0307-003 (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
Date�-�j���
Signature of Contractor ����� j
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
Se`ciibn 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 DT.AUT, CO)APHIMA.'I'I Policy No. 00-0168-20103
(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 Sectio 3700 of the Labor
Code, I shall forthwith comply with tho e provisions.
Date: 7%' /} Applicant-
Warning:
pplicant Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property`.for inspection purposes.
Signature (Owner/Agent)':45.444-Date
a--- PERMIT #
PERMIT
-.-BUILDING . os f.
DATE VALUATION U 7 If1�,f LOT TRACT
JOB SITE
ADDRESS7�9°iLn��e��aA%af
APN -
141 _-5
OWNER
CONTRACTOR/DESIGNER/EN INFER
MR. Atdlr+ OR AlRS:MORM
CXIf%t'fa[IA "00.1; :T.PA3 (riDP M;'i AC. 0
37-4.1 h SPIt,Al2H RML LANE
£3%-100 x� i�:ta�r• 54
LA(.�TANTA CA, 92253
CA 92236
(mows -9222 csht '}t" um,,
USE OF PERMIT
,x'00),.. AIWOR RI :&
i'i3$�JJSN .��1.<€1Ld.as C6L•1?!•lVW� i{4Sat:�`i'A' iEd�JIFi+`fiil j, eel L C°.
4' BBC°K'#A1At CITY rN
MACE AT INFd.' -PU, S'TZlt
4 iI'. VMLL a"" Q :LF
POOL ANflle',�� SPA 16,340.0o x.,b
ESM UND COST OF CONST EK" 'ION
i
17.mwo
PLAN (°.k1 IC Fk'1 •• ,101-(00.439.316 $11%00
CC7hI VrRU`C A'10X,10f 1. G1 -WO-4.19.000 V�i�i,,:7i1 .
MECHANICAL P�"B — POW, I-DI.000.421. 300
ELF'PJr,.AJ', ),7?2 —POOL 101-000-420-000
PI.UNDING FEE POOL - '10 1�Q00-,c 19.000 b??.f7ta
JUL 09 2003
y CITY OF LA QUINTA'
= FINANCE DEPT. 33r
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ff U B�l -'1't ' 'Ai. C' }. 1 i?:'Ut Tif �R1';A' R-) PT •.ilk dk
• Y.as.1 F-1 t1P�'r.:-F Is
Df"V1A•e]: IMINW, PWAV DI A,' Vi�:`S!
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4Yw�.l�a oi.R7
r
RECEIPT
DATE
BY
ATE A D
INS OR
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 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
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 Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
06/25/2003 15:01 7605642329 PGAWEST PAGE 01/01
.0
FAIRWAYS ASSOCIATION
June 25; 2003
Mr. Alan Morse
2800 Elliott Avenue #1128
Seattle, WA 98211,
RB: 57-403 Spanish Hills
Pool, Spa, BBQ, Fire Pit, & Decking
Dear Mr. Morse:
At the June 23, 2003- Architechau /T_,andscape committee meetiiag the plains that you'
submitted were reviewed and approved with the following conditions:
• U the water lines for the pool are within the five foot setback, than a variance
from K.SL is required.
+ The BBQ can be relocated to be 1-% feet fro:oa"the sidewall if the neighbor signs
off on the change.
If you have any questions please contact me. .
Sincerely,
Donna. Man cio, CMCA
Association Manager
DM/ncp
CC: California Pools
Wayne Myers
V.
Post Office Box 1658 • a nuinta. California 92253 •phone (760) 564-3858 • Fax (760) 564-2329
Yi