0201-118 (RPL)LICENSED CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 ofXhe-Busiwss and
Professionals Code, and my License is in full force and effect.
License # Lic. Class - '' Exp. Date
4-A
so RO C-53 i 10131IM
DatJ P1 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:
( ) 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 arp exempt under Section B&P.G%for this reason
Date � _ - Signature of Owned
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 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,
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 hall forthwith comply with th,�os rovi Ion°s.
Date:#1 Applicant ����1A"`�
All
�.
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.
1 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 or Inspec tion purposes.
'Signature (Owner/Agent) Date
'BUILDING PERMIT PERMIT#
DATE VALUATION LOT 020.1-1.18 TRACT
JOB SITE APN
ADDRESS
45 -MS LAS CULUTAS
OWNER I I CONTRACTOR / DESIGNER / EN &NEER
,i.• SSION .`0.WD 1210A GIL"ROYM MOIF,.CadL'IDT POID ILOi $`..A' D SPAS
45.905.1AN COLDW 46880 ?MOtkAW COVE, DRN 494
Lk QT.10rfA CA. 92253 T,kfS_4LAN't+Lf1»5.LS C'A 92210
(760)345-:1376 CS119
USE OF PERMIT
X) M AMIOP. SPA '
'C0IBPA..A1AR4SITSAZWiX551,LHE111PLACZ+f
APiC