0209-172 (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
'17916:5 A B 1110 � 3)31/04 r
'Date Si nature 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).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044 --Business & Professionals
Code).
O I am exempt under Section , B&P.C. for this re, son
Date wature of Owner ' I// �i , m G ��yw�.
WORKER'S COMPENSATION EC RATION ?i'
1 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 t2Up, D Policy No.
(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 S_0ould become
subject to the workers' compensation'_ provisions of Section 3709.5f the Labor
Code, I shall forthwith comply with those provisions. E'� ��
Date: Ap"pl"icant �'�n,+f 1�n• ECJ s / 14 l4,L''Y
Warning: Failure to secure Workers' Compensation coverage is unf9wful 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 10
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.Ithis City to enter upon
the above-mentioned property for inspection purposes. 4 / S
,Signature (Owner/Agent) �'_�'��� f .� �� �fDate
BUILDING PERMIT PERMIT#
M
f1� ID9 .� 7�
DATE SiIn 02 VALUATION o i78300i 00 LOT TRACT
ADDRESS ME -7 � a��i,'�. K RICELAYS JOB SITE
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
56-71'5 JACK MCXT,. US
'AR •P(K.R1_)
CA %2253
S. 921262
PALM 87sr317 )
w
(760)771-2700 CBVII Z45 3.
USE OF PERMIT
r'
IPO OL AWDIOR'S.I IA
INSPECTION. �11t31�M?�)t� l�v'c�L�'t1RN3�K�a i.N�;ACi�C��
VALUATION Wq
�r
X91M.. COST Ole CONVIRWY10
;N),000AV
P11M. .•T�' Tis. SUMMARY
:PLAN CHECK 191-000,439-318 $334:3i
CONSTRUCTION ION IFE 101.-000-41CN-000 ' $207.00
Ht,,,,,'A1�Ce,.P.3t:;;ryY :. -g-.POOL
•��!j5..24¢ 0
{1/�/�1,a1a-fiGt,C/ry+rR�3<���b�syy��3yy.-`�fh+i�00,
lMqq�C
LUL A3'TrJCA7o L'R:i.'w - P001.e 6'V J.•`L4f.F01-42010 0 JI`+. -010
PLU'MN40 YER .,.• POOL 301-000419-000 $ ,00
14T t
p , LES9. PRE—PA's Taus
10.00
D
2 b 2��2 ` Ar :�'�."C 9'a 5.E1T:1:'; -wil
SEP ,
CITY OF LA GUINTA
FINANCE DEPT-
RECEIPT
DATE l
7- .-,-' f1i
BYDATE
3144�
NALED
z9
INSP C
tji-_
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 Wali Insulation
Condensate Lines
Party -Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
steel
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:
3 Z71 c5 G
Final
Utility Notice (Gas)
ELECTRICAL_ APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Lxwv Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
00
m
m
04
m
04
m
\
m
m
760-778-2700 760-320-3667 FAX
HAYES RESIDENCE
56755 JACK NICHOLAS
LA QUINTA: CA
GENERAL SPECIFICATIONS
!stop stone i
BOOM-ISION-S:
PO SPA
Length:
4010" 810"
Width:
1010" 510"
Surface Area:
888 SF 38 SF
Perimeter.
1221Y 271.E
Depth:
3'6'-5'0"-3'6" 42"
I
Decking:
828 SF Quartzite with Visaueen i
484 SF Ceacrete wffim: " �isti
Tile:
ii_ LF QuarT1J e t' W-wHine
Dam Halt:
Boulder SpillwayiNvEieew'.
Plaster:
Pebble (color to be selected)
Raised Bond Beam: +2,V'@ spa
Spa iiterior.
Qua to
>✓ovi�n�_rrr:
Pump:
Ha3wardNwthslar1.5HP
Booster:
Hayward Nodhslsrl.5
Fitter:
Hayward 300 Cartridge -type
Eleater:
Hayward 400k BTU Lo-Nox
Clem er,
iiW'Nacigatorw/Sep. Suction
Poul Light:
1 ea. 400 Wait
Spa Light:
2 ea. 100 Watt (spa& Can ]edge)
Pun'rieation SFslem: Aqua -Rite Salt System'
Deck Drains:
2 (two) patio drains
Spa dei.
Five back jets and two calf -jets
Controller.
