0108-187 (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
a6 28 � C i �mc; r -fid r,"I'fi � �• 19�C
f
Date 5� Signature of Contractor
O
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 which1his
permit is issued. My workers' compensation insurance carrier & policy ho..are:
Cartier Policy No. =�.•:
Sit:Eb`V�` £ Q�16f6S$
(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 ppvisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
Bate: Applicant ,/
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 thisapplication 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•(esult 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
theFabove-mentioned property f r inspe4 _Action ,purposes. r
S'nature (Owner/A ent) IVV," Date • l
U.ILDING PERMIT PERMIT#
DATE �; / �� ,-LUATION LOT TRACT
JOB SITE
APN
ADDRESS
54-900UQT0•'j)(�Y Hq y
AR
OWNER
CONTRACTOR / DESIGNER / ENGINEER -
z erg.�:���i/:�119'' 'PI ;
Cy.{�yl AB (`�?P :kbfA C01
A�.'i�CglpC�3I;.S�y�ycY
�
y�A�lp�f�3•�N MUS
54-4 00 SOU A4�.0>�E 4S3�.Y1s7 S
54-4900
�1�v'C+'d3,���iiI
p�;
74&.4•J d:fNI J./PJYZ �T 4.FS.aE#A
LA QUINTA
PA.:M DESM CA 92260
(760)340.9000 CRU 135
USE OF PERMIT
POCIUSSPA..Ald'.. NSA RARS Stl 1f U, BE IN PLAGZ M PRE-PIAMfEp,
WSPW'VON, POOL EQUIPM.EN ENC1.O SiSRE 'N01' WCLI DED. BBQ.
ANSI 721-58-1993. 29 W f3T+ T I9LOCrFC WAI.,LS-, C1'TY' STA14DARD.
P��01,.ANDIOR SPAAM," i's
WALL 20.00 L?
y:
E2+�MA' COST OF Cd3AMM'RUCT1eJ11
1 ANT CHWK ME 101-000-039-318 MOM
ItR1?f:liiic'aASf•C;.,,1iL Fa -• PPOL 101 r5)00-421.000 $2.4.00
EJE.EG�rE{l.£';�,At, .F,— Pd;x511,, "101-000-420—.000 $45.00
:�' ,1li�r O Ifrirs -- pQO„� 101 ds1i��41 ':000
AUG 21 2001
.. CITY
NC QUINTA
SUBAOTAII L"t`3
r R -PAID S0100
-w
RECEIPTDATEi%
��77 r I'(1�
BY
DAT F A D
I ECT
R v
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL A�RROVALS
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
Footings
_ _
0 g
_
Electric Bond
Main Drain
Bond Beam
_ _
�oa_ _ � � 6�
Approval to Cover
Equipment Location
Underground Electric I _
Underground Plbg. Test
Final
Gas Piping
p PLUMBING APPROVALS
Gas Test
Electric Final
�'JUaste Lines
Heater Final
Wt�ater Piping
Plumbing Final
!P[Mmbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
/ _
. Pool Cover �f/m/um—
Encapsulation /G y p /7-i m`
Gas
Gas Piping
_ —
Gas Test
Appliances
Final f
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 Defectors
Temp. Use of Power
Final
Utility Notice (Perm)
,SENT BY: PGA WEST RESIDENTIAL ASSOC, I; 760 771 5125; AUG -15-0i 4.:41 -PM; PAGE ",213, . L
tAl
%j Y
N7.�.t O� fHO
POA WEST .,---•--- —
RESIDENTIAL ASSOCIATION, INC.
,t
E.
August 15,.20 01.
Mr., Bruce Redmon . t
54-900 SoutherrHilis
• La Quinta, CA 9225:1
Dear Mr. Redmon:
The plaits to construct a pool and spa at your 54-900 Southern I•iills residence Have been reviewed
by Mr. Don Adolph, Architectural Committee Chairman. Approval has been granted on the
condition the following stipulations must be satisfied or adhered to: -
1. A gate is required in the new wall ati 'shown in the plans.
2. Ali grass replacement is to be sod r - '
3. H(aneowner will be responsible for any damage to golf course property. -
4. Keep all new, construction back IT' from property line.
We appreciate your cooperation In submitting 06'request for approval. if E may be -of further
assistance,-please.contact me, at.the.HOA..office, (760) 7717-1234,.Extension 15:
Sincerely;. :
Ke McOalliard
Operations Manager 4
KM/sno
cc: Architec:t4ral Committee" „
P.O. Box 1060, La Quints, California 92253,' Telephone 760-771-1234 FAX 760-771-5125
s