0110-263 (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
c4��� �� �� � I Qtr': �_� ? a,"M'a!�►a
Date/ �1�'l 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:
( ) 1, 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).
( ) 1, 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
Seciion 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 Sle..11E L MPEN—GA 1' Policy No. 546006160
(This section need not be completed if the permit valuation is for $100.00 or less).
( ),1 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
Xode, I shall forthwith comply with thoss provisions.
Date: `> e' ga r 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.
r 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) r• •+ Date !f'=3'�
-y
PERMIT #
BUILDING PERMIT
W10-20
DATE / ! VALUATION p LO,fTRACT
JOB SITE
ADDRESS .56-i�.-K. �,f IMA LTIS DIN a
APN
OWNER
CONTRACTOR / DESIGNER / EN 1NEER
C'A%MC.IRNIA POOLS & ,SP s`£ (100 MA14 X101
56-16,55 , ACX N ICICLACDHI.'a D,
7r'r`l25 3ONI DRIVE, SME #A
I.A QUNT-A „CFS. 9225.5
?,.AW DE'S"FRX CA 92,260
.(760)'440-19000 CI LA 00335
USE OF PERMIT
k L�C3l�st�o-�, Ai.,dARIMINIBIA.kk,liJit:RS 3HALLK1 IN PLAI..ty A'1' PRZ t"LA's ]'KR
N'ay11iECTiON. POOLI<'.QU1"t'i+llENT MC'LC7SUFeRHOT INCt,CFND
P001., ANT)JOR SPA 1.8
t'+oy"4��Jp�'i�.�''
,4L�,3p�e.'nA'tt:t?��';;'...1��;pp R ( 00 y 9 y $134,5S 3,4pS
CCiNd;d'Ir:3w7'40p1,FVE 101.1000418-000 Wl.00
M711jt1,�I� 1/.LCy�s}�}�(nPIER'�y .-q.]Pool, �9q�.K040tl,�g9ltij 1ry-ery3(��D� 124.00
q7
e?: Is;.,.�.�.3'RJCM AL..R-d'rll'�I - POO1. 10 1:''fkJ0 �6Gs6,9-00.0 $4me
( ,S'e 1;glVI 9 ac3' ::ice • POOL 101 000-41.0a000 $27.00
epOCT
2 5 2001QUTAITAFIMAN��
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RECEIPT
DATE f r
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE ..
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings •
Ducts
Slab Grade
Return Air
Steen
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
• U� I IFinal
Final -I IPOOLS
- SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
�I
Underground PI . 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 C
Sewer Connection
En psulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
riiaal
Uti ity 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)
FROM : MOWPCH
WPA 1
October 23, 2001
Mr. and Mrs. Al Lamperd
f.
PHONE F0. : 760 776 8112 Oct. 23 2001 03:-'3PM P1
w;l
PGA WEST iI RES.IDENTIAL ASSOCIATION, INC.
PO. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 56-855 Jack Nicklaus Blvd., La Quinta, CA
Architectural Change Request - Pool & Spa Addition and Patio Dock Exicnsion
i�
Dear Mr, 8t Mrs. Lantperti:
The Architectural Committee is in receipt of you're the additional information as requested in our Octobcr
18h letter and unanimously approved your application, with the understanding that there will be no
additional,landscaping or lighting installed.
Rewiaw by the Committee is only for general conformance with the architectural guidelines. Itis the
responsibility of the owner to Hilly understand and conform to the architccturaI guidelines criteria whcthcr
or not all deficiencies are noted during review. It is also the owncr's.full responsibility to field verify all
existing conditions. The Committee's da:ision with rogard to project design will be final. Plcasc refer to
the Architectuml Rules for all rcquircd submittals,
Pleasc cor tact Javier Contreras, supervisor for Valley Gardening Service at 760/399-1844 and Carol Fuller,
the Association Manager, prior to any irrigation modifications associated with this change. Damage to the
landscaping i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The Iaridscaping
must be brought back to its original condition when the project is completed.
Approvals given by the Architectural Committee are good for only six mouths from the date on the
approval letter. After that time a new application must be submitted.
t
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
r
If you have any additional questions or. concerns, please do not hesitate to contact Carol Fidler, Association
Manager, at 760f776-5100, Ext. 20.
Sincerely;
PGA WEST 11 RESIDENTIAL ASSOCIATION
For the Arehitectural Committee
f
Carol Fulicr
Association Manager
cc: Board of Directors
Unit Filc
I