprdbV common area damage, work hours and authorized access by
contractors (pg -2, para 4, 10, 11).
2. Pelycles and , par kiV, regardifWcontractors (A94, Pam 4, 10, 11)
3 Architectural/Landscape Gi idelines:
a. Pats 3, ElevatiowDraingage (pg 9)
b. Para 4, Bc oWSpas Off 10)
c. Para 1J, Common Area Obstruction (pg 16)
All necessary City permits must be obtained prior to starting the construction. Thank you for your
cooperation in this matter.
Sincerely,
Cam Anderson
Project Manager