Hayward in-home controller
DEMO 650 SF OF 4" THICK CONCRE Ig: PATIO
JMIDF 9-1742
4;b
NO LANDSCAPE LIGHTING
INCLUDED IN CONTRACT
.are2drsin O—Yt---.-
stub all plante a
areas for
irrigation t
I
pl i9'6l
Vv stub at
postfoT
future misting
keep 2 planter
at patio post
per pian I p
GOLF COURSE
boaldus at back of plahter
perptao
1
I
tamping ledge'
whimbrella
sleeve
• -91J
Grp
LANDSCAPE REPAIR
BY CONTRACTOR
3'2
l
quartzite cap at hard
of pool
all boulders La be
approx 24" to 30
bench 71
. ' I� existing
J I PIA k %^,L�?.J�Q 1 %�✓g
i Stop alone '.
62" past Comer i a 82 Quartzite decking per plan
of hoarse
I I I I /tel I I APPrOMOBI'RICHAAD&OAS"'
to be 2'ti" wide F•
are DPM
• � SOr
concrete down I APAW;? DBrrAMZA(0GRE:'OR
to eA ling pad 0
DATE
GREENLEAF CORPORA TZOA
.CPTJOO i'ED BF G£OR G6 h7L.IN
56755 JACK.-
'� �/ LSA SQA.UEVT, CA - --- - _ - - - - - -
Ci 1 T 0.Jf D l7 UINTP ntgs
BUILDING & SAFETY DEPT.
master
bedroom
F;a.v%,wd
+24"
boulder
! j box
REPLACE ACCESS WALL
I I
AP PR®&st Tai a>risk Road - Palm Springs, CA 92262 icense No. 779165
FOR CONSTRUCTION j
DATE - 62 BY t,41I
!stop stone i
q ' --n
7"i
T past comer f
t
l C. VA
-i? I
egruPmeal
/smooth
plaster to c=ch
I
P1
! j box
REPLACE ACCESS WALL
I I
AP PR®&st Tai a>risk Road - Palm Springs, CA 92262 icense No. 779165
FOR CONSTRUCTION j
DATE - 62 BY t,41I
09/18/2002 12:27 760-320-3667 SAUNDERS ENG PAGE 03
FRC'•'i', : MONARCH 1'
P Wwrll
'L
July 29, 2002
fy
The GreWeat Corporation
c/o Mr. Richard Hayes
56-755 Jack Nicklaus Blvd.
La Qiiiaua, CA 92233
P1101,F NO. : 760 776 5111
Jul. 29 2002 03:36PM P1
PGA WEST 11 RESIDENTIAL. ASSOCIATION, INC.
Rel'er¢ttee: Architectural Change Request - Pool and Spa
Dear Homeowner:
P.O. BOX 1282, LA QUINTA, CA 92253
(700) 776-5100 FAX (760) 776-5111
fire Architemural Committee ,reviewed ,your plans for the addition Of it pool and spa and approvod your
application.
Review by the Committee is only for general conformance with thy: ardMtectural guidelines. It is the
respwmbility of the owner to fully understand and conform to the uclute%wm d, guidelines criteria whether
or not *aH deftiencies =noted during review, It is also the ownea's full responsibility to Meld verify all
c�istimg conditions, Tlhe Co mmitte4`s decision with regard to project design will be final. Please t eibr to
the Architech l Rules for all required submittals,
eN contact Javier Contreras, supervisor for Valley Gardening & %attdscaapee at 760/776�667athd Carol
Pleas
Fuller, the Association Mamrger, prior to any irrigatiort modifications axsoolated with this ftW. Damage
to the landscaping; i.e_, shrubs, tines, flowers and, turf is the responsibility of the contractor.. The
landscaping mug be brought back to its original condition when the project is completed•
There were no landscape plans attached to your application. Thertfor'e, additional landscaping was not
considered, and is not part of this approval.
. I.
Apprpvala-given by the Architectural Committee arc good for 001:' six months from the elate on the
approval letter. After that time a new VOW must be suban ttod.
,tt
t Jpo ft completion of youk pr'olect,' P1e: sa eoinplete and return The notice of Completion of Arehitecnuhtl
Change,
I
in tyre meantime if your have any additional questions or concerns, please do not hesitate to contact Carol
Fuller, Association Manager, at 760/776-51.00, tact• 20.
Sino�ely
nA" WEST It RESJVB MAL A 6 SOCIATION
for the Arclhite0u al Committee
I
Canal Fuller, CLAM
Association Manager
cc_] Board of Directors
t Unit File
,