0205-143 (RPL)LICENSED CONTRACTOR DECLARATION
1 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
656128 C5$i�iC' `� 10/'31M
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). s r.
( ) 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�J I have and will maintain workers' compensation insurance, as required by
-SeRlon 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 SIZVE tMOMPENSAT1 Policy No. 016,0006168.9).
(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 t dse provisions.
Date: _�- Applicant 7
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, indemnity
& 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 f nspection purpo es.
Signature (Owner/Agent) ✓ . Date
B
PERMIT #
BUILDING PERMIT 02,M-143
DATE _ /� VALUATION.atTRACT
LOT ;i�
ADDRESS 6^850"1' (r�-,L�L°d1t'OOD JOB SITE APN 4
OWNER CONTRACTOR / DESIGNER / EN (NEER
MO2d"'di0YA C.ALIFOR?+3LA POOLS SPAD kTOP MAN C10 FC:
54-850 TANCzt.MOM -1472Z, xx1 I?3.alye, mm #A
LA QUINT A CA PA1'.14f: OYSM CA 97260
f/6p33410-9 00 OUR 0.0335
USE OF PERMIT
POOL .ANDICYla. SPA r
PRE-PLAS f. Er'1 INSPEe T ION.
POOL ANIVOR W"A
MOR TO
191000.041 1�f3
d' i)VADSACJa'.i..Au&/ CoNX O., AvOi'1S.7.RNlCTI\.s'N
1'ERWI-JUS SWMMA'f Y
PIAN CHECK'994 101-000-439-338 $12&7D
CONSTRUCTION F", 101-0M418-000
WCHANICAL �•_E--F0'OL 101-000,421-000 1 $2,4.00
i�:l:�.�,".f alt; AL. rNE -- IPOO1 101 -000 -;no -ow $0.06
PLUMU NO IFFZ - POOL ` 101-000.419.000is
MAY 16 "21062
CffyOF LAQUINTA
(' R
f
.ey
RECEIPT DATA `r � I BY ' DATFjb7 A.;-
' IN PE R
:r%�9 22.70
$0.00
;SQ2.7C
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
BLOCKWALL APPROVALS.
Steel
POOLS - SPAS
/
Set Backs
Electric Bond
/y
7
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
W'3ter 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
Appliances
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)
Final
COMMENTS:
:19&k OF
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
May 2, 2002
Mark and Janet Montoya
54-850 'I'anglewood
La Quints, CA 92253
Dear Mr. and Mrs. Montoya
Mr. Don Adolph Architectural Committee Chairman, Inas approved your request to install a new
pool, spu, decking mid barbecue at your -54-850 Tunt;lcwood residence. Plcasc note: A minimum
ol'a 4' wall to screen off the pool.equipment n-.ust be installed. Also, any dantag to the lawn area
must be replaced with sod, tlpon uotnpietion pLase submit the citclosed Notice of Completion form
to this office.
We reserve the right to stake a final inspection of this change to make sure shut it matches the
original Request. An approval is based only on the aesthetics of your proposed plan and should nett
be taken as any cel'itl c atim as to the construction worthiness or sti-betural inteority'of the proposed
chunge.
We appreciate your cooperation in submitting. this request for appruval. 11'I may be o1' further
assistance, please contact me at the HOA oPtic�, (760) 771-1234 extension 15.
Sincerely, .
Mc Iliard
Kell y;
Operations Manager
cc; Architectural Committee
F•.nclosurc
P.O. Box 1060, La Oulnta, t✓a;'MMA 922,;:!' 4, Telephone r60 -I/1-1234 FAX /60-111-512b