0108-296 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am lice•ised under provisions of
Chapter 9 (commending 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
Date Signature of Contractor,AAa
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from.the Contractor's
License Law for the following reason: U
( •) 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.
j(t�) 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:
Cartier Policy No.
ST Rf E C OVIPENaATf 046006168
(This section need not be completed if the permit valuation is for $100.00 or less).
( ) 'l.certlfy 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,'lahall forthwith comply with those provisions s
Date: ' Applicant
Warning: Failure to secure Workers' Compensa coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100;000_,rr—
i
r�G:a
addition to the cost of compensation, damages as provided for in Sectiehr, 06
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building an a ty
for a permit subject to the conditions ,and restrictions set ,forth or is
application.
1. Each person uporimhose. behalf this application is made & each pe son at C!'
whose request and for whose benefit work is performed under or purs ant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance ofksuch
_ permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building.
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned propert�for inspection purposes.
A44Signature (Owner/Agent) � -��+" J-' � Date 6)
BUILDING PERMIT PERMT#
/
DATE f VALUATION LOT ��., TRACT
JOb'-SITEAPN
ADDRESS
is IwvP lsa BAY `�� • .
_
OWNER
CONTRACTOR/DESIGNER/EN INEER -
2280 •i AITMLC7W `M.t"..CnL4 WI1E 150
74'.725 JC)2TD. 0W% ffl%ireVA,
CC71r1:O141K CTs 91720
PALM DESEEff CA 92250
'
('760)24.0-9000 amo 355
USE OF PERMIT
POOL AMYOR UPA
daMAA."PA. Aii.Fi.e' M3W—i 1FKS SHALL RE IN Nf. CM? AT 13bti'.Z PLA,`.M.R
bRMI.C:•" ION. POOL EQUIPMENT ENT ZIMCLOSWRE NOT 111CLILIDEO,
P001}pil}DIO SPA 19,:W0,00 I's
.
��•4Mv+{�,ih.�.it'�a AY��4�N.'0v
11b" CrIFI Ful 101-000-439-318 SHUM
CON11`I'MI'LIC TIM FXF1' 101 -000-41€6-f.XX) SM.00
KWHA1zilCAL FLU, - POOL 101-000-4,21-000 01.00
E��� F,;y�Gpg'��I��'iyyt' ICAxL. I' — F'�001, 1 -f/7�t�/D-,�(1
y� (0
y2(0-fg'�Ify��•}0 p$r45.E00
3 P Y.(i7'lVAb7l f I FEE, — P0V1, I ;l 4P 1 "114��'^"P l "� � V N4✓ %2 100
.
V• 9
T 2;5 2001
I'y OF LA QUINTA
�1POANt E 17=?% 4�"f"�OL C. :�1 k°]� Tf 1101ST A14D 1r7..AN C'`�'1� K
x.55
IMS r�;SY PATJD Fh FS
TOTAL .1"M S' 3 IMS DU Nt)W
$437_55
RECEIPT
r�
DATE
BY
DATE FINALED
INSPECTOR
6
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
i F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
i
Exterior Lath
Drywall - Int. Lath
i
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond ��//��
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
i
Underground Electric
Underground Plbg. Test b
Final
�O
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 5
Gas Piping
Gas Test
Appliancps
Final ��HS ' 7!" Z
COMMENTS:
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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
PALPGAWES,
r�A -
FAIRWAYS ASSOCIATION
October 17, 2001
Dr. Anthony Mills
1 544 North Doheny Drive
Los Angeles CA 90069
Dear Dr, ?Mills,
At the October 15, 2001 meeting of the ArchitecturaL'Lendscape Committee, your request
for the pool, and, spa was approved upon the following conditions:
A' There roust beat least five feet from the back property line with no
obstruction.
B. You need to request an easement agreement from Barbara Larsh of.
KSL. .
C. Need to submit landscape and irrigation plans (not allowed to tie into
associations irrigation) along with the required deposit.
If you have any questions, you may contact, me at 760-564-3858.
Sincere
Donna I nacc_o
Association Manager `f ,
P.O. BOX 13710 • i'ALtil DESERT, CALI>!ORNI.4 92255 % Tel. (760) 776-5100 • Fax (760).776-5111
email: pgawest(2monarchgrp.com