9907-629 (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
'l4fessionals Code, and my License is in full force and effect.
—License # Lic. Class Exp. Date
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).
('`C ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code .%
() am,gxempt under Section , B&P.C., for, this reason
flDate ate `9 t 1-1'r- `, Signature of Owner (.. E N; 'k•"I
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 Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
(f) 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 provisionsiof Section,3700 of the Labor
Code, Ix shall forthwith comply with,tho e provisions. f"
Ate: 1 `► 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 Ahe 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 harmle'ss.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) "- Date ' I./ a
( 17
BUILDING PERMIT PERMIT9M,H}?-62n
DATE [tt 1 VALUATIONLOT TRACT
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JOB SITE I
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER//ENGINEER
1
CHRIS AAKA�hDEVI �D
OWN, WMA t,DER
7 440 SPYGLASS HILL
1A QIJ INTA CA. 92253
USE OF PERMIT
POOL& SP.A, ONL }`. ALAFtMS)''3ARRiLR i !iii LL IE fltd ;t'LACZ-'. l' 7'TW..
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POOL ANt:3IOR SPA 10,6130011.3
.¢+1sr,.9:fit'Y.6'11•ra) YDS-B':ll� 1A�1,� L.'t.Jl ilJT.hMerno ,
Ali 1'ILV,A�V�'�V�1
PERMIT VVIE, 11;3mw��'�f
PLAN' c:'ISI::Ci FUR 101 AM I-019-318 $7G_04
C`OihT;.i"f FtC"!1C7!yi i% E(II.d1EEltb-41��-(D!�31 fyy17.M
N%L11ANIC&L 11TM pool, 1011-000-424-0) $124,00
W. Ci'RR:.AL tW3''- NKA, 101 C7l El 2ff i 3A5_0
PILUMlBM RIE --COOL 101 -(M -419-0(k MOO
x
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LESS 11., x;-NUD FEES
sO.t q
TOTAL L AMMILT FIMS OIl E' NOW
r,
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
mac?
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
Partv Wall Insulation
; Condensate Lines
Party Wall Firewall
3
Exterior Lath
Drywall - Int. Lath
i Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
i Final Q�
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)
COMMENTS:
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I CITY OF LA QUINTA SUB -CONT CTO"S
JOB ADDRESS g ��17 Sp I qSS y` I I. PERMIT NUMBER OWNER(��''�S 1 0 � BUILDERgQ— r
This form shall be posted on the job I�Building Inspection Card at all times in a conseicuous Place. Only persons appearing on this list or their employees are authorized to work
on this job. Any changes to this,list must be approved by the Building Division prior to commencement of work. Failure to comply will result in a stoppage of work and/or the voidance
of building permit. For each applicable trade, all information requested below must be completed by applicant. "On File" is not an acceptable response.
Trade I Classification
Contractor'
State Contractor's License
Workers Compensation Insurance
City Business License
Company Name
Classification
(e.g. A, B, C-8)
License Number
(xxxxxx)
Exp. Date
(xx/xx/xx)
Carrier Name
(e.g. State Fund, CalComp)
Policy Number
(Format Varies)
Exp. Date
(xx/xx/xx)
License Number
(xxxx) -
Exp. Date
(xx/xx/xx)
EARTHWORK IC -121
73 7 3p
06M�e7
O & 3
S t QO
y 83
Y// Op
CONCRETE (C-8)
C—V
22-7- r- U iv
-�-oU
FRAMING (C-5)
STRUCT. STEEL (C-51)
MASONRY IC -29)
P �
(,j;
5-10 Y Z-
!A �1 (707 -
PLUMBING IC -36)
LATH, PLASTER (Cr35)
ig
t
DRYWALL (C-9)
L) G
C 16'
Z O
O
Rio 4 u
1405IO - O
11(2131iq
31$
� Ifo
HVAC IC -201
ELECTRICAL (C-10)
ROOFING (C-39)
SHEET METAL (C-43)
FLOORING (C-15)
GLAZING IC -171
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING (C-33)
1 2 3 9
CERAMIC TILE (C-54)
��.
5
7y jy /�
s a74 0 :
153 91
Lo
5511
t
CABINETS (C-6)
FENCING IC -131
LANDSCAPING (C-27)
POOL(C-53) t'7u^�
Ste. �f.C� >uFli.
7S�o yZ
/�tlQi`i� +"�
2217 .R9 =.OOIy D
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y 15 y
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LA QUINTA FAIRWAYS HOMEOWNERS ASSOCIATION
AVAIL PROPERTY MANAGEMENT
P.O.. BOX 1032
PALM DESERT, CA ,92261
(760) 568-2717
August 5, 1999
Mr. Chris Todd
78-840 Spyglass Hill Drive
La Quinta, Ca 92253
RE 4,'Architectural Approval
Dear Mr Todd:
The Architectural Review Committee. has reviewed your request for the rear yard
pool and landscaping. "The committee has approved the request as presented:
All construction debris must be cleaned from the front yard and street each day
before ,construction workers leave. The side gate/wall must be re-installed to
the exact location and. specifications it was prior to its removal. , All necessary
permits froin the City-of La Quinta must be received prior to work starting.
Thank you for your cooperation.
Sincerely,
Cam Anderson ,
Project,_'Manger:-, %11,1f ,,3 :4
OWNER/BUILDER INFORMATION
Dear Property Owner:
An application for a building permit has been submitted in your name listing yourself as the builder of the property
improvements specified.
For your protection you should be aware that'as "Owner/ you are the responsible party_of record on such a
.permit. Building permits are not required to be signed by property owners unless they are -personally performing their
own work. If your work is being performed by someone other than yourself, you may protect yourself from possible
liability if that person applies for the proper permit in his or her name.
Contractors are required by law to be licensed and bonded by the State of California and to have a business license
from the City or County. They are also °required.by law to put their license number on all permits for which they
apply.
If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be
aware of the following information for your benefit and protection:
If you employ or otherwise engage any persons other than your immediate family, and the work (including materials
and other costs)` is $200.00 or, more for the entire project, and such persons are not licensed as contractors or
subcontractors, then you may be an employer.
If you are an employer, you must register with the State and Federal Government as an employer,and you are subject
to several obligations including State and Federal income tax withholding, federal social security taxes, worker's
compensation insurance, disability insurance costs and unemployment compensation contributions.
There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with
respect to worker's compensation insurance.
For more specific information about your obligations undei_Federal Law, contact the Internal Revenue Service (and, if
you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State
Law, contact the Department of Benefit Payments and the Division of Industrial Accidents.
If the structure is intended for sale, property owners who are not licensed contractors are allowed .to perform their
work personally or through their own employees, without a licensed contractor or subcontractor, only under limiied
conditions.
A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building
permit, erroneously implying that the property owner is providing his or her own labor and material personally.
Building permits . are not required to be signed by property owners unless' they are performing their own work
personally.
Information about licensed contractors' may be obtained by contacting the Contractors' State License Board in' your
community or at 1020 N. Street, Sacramento, California 95814.
Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of
these matters. The building permit will not be issued until the verification is returned.
Very truly yours,
CITY OF LA QUINTA _ y
DEPT. OF BUILDING AND SAFETY
78-495 Calle Tampico
LaQI inta, 92253 ,
(760) 7 7012 '
F6) 777- 11
i Ike
O 'S SIGNATURE/DATE
1$ F O C_
PROPERTY ADDRES
PERMIT NUMBER(s) t
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CITY OF'�LA
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APPRO -
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By
DATE
A - RE -INSPECTION
WILL BE CHARGED IF I
PLANS AND JOB CART
THE SITS. fOR..*''A
:FCOPIN(
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POOL
PUMP
MOTOf
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FILTER
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TURNO'
SUCTI
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GENERAL SPECIFICATIONS
SIZE '/0 Y,
AREA 177 PLKimETER 57
5
DEPTH -
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CNriIrF- MDT175 So. 50
CITY OF'�LA
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B I VEC
APPRO -
FOR
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By
DATE
A - RE -INSPECTION
WILL BE CHARGED IF I
PLANS AND JOB CART
THE SITS. fOR..*''A
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POOL
PUMP
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'A RITE 300 SQ FT
INES —2
pFL AMERICAN
LYE YES
Of "o
U)MVED
E NOT ON
HEDULED
ELECTRICAL BY. FT- 200
AUTO CLEANER ...........
_CHEM FFFQFR ........
PLASTER CQLog KE; FMS. TAHOE EWE
2LQ�.RY DOD SQ�'91 3
DECK TYPE
��Ep 2 FT. 12
SPA SPECS.
SIZE 7X5 RAISED YES ;IV
LITE 100 WATTS
TRI LEVEL SEATS 22' 24' 27"
DAMWALL STAIRSTEP
DAMWALLTOP MUARTZITMNJL�
-SPILLWAY SIZE -WIOE
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