0008-390 (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
514117 f1 1/2(
Signature of Contractor.
OWNER -BUILDER DECLARATION
I herebyaffirm under penalty of perjury that I am exempt from the Contractor's
License Law for,the following reason:
( ,)` I, as owner of the`:Oir perty, or my employees with wages as their. sole
compensation', will do th6.v ork, 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 UTME PUNT) Policy No. 046.00-000W34
(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.
Date:. 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 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) Date—
,
BUILDING PERMIT PERMIT"
1
`L8-S9O
DATE t 1 � VALUATION LOT TRACT
,
JOB SITE
APN
ADDRESS 54-4." 05 01M M T -MLS
- -
OWNER
CONTRACTOR / DESIGNER / EN (NEER
W"T1t & 1?AU ..4 DAVIS
S'I'EVE DODSON C;ONSMUC;17014INC.
54.438 SOLTIEI I E1{ILS
7301 i COUN'CRY mum iYA., atJxS:t7 F4
L-A QVI NT.A° ,= CA. 92253
11AL M DF kRT CA, 92260
(760),3464032 OBL4 1044
USE OF PERMIT
P00F° AN YOR 1'3i?A
P001., hY SPA ONLY•AL.ARMSMARRIERS SHALL RX IN P"C X AT PRZ
PLASTER INSPECTION, POOL NUII'MENT I?NMOBURE I3140T-IMMY10ED
n4 THIS PERMT
POOL A I'I)IOR SPA 27,717.00 I.3
$:+:STIMM COST OF COMMt"fGMON '
27,717.00
'Muff E'6i E subMA�iIN
'
PLAN CHECK ME 101.000.439318 1176,49
CON.TCRUCTION ML 101.000-418-000 $371.50"
MECHANICAL IEEE — POOL, 101-000-411-000' $24,00
IpL.ECTILICAL IQ`EE — POOL 101-000-420-000 /_845.00
PLUMBTNCI FEE =• POOL 101.000.419--000 $27.00
i�fl
aR
8TB- PC TAL C ONMUC`T ON AND PLAN CHMC
$543.98
L=9 PRF, -PAM FFM
$0.00
TOTAL PERMM -"N%R DUE NOW
1 /
RECEIPT
DATE { 1
BY "`j':
DATE FINALED
INSPECTOR
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel 1A A
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
001
Final
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:
4-1
Bui .RJ/
4G & S N rkl
PGA WEST
'j'
7 Y DE
,RESIDENTIAL ASSOCIATION, INC.
F!;
1--ONS7-n
U:C7_10j
DATE
August 23, 2000
13'Y
Martin & Paula Davis
P.O.Box 91853
Los Angeles, CA 90009
Dear Mr. and Mrs. Davis:
Your request for an architectural variance has been" approved by. Mr. Ralph And'erso
n, Architectural
Committee Member. You have the approval to install a pool and spa at, your 54-438 Southern Hills
residence. Please. be advised that prior to excavating your contractor must meet on site with Dave
Graham, Maintenance Manager and Bill Bobbitt, Landscape/Irrigation Manager. Upon completion,
please submit the enclosed Notice of Completion form to our office.
...We reserve the right'to make a final inspection of this change . to make sure"
that it matches the
original request. An approval is based only on the aesthetics ,.o
f your proposed plan and 'Should' not
be taken as any -certification as, to the construction worthiness or structural- integrity of the prop6sed
change.
We appreciate your cooperation in submitting this request -for approval. If I may be of ftirther,
assistance, please contact me at the HOA office, (760) 77-1-1234 extension 15.
Sincerely,
McGal iard
Operations Manager
cc: Architectural Committee
Enclosure (1)
P.O. Box 1060, La Quinta, California 92253, Telephone 760-
7717-1234 FAX 760-771-5125