0309-294 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby af`'irm under penalty of perjury that I am licensed under provisions of
Cim-pter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # 11 Lic. Class Exp. Date
17916-5 ,A,BHIIC �,+��,• U5/�1/.V
Date �� /: rSignature of Contractor
!' jv ,_�i .fry'%„" ✓-''
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. 1680467-2003
(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 tho'se provisions. i ,,
Date:"- n. ,. <' s Applicant /s:- "'•'� .r ^..,a.;,
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, 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.
Si 'nature (Owner/Agent �`'-" "'=� Date
BUILDING -PERMIT PERMIT#
DATE VALUATION LOT '_4 TRACT
JOB SITE APN
ADDRESS 99 S0li`x'FF'f9.-.,R1 ,X8
OWNER CONTRACTOR / DESIGNER / EN (NEER
AYE C3T;.0WArM. 30N C.R.AiI''ON V r&W 'POQL9
55^599 St7A7;1 X 1iH1L3 2 25 5 11.:1'AMA.'�WX
LA QUINTA. CA 92253 PAUARPRINGS CA 9226.2
(160)78.2100 M1.0 2951
USE OFF^PERMIT
� �7 yy �yp�
�F'1J4�A...PL�YI.�.�/4'.`4. A3.CA
PCOUSPA, 6 IX. 4' HIGH BLOCK WALL A
1W PRIOR TO 1?R PIASTER INSPECTION
4 %f. WALL
POOL AND/OR SPA
6,00 LF
34,904.0 1-3
E5'i'nU. 1. COST O`ir i"O:td'S'mrt7Y,'9�t`i.0H
Zs"IMWr Tt"6 1 BURY
PIAN CHECK FU 101-000-439-318 $547.80
LONSTI UCTION F'LE 101 -000.4 1 8.600 $252.00
NISCHNOICAL FER -- POOL 101-000-411-000 $24.01
`frLECTIUCAL i+ZZ — POOL 101-000-420-000 $+ AD
PLUMBING .FLEE -- POOL 101.13WO.41.9-000 VIA
MR -TOTAL COkB'9'.C'k' IJ0.110M ANIS P 4?el~1' C': W `
S Pfi1-PAID FsM
tq-,02-9
t"p 2 9 lUU3.
FKCS DUF1f NOW
CITY. Ot _ < » : J
FIN.A,N?CE 11°..
RECEIPT DATE
B ." L Dr
25,000M
$5'11.80
$0.00
$511. RD
A
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines,
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral
Pool Cover
A.
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice. (Perm)
P/L
RB V , NO i To EXCEED 40'! n
LAWN14.5.. Ik LAWN c
J,
+18" RBB WAAAMOND TILE VENEER
i
P/L
n
� \36"SHEER CASCADES � i c
_k
L
13'2 8'6-- -
ii c
.460 :- _ I c
• pool-2umbrella sleeve18 ' 3
,
entry steps i spa set @ +i6"
i vac i; I in %.,i /, stucco ext.i
A S spa I five bock jets
bekh -6WL
i
e TAM
'Ldec ddrains SHELF
i - decking.
i----------------------- -------- i
_----------- -- —b ---------
lb ----------' q a
' u riz'te spit way
i
existing wall ; f
20'9 20-0
rXI$TENGDECK 1fl
BUI _ ING, MW"T ;
PROVE
..FO _CONSTRUCT!
Pj � f
! GUDVNIJSON" light switch G1E
i5'
` .
LF; -
s
if�I
RESIDENCE
09/25/2003 13:39 760-320-3667 L SAUNDERS ENG PAGE 02•
9-02-203 3 : 51 PM' FROM GUDMUNDSON. CO? t. INC.. 425.228 5034 P: 1
09/02/2003 16:33 7765111 MpNARD4 PAGE 01"
MA, WEST II REsiDENTIAL ASSOCIATION , TNC.
P+O. BOX 1.282. LA QUT,NT,A,, CA 9243.
(7(o0) 776-516Q PAX (760),77.6-5 .111
Sept�t�a �. x0123,
bqr. do Mrs. Pwmld Gadbftodm
102 !.ohne AV== So.
Rsrtlott"WA 98005
Refe�a,oc - 55.5" s0 atm tUUs, La Qm� CA
Ard*ECMW Mop RaquA P601 9pa
VJrt.1� Nu, a bft Oudnmt&mi
L"be AfthitaCtu[81 G+a+ tae `'Icwad ibis tik colo* as ab d by ym PW oto! and hv*
appIic�ctinn. R b% bum M*A that 9O' dtVwwg wd1cao ] it w htsi t fvt ft be* v[ your
PWI fscwg awomm
.x� � tr�elriteensrat gviddirtes. h is thr
Reviaw by the Cott wiMw is for B9ON&W mb=3'*oc itc& wh ftlr
Tcsponsib" of the own ar to MY m dwtud sora to tl+e at�chtu ctur�guldelim
or WWI dleCtciortata axe n Md dtt * Mirw. It is also the ovnff'es �i.l ni spdtts�ility to laatd vta fy AU
exison c000tim: Tr0 pMc0 dx iigtt wi)! be final Prue rekc m
tlis ArxUitariaAl >� � � �• ,
Aon/d►'dtm 11 i►Xtng chow MUM adherr
Piea:ae, l6efct 't10 pale 7 of X. aihiCb states... 'tom' � Aioasd shall he
m ►he wonet theme unless otherwt�s gpppm+ and mW dawe a ehm, 90 ro tha aib< zf $h ll be
at the (Am&'$ rra,�- : It is oor tetdetst� i 78 that these will be add itioeal 8
oris >lppittadion
Approv* t� by Or At'mtttocctffal CO�euixtittoe am rod for on)Y aix saontbnt >�+ the dau on the
sPpt'�''� liter. tf constrteotlar} has not cbtrtttteitoeti wfthiut s+ac neonths aib 0' the pr�Bew1 aPP�'al date a tttw .
application mast bo %*mitt
ptaasoo cotttaet laviatt Cdtdltaexas. ggpeevitaor fvr Vaft
Gstdcn i0g & Lamt l9arpe esti 7601 i7i6.66G7 md Car+ut
Fullcr, tlto As'a0dispon M$mgN, Fritts to 2M kap?" moM Q tms ass xaatett with this d>=P• DMMF
to the lm*c*n& l.c., sbAft trees, •tlowm and the is " t5bil v of the condor. The i
Im4mming mus[ be bxa0laht beck tc its otigia�l o0arditiodt w� the t� a i§ oo><dp)et04•
Up= co vwim of 700* prom, Pl
lots and ittntn e Nott
x of CM71etitnt of Amlbtoaand
!n the tnt�ntinte if yW h= MW
addfoiUW goaiib+ia or woac�ttac. pleaaC d4 Trot treaitnu to aatalatt Carel
kl ia. M7aVpm.im 1MamVr, A 76121776.5109. bd7 20• . C
MA V= RRESIDE IAL A550OA"
kbr tltc Ata2xit�ca! Committcz � ., .
Carni Farr, CCAN!
Aaeodatim Uhm6a
oc. Board of Di Worn
Unit File
Q;X
I
t
9-02-203 3:61PM FROM GUDMUNDSON. CO. INC.* 4.25'2.28 5034 P.1
09/02/2003 16:33 7765111 MONARCH- PAGE 01
PGA WEST 11 RESIDENTIAL AStOCIATIOINIANC
X 128A 2. LQ(jWrA, CA, 92253
P.O. 0 . .
(760)'776-5160 PAX (760).776-5.111
SWonber 2, 2003
Mr. & MM Dwreld Gadmiodsan
102 Lake Avenue SO.
Radom WA 95455
55.5" South4m MRS, LO Qub" CA
AvAgectitlil ChP9C ROVINt — PW1 Ift SPU
Dear Mr. & him Guidmundson;
The ArduWMW Con W11t�e ftvmwod ax bk calm ps %WftW by, Your Pool wubWgr and bm4y
Vco y
pmv"r application, 'It has been mUd didlym ftwilig w&cMm.Ir in borsht fbt ft.ba& Of your
VOW Wus the 1101f coip[se
.Rcvicw by ibCMMRW 15 ** for gavew confixtWice with the It is the
rcSpons'bft of the awnei to f to the mchimaCkW guidelines criteria Whcftr
fully andmAmd and conform
or not all dies we noted during Micro. It is also the owner's f011 TesPORROWty to field vtT'fy all
vrisdng comftons, The Committee's decision v'n",' .1 ragwd to Project design will bi final. .,Plc= refer to
the ATehiteconul Rules ft? all teq*ed submittals.
p1=9e rcra to page I of 20• which stam—
to rho oro final theme antras other Lw approved arid awry domVe of ChWW 10 the 4fQPvfflMfivfl9d A04 be
at the Owner's expense. ..' it Is our UmkTsmuft that there will be vto'additional landscaping afffimod WO
this 40ication.
C
Approvals given by the ArcWUnuW Comaittee am pad fur only six mauft bom the dale on ft
approval kW if construction has not conatuxuDed within six months after the pro).00 aPP16W daze— a ww
application Hurst be submiuc&
•
pkm cog= jw;i= core.=. sqc?Vm for Wky CwdcMng & Lmdm;qe SA 76OM6-W7 and Oral
Fauct. the AwocMun MawScr. p= to any uvpdiov modifications associated with this chanp DSnMF
to the Wndsc*w i.e.. sbrtft. traiis. flowas and Wd its the 1WW tjr of the witactor.MW
landscaping nuna W Wvu& bock to its original WVftW wW ShC WCOW IS MnOdW.
T.!P= COMACtiM Of YM'pmjm. pleasc wVlcw and remm ne Notice of -Cvapiefion of Ard&c=W
' Change.
In the Incentimc if you lam any additional qw0com or =ccrnr. Oleme do not bak%c to COBW Carol
Ma. Asmi;Wim Manager, at 769/776-5100. E7d, 20,
sinca*
PGA VIM Il RESIDENTIAL A&SQUATION
For ft ATdjih=bu2i Committee
Carol FURcr, CCAM
cc: Board of DbMugs
Unit File