0309-288 (RPL)LICENSED CONTRACTOR DECLARATION,
14hereby 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.
979165 A B RIC ''` �f .r y✓ /31/2(
0
,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 STATE FUND Policy No. 1689467.2003
(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.r�°`
Date: 21 m?: -c^°�` Applicant_
Oy
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 .ori 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 i D
work is not commenced within 180 days from date of issuance of suc
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 i
correct. I agree to comply with all City, and State laws relating to the buildin
construction, and hereby authorize representatives of this City to enter'upo
the above-mentioned property for inspectionpurposes. eM .
Signature(Owner/Agent) ~ Date 7
P
BUILDING PERMIT PERM T#
0309-283
DATE VALUATION LOT. TRACT
JOB SITE
APN
pq�� ��,Yy�^�. y�•�3�,t •
ADDRESS as';. 426�AAA.v4,r1A['r��00.1)
.•. .
OWNER
CONTRACTOR/DESIGNER/EN INFER
vS i�Z.A tC°r E> iTI iI ,
CA"ON ViM POOLS
55.426 TAXQLEWC)CyD
22:51~ T,AMARMC
U%QTIlITrA CA 92'233
PAIM SPIRD1CS CA. 92262
(160)7'18.,2700 MTA '2951
USE OF PERMIT
:E OOL ANDIOR. SPA.
POIDI d5.PA, 4 LB' 4'HIGH IGH BLOCK WA.e, , .ALA>R(d.SM A.RRIERS SHALL BE
IN PRIOR TO PRE-PLAZTER INSPECTION
4 FT, , V A11 ,
POOL.t1.1MIOR: SPA 10,936.00 LS
: MINA'T'O) COW OF C±G)MM74M..W011
23100.00
P'E1R''.61M SUMMARY
PLAN CHECK NK) .101-000-439-318 �13Q.Sg
Ct3'I+fST.RUCTION FEE 101-000,41"00 ��Q7.ib6
MMWICAL FEE -- POOL 101.000.-421-000
Z12CTRICAL FEE— POOL
PLIIMBiNO ME --POOL 1.01.000.419,000 $27.30
RM -TOTAL C;OWfEW SON' AND PLfi-W C:RECY,
$4 31'.5:5
LES PRE-PAU) rS20
$0,00
v 7.CalAL PTI R T FF -C-8 DUE NOW
$437.55
SEP 2 9 2003
CITY OF LA QUINTA L ,
4
BY !'
DATE FINALED
INSPECTOR
a
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
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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
OX for Finish Plaster
Sewer lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final.
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 Detector;
Temp. Use of Power
Final
utility Notice (Perin)
09/24/2003 :16:41 760-320-3667 SAUNDERS:ENG PAGE 02
K 'f ,r - I • +' " +4 r to " 1 t _ +� •
t w
"'GOLF COURSE ; t
5'0 LAWN r y ' i 5'0
five spa jets ! y �"umbr¢Ila sleeve , • 4 _ LAWN ,N
'
spa set @
stucco extPOOL
(7�O
7'7R ('il
` 'qua rtzite splllway_4 WO
10'10 I u t 17'0
3.6 C Sro `r
umbrella eeve
sir / ANNNGLEDGE
LAWN /14'1
A, 5�,
bench
USE QU RTZITE FLAT
st m stones ste in stones
LAWN' . PIEGES
decking P/l..
existing Wall!
r 35'4
24'10
` P/� / FILL IN WITH I
' Arizona smooth
LAWN F
giver rock `` BBQ
:4
by ogwner ,
EXISTING•PATTO ; \\
4 light switch
G/E . FHP -
,
RESIDENCE 15p- WAU,
J l' GATE
GAS RUN MUST BE MADE AROUND FRONT'
OF HOUSE AND DOWN RIGHT SIDE OF F LA Qu'NT'A
YARD TO, EQUIP. LOCATION ILDI G
(Le,S & W Err D��
APPROVED
s GTION
VATS . .
3667 FAX 2295 East'axnari,sk Road. -Palm Springs, CA, 92262 � License No. 77!
09/24/2003 16:41 760-320-3667 SAUNDEHS 6N5
SENT BY: PGA WEST RESIDENTIAL ASSOC, I; 760 771 5125; 3EP-24-03 3:30PM;
PGAWEST
RESIDENTIAL ASSOCIATION, INC.
September 24,2003
NAUE 03
PAGE 212
Ms. Sheila Rosenthal
55.426 Tanglewood -
La Quinta, CA 92253
Dear Ms. Roeenthal,
The A.rchitcetural Committee his approved. your plans to build a pool and spa at your 55-426
Tanglewood residence contingent upon the following:
♦ Protect existing surfaces, etc. in access ar °as to the street.
• In the event that gas and/or electric rg)air is necessary as a resul,t of this
installation, the homeowner shah bear the Expense.
• Sunl3rclla color is taupe.
• please contact the Homeowner's Asuxiation regarding underground
locations of the irrigation, gas line, and - ririnlg prior to digging.
We reserve the right to make a final inspection of this change to make sure that it`mauhcs the
original inquest. An approval. is based only -op the aesthetics of your pmlx,aeci plan and should not
be taken as any certification as to the construction worthiness or structural integt1ry of the
proposed change.
We appreciate your cooperadon in subnufring this itquesr f)r approval. It I may be. of .further
assistance, please contact me at the HCFA office, (760) 771.1234, Extension 15.
Sincerely,
G -
Ke cGalliard
fvr the Architectural Committee
KM/bvf
cc Architectural Committee
R0, Box 1,060, La Qulnta, Cellfvrnis 92253, Telephone 700-771 - . 1234 FAX 760-771-5125