9810-152 (CP)LICENSED CONTRACTOR DECLARATION
U) I1` I hereby affirm under penalty of perjury that I am licensed under provisions of
I- Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
C14 W Professionals Code, and my License is in full force and effect.'
O n m License # _ Lic. Class Exp. Date
C'1 $37412T .A
r— W
~o Z � Date -'? % -4 Signature of Contractor , 7"
CD 0
I.— C) OWNER -BUILDER DECLARATION
cD
LU W I hereby affirm under penalty of perjury.that I am exempt from the Contractor's
~ tl License Law for the following reason: i
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
LO
N Date Signature of Owner
ON
rn
d Q WORKER'S COMPENSATION DECLARATION
2 Z I hereby affirm under penalty of perjury one of the following declarations:
O . () I have and will maintain a certificate of consent to self -insure for workers'
K W �= compensation, as provided for by Section 3700 of the Labor Code, for the
D � Q performance of the work for which this permit is issued.
n Q U ( ) I have and will maintain workers' compensation insurance, as required by
j U Q Section 3700 of the Labor Code, for the performance of the work for which this
i rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
,Zt Z Carrier Policy No.
R Q
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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply w1 ith�tho�se)provisions. k1
Date: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to . the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void 1f
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) � = _..' - ( Date—T
BUILDING PERMIT PERMI'#810-15g CONTROL#
DATE "VALUATION S" Jr4r)$%04) LOT TRACT 8 514
JOB SITE "57,443 COLONIALAPN
ADDRESS`
OWNER
CONTRACTOR/DESIGNER/ENGINEER
rr 'INS WEST HOUSING INC
y"" VE, DODSON CC�'LTSTRUC�TIC I
78.101 V 1-ICCH*AY 111 j
73011 COUNI'MY C"-1;Ub JIM_ SUM, 1-4
.L QUIN-V . CA. 92253
PA VI Df.;tilsWr CA 92260
' - !
f7fOl;�nfs-4Q32. f�i�I.,4� i(1r14
USE OF PERMIT
fJ00L .AND/0R,, SPA
1100USPA, AJ..t11tM&i ARRI RS SHALL BE IN AT PRE-PU1S iT-A—c
iNSPFC 1W.8N.
POOL ANYDIGI3. SPA 3 ,9!!M.00 1.J
i
V
REIRlbT T FEllSbAW.ti&(V
LAN t'"i•1t:CK VE6 101.000-439-3111 Vsw"Uf.K3
rr�nf�il rTc;'r�rr!d �; I0(.W(!-4184KHI
,iii^�aiu",w' C A1 17 to .._ T'OCiL 101-i�li'i -121-000 o2y.CL'
ftEC:'TRK,'AL, 3TEE -•- POCA. M -OCI-+120-W o4S.(ff!
P1;UMB1N4 C'isE--Pt.1OL i.0.1-000-4t9-0f)(f b27.tW
g { Yrt !1, C ')N�"i�P.�GP0N ANi:) TJI.AV, C-4ECK
�r;�)S 33
OCT 2 81998
11.` K My q. p a DUE
tf NOW
MUM,
{ e (
*,ITY OF LA. QX011
01.
RECEIPT
DATE
f3y
DATE FINALED
INSPECTOR
�.
G,.
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 Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain'tv
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
Sewer Connection
Pool Cover
Encapsulation l
Gas Piping
Gas Test
Appliances
Final Z,Z„J!�
COMMENTS:
n
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.1.
Smoke Detectors
Temp. Use of Power
IF
Final
Utility Notice (Perm)
OCT -28-98 03:16 PM DODSON POOLS
c
PGA WESTy
7603410895
~ PPI N," _619 776 5,11'
PGAWFAT 11 R3s81fl81MAL ASSOCIATION, INC.
RO, BM 1282, LAQtriNTA, CA 922S3
(764) 776-5100 PAX(7W)776-5111
O[hober 2�,1MJd
W. Gee M[Q mIc
750 5 StreA SW. 3140
san aep, CA 92101
RE Pool APPWW
ace► c,�o�r:
The PGA WEST 11 Resl"mMal Assv ,aftn ha= t® !9wo l.the pians for td IrMWIStlan of a
VWPVrdnp phot at 57-443 colonial, Trtd 428104. This letter vv?II W" as cmdal
aWmvel brthis >pwl to in built a$ per plan subffl ttod,
hm* you for ImOvding the Association is this process, cal me 1f I an be of any furew
essistenc�, ,
Sinwely,
ion J. Mmahan
AuWatlan Marmot
CC: 804 at Ch"mC1 M
P.01
Td Wk -'-43:80 466T GT 'da -r- - , 'CN 3140Hd : w0cj
SPA AT +18"
/- AIRPIPE
241-61#
L
P/L
R31-5
STRIP FORM FOR FINISH
R51-9 11
EQUIPMENT 5' LOV
BOBCAT ACCESS
RS'
231-311
l E 7
STACKEn -WATERFAI I uu;
SCA
WATERLINE & CAP FOR CA
t -+18"BB
.... +151IMPOFDAM
IC
WALL N'
4 A rCEP'
5 p':
T'
SUBJEC.1 u ll'4
WATERLINE
........... B
. .......... ....
..........
.............!DES
'ix
f; 0
WIDE
...........
:SPA DAM l BY
-MM . . . ...........
WALL
..............
Q
.................
...... ....
P/L
R8'
BACKSIDE AT +12"
R5'-3" ' 12
5 1616
REMOTE LIGHT SWITC• DININGR
ROOM
3
R8
FREEFORM RADIUS
GENERAL SPECIFICATIONS
SIZE 12 X29
NREA 263 PERIMETER 75
m
MOTOR HP STA grrF HP1.5
MOTOR HP ............ HP
FILTER STA RITE 300 SQ FT
Fll* TFR RATF 102 GPM
GASLINE BY DOD FT. 1.50
POOL LIGHT 400 W CLOCKT1 04R
18U I USttl-
...... . �Nttl ...
.. ...........
ANTIQUE GOLD BOULDERS
D OT DOD SQ• 1261
DECK TYPE SALT FINISH NTRL GREY
STEP FT.
SPA SPECS.
SIZE 7 RAISED YES +18"
LITE 100 WATTS
TRI LEVEL SEATS 22" 24" 27"
DESIGNER DAMWALL STACKED
- DAMWALL TOP QUARTZITE
RANDY/EV SPILLWAY SIZE x WIDE
P/L DATE SPILLWAY XX OPEN CLOSED
1 # JETS 4 UPER LOWER
9-28-98
Name: TRANSWEST/MASAYOSHI PLAN
Address: 57-443 COLONIAL
CitlL LA QUINTA
TRACT AUGUSTA LQI# 41
DO dS ON
X00 S
G/E
PALM DESERT TEMECULA
73-011 COUNTRY 28910 RANCHO
CLUB DR. STE F-4 CALIFORNIA RD.
-A PALM DESERT CA. STE 206
TEMECULA CA
,PE AND FURNITURE92260
(619) 346-4032 92590
VN FOR ILLUSTRATION
ARE NOT INCLUDED.
LIC # A-574127
291-611
1 ---------------------------- I -------------------
30'
NOTE: LAN
ARE
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