0209-174 (RPL)H
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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
1556128 C53 SIC C-8 2 1 I/%(.
r^?_ Gt vI �}, �
Date r Signature of Contractor �JFl�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:
( ) 1, 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 STAf?i i°rJMPFVI� TI Policy No. aC+pb�l��-Jl
(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 sgall forthwith comply with th se/provisions.
Date: u M 0. urx. Applicant`"
Warning: Failure to secure Workers' Compensation coverage is unl4
shall subject an employer to criminal penalties and civil fines up to $1in
addition to the cost of compensation, damages as provided for in Sec i 06`
of the Labor Code, interest and attorney's fees. J
IMPORTANT Application is hereby made to the Director of Building a d S
for a permit subject to the conditions and restrictions set fort on his IT
application.
1. Each person upon whose behalf this application is madee& 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.fGrr inspection pu poses.
Signature (Owner/Agent) �- ��"� Date
ILDING PERMIT PERMIT#
F
0200-• .1111
DATE VALUATION sls yq}�� oo LOT TRACT
SDE V yJi.T!'_YYi9
t
r d
JOB SITE
ADDRESS 70.921 J�iS;�i;Q.,�4,'�'f_FN11W .' DSA
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
)&it. Ai�°7VOR WdS. ROSIR
CALIPORKAP-CAD1 S SPAS C'1"C.P a'V. M CO
75.-91 ')y 'L�,REM--WRIDGE DR.
O;F�• 100 A'b' KIM � 54
LA Q� :4?TvTTA CA 9 253
C OA�:r'_"VOKILA CA � 2236
(760)398-9222 U3L*� 00355
USE OF PERMIT
k�001,.�3� AND/OR SPA
19C3G?t,ISPA. .Aif..�1kA�CS/f1�.(a13':1P;RS SHALL BY, i.i'i Flh.' CF.? ALT f>6FZ-PL�,3TZR
11181`I�Cxlc�N, FC�(JI'�l�'k�d'I* �+��;x�Cya U1'f.%* �t7 i' 1N("t,�ifaPU
POOL A1`iDIOR SPA 18,000.0 W
�a AM COOT OY CODIS;Ia,t:UC��xc�N
,�� °�: StTY[Ibkfik�.�'
PLAN CBEC%, IT& BCS7--000-439.318 SWIM
'�CA71dw'.�'Ittic.-row I�kr 101-CJi 0.418-000 $199,6(3
I EC'TIANIr #f,t,;X�'&E - POOL 101st 00-4 s1-000 $24,011
aw,c:-mr.t��., V,W? .. P0()L 1011-000-442-000 $45.00
Pl.,lf�fDTHO S Pool, 101-, O.419.000 $27,00
A\
P 2 5 2002
OF LAQUINTA
-
NANCEDEPT.
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RECEIPT
DATE
BY /
DATE FINAL D
INSPECT]
�? INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS I MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pate
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
POOLS - SPAS
Final
Final
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
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
Final
COMMENTS:
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pate
Underground Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Tema. Use of Power
Final
Utility Notice
POOLS - SPAS
09/17/20e2 i%:52 7605680324
AVAIL PROP MGT
PAGE 02
fA QUINTA FAIRWAYS HOMEOWNERS ASSOCIATION
AVAIL. PROPERTY MANGEMFNT
P. O. BOX 1032
PALM. DESERT, CA 92261
(760) 568-2717
September 7, 2002
Sue
7_ Rossi
78-911 Breckenridge Drive
La Quints, Cts 92253
RE: Arc;liEe to al, Variance Request
I Dear Ms. Rossi:
Your request fox the addition of a swimming pool and spa, along witb additional
landscaping .in the front courtyard and rear yard was reviewed and approved by the
Architccuural Committm.
You must first obtain all n�cce§sary permits from the City of I Quxnta. 1)v not
leave any debris or materials mi the street overnight. If the eommOn area is
dammed during this construction, it will be your sole responsibility to repair or
replace the damaged portion.
Thank you for your cooperation in this matter. Please contact this office if you have
any questions.
Sincerely,
Cam A.ndtnson
Project `tanager