0402-223 (RPL)LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
f— Chapter 9 (commencing with Section 7000) of. Division 3 of the Business and
04 W Professionals Code, and my License is in - lull force and effect. `+
O =) M License # Lic. Class Exp. Date
W
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483498 L' C53 1.131,10 ;
Z /Date J'"r' ` Signature of Contractor f�' -° �9J
CD 0. 11�
Ji.— C:) OWNER -BUILDER DECLARATION
W W r` I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ IZ 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).
<") () I am exempt under Section , B&P.C. for this reason
N Date Signature of Owner
ON
EL Q WORKER'S COMPENSATION DECLARATION
p � I hereby affirm under penalty of perjury one of the following declarations:
Lo r � O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
co Q C) ( ) I have and will maintain workers' compensation insurance, as required by
(j LO Q Section 3700 of the Labor Code, for the performance of the work for which this
a 0)H permit is issued. My workers' compensation insurance carrier & policy no. are:
"t Z Carrier Policy No.
ob O STATE FLYND 1. 0N30 -0e
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
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
,/Date: Applicant
m 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.
/Signature (Owner/Agent) /-1=,`'� Date
BUILDING PERMIT_ PERMIT
DATEVALUATION LOT_'�%`A;;- TRACT
JOB SITE
APN
ADDRESS
79••.1409 :1PAS) O f.liL T&Y
OWNER
CONTRACTOR/ ESIGNER/ EN INEER
1v l' ld t t St�Ai
P (rh.T FWr P001Z AND
79-309:P. SE -10 DEL RL- Y
P,O, BOX 1524
Uk QilW A CA 022.15?
Pt':tsM DT�.SlERT CA 9226',
C760)568-4963 CBIN 725
USE OF PERMIT '
POOL. Ami- OR SPA
POCILISPA. ,I LARUNI lISARRIERS ShALL• BF IN PLACE AT PIZ&PL.ASTER
INSPECTION. YQUIPMZNT i?AICUOSURE NOT n4CL UDBD
POOLANDIOR SPA 2VIOD.00 1A
ESTVIIIA= CONT, (YF CONFTRUCT-10N
1''l';92L� Ir TWEE SUMMARY
PLN HECK i+Z l�lt1f30w439=318 $]ZS.^�.a:1
CONSTRUCTION MI 1 U 1-OtaU � 1 >�-OiIPJ $Z�a.Ofi
P&EC"HAYiMCAL FETA -- POOL 101-000.421-000 �24,tsA
E'LJiCT1..1CAL F&K ,. POOL 101-000-420-000
PLUM..BIN0 FEE -• POOL 101.000.419.000 x'7.09
MAR 16 2004
CITY OF L,A QUINTA
FINANCE DEPT.
q,UR-'r0TAL C0K.tT.I3.L'TL'°I1013 ANIS PLAN CHECK
$51.1:80 ,
IHSS PRE -PAM .,±
$0,00
'9 YTA? , :!?IVIIT T 5.931712. NOW
$511.80
f
RECEIPT
DATE
BY ,'
DATE FINALED
INSPECTOR
r_A
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
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
steel
POOLS - SP
BLOCKWALL APPROVALS
Se: Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
•
Equipment Location
a
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 Piaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
L
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
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)
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03/02/2004 01:35: 7603273278 SPEERBUSMS PACE 01
ALISO L, QUINTA;HOMEP NNERS ASSOCIATION
C/O SP'EER.BURNESS-SERVICES.
200 E. Racquet. Club Road; Suite H-38
Palm Springs, Ca 92262
(760) 327.32782'Phone. And Fax
Kelly Grim" :Bob Jor►es. iftuldfa ltcbert§on Arms Rhein
President vice Nii�dem _
_ ;mac Treasa,,rerr�c, ��� 17,rec+foc
�•:��'....:'�.tti•�!'��.�a��5^.�x•�-'�'�7,.,�r'�C�'��"�.'•'y�''W�/�Z`.��iC-,,.�i��"`R�},�'-'i�.K;�Q�..:s'.:a!;;^Y%N�'Y.e�'�S�s�:f�.x.�"-.h���c;"�.-�Y.,+t'.
March 2, 2004
Brett and Raquel Nelson
7"09 Paseo Del Rey
la Quinta, CA 92253
RE.:. Account #U6
Dear Mr. and Mrs. Nelson:
Your Architectural'.Improvement Application da 18, :2004, >requiwtb*-,.approval for the
instaIlat on of a *nn+ing .pool;°spa and decking 14 -Your backyard was.reviewed and approved by the
Board of Directors/Architectural Committer.
We are glad to see. that you hired. bicensexi and msuredPpntractor to perfot ua the work and expect that
all applicable City required per' ri i4ill,bepthmofhworkio u
We thank you for your cyooperation -in llowiii<g the gn>ldelin,es set forth in the Mks. If at any time, a
portion of .the.plains or related d6bitneitrs --'b 1to the Baard:of Directors/Architectural. Review
.. Committee is later determined to requnregn�ificant modifications, the Association -reserves -the right to
require you to:submt�ad"onal plans: for revxew;h in such as 'event, `the As : tion may, withhold
approval � for' that portion of the 'modifications cations -* a- they have' been deterlmn to conform to the
Assod%fiQp`.S.requirements.
We rely on the. participation of all residents withm:Aliso La.Qumta to maintain'uniform#y
.. withion the
neighborhood so tlia1t the visnal,eitperience:is:aPP��; prol3' � increase`and the community
remains a desirable place to M.
Your cooperation in:this matier is:very much anpreciated.. If you `should have any questiomas, please feel.
free to contact me
Speer Business:$
R S4 LA A110A,
Nancy per
Community `atioa Manager
CC: Board ofDirectors/ARC