9709-050 (RPL)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
574127 A 8/31 /94
Date 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 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 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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Date: Applicant
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) Date
BUILDINGPERMIT PERMIT # A ` CONTROL#
' 5890
DATE 11197 VALUATION SS.2.8.437•tif) LOT TRACT
JOB SITE
ADDRESS-,y'++��
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
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Gt1. QI.)iN'1 A ('A 02,253
PALM 1J1rSi3RT Ch 92200
(1360,1146-40,121 t" RI,ff 1044
USE OF PERMIT
0.AiL
"'PA ONLY
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eW i'::aIADa;►D.' COST OF ��.'.c.va3.SI.F1.0.3c.e't`%
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tat.is� 1'.f't.fe'/af. r~fK� -- th.��.>c, If.1i-U01i-4:�t?-4�)fi $•1b.ui,
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70
LES'S PREAVA11.) FQf? ;SON0
SEP 2 5 1997
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AEOEIPT
DATE BY
DATE FINALED
INSPECTOR
k
V
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 Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROVALS
steeE>
POOLS - SPAS
Set Backs
Electric BondF7/7
I
Footings Q 7
Main Drain
Bond Beam 42LI a ZT,
Approval to Cover
Equipment Location
Underground Electric
)
Underground Plbg. Test
Final ; —
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
14-7
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
Z
Gas Piping
Gas Test
Appliances
t
Final
La 4
4
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles i
G.F.I.
Smoke Detectors
Temp. Use of Power
a
Final
r Utility Notice (Perm)
COMMENTS:
3 4.0 o G
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4
IN
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
September 18, 1997
Marty & Stacy Chilberg
5583 171st. Ave. S.E.
Bellevue, WA 98006
RE: Architectural variance for 55-506 Pinehurst.LA Quinta;:.Ca.
Dear Mr. and Mrs. Chilberg:
Your request for an architectural variance -has .been approved, by Mr. Dan Shepardson, Architectural
Committee Member. Specifically, you ,have the' approval to proceed witha;the replacement of the
deck and to build an in"ground, spa in -the courtyard.of. your: 55=506 Pinehurst residence. Upon
completion of the deck replacement and spa installation, please submit ,the enclosed Notice of
Completion form to this office..
We reserve the right to make a final inspection of this change. to make sure that it matches the
original request. An approval is.based only on the aesthetics' of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
We appreciate your cooperation in submitting this request for; approval. j If I may be of further
assistance, please contact me at the HOA office, (760)'771.4234:
Sincerely,
eMcGaKlliard
Operations Manager
cc: Architectural Committee
Enclosure (1)
P.O. Box 1060, La Quinta, California 922531; Telephone. 760-771-1234 FAX 760-771-5125
*SPA WITH +30"X4'X6'
CRESTA VERDE BOULDER
WATERFALL
* coca flat arizona cobble stone
coping around spa
* NEW SIDE WALK TO SPA
COCO FLAT ARIZONA COBBLE STONE
* TILE ON EXISTING PATIO
& SIDE WALKS TO BE CHIPED
OFF AND REPLACED WITH
COCO FLAT ARIZONA COBBLE STONE
* ANY LANDSCAPE REPAIRS DO TO
HAND DIG OF SPA WILL BE REPAIRED
BY DODSON POOLS/UPON HOA
LANDSCAPE APROVAL
equip
wall
EXISTING PATIO
& SIDE WALKS
U.
pa
pa
i
i
pa
pa
pl �
HAND DIG THROUGH FRONT GAT,-
i
CHILBERG RESIDENCE
CITY OF LA QUINTA
BUILDING & SAFETY DEPARTMENT
CONDITIONALLY
ACCEPTED FOR CONSTRUCTION
SUBJECT TO INSTALLATION AS PER
A ALL APPLICABL CODES
BY 9
GARAGE
Scale: 1 /8"=1'0"
NOTE: LANDSCAPE AND FURNITURE
ARE SHOWN FOR ILLUSTRATION
ONLY AND ARE NOT INCLUDED.
GENERAL SPECIFICATIONS '
SIZE 6 x 7 _
AREA 50 PERIMETER 26
CF T.B.S
COPING rock/flaclstone
PUMP CAPACITY 100 GPM _
MOTOR HP STA RITE HPI .5
MOTOR HP HP _
FILTER STA RITE 300 SQ FT_
FII TFR RATF 103 GPM
SUCTION LINES 2 "
RETURN LINES 2-1-5
CVik AhAC❑ AAnnn ...
GASLINE BY J.U.t-. FT.
POOL LIGHT 100 CLOCK220V_
ELECTRICAL BY. S.D.C. FT..
AUTO CLEANER OPTIONAL
CHEM. FEEDER OPTIONAL _
PLASTER rnl nR WHITE
Name: MR,MRS CHILBERG
Address: 55506 PINEHURST
city: LQ
TRACT PGA LOT#
IdArsol,
POO/S
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
92260 TEMECULA CA.
90
(619) 346-4032 (909)676 -SWIM
STEP FT.
SPA SPECS.
SIZE 7/dia RAISED.
LITE 1 WATTS 100
RI LEVEL SEATS 22" 24" 27"
DAMWALL " X FT.
DESIGNER
DAMWALL TOP
jamie
SPILLWAY SIZE " X It
SPILLWAY OPEN CL
DATE
# JETS 4 UPER D
6-28-97
Name: MR,MRS CHILBERG
Address: 55506 PINEHURST
city: LQ
TRACT PGA LOT#
IdArsol,
POO/S
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
PALM DESERT CA. STE 206
92260 TEMECULA CA.
90
(619) 346-4032 (909)676 -SWIM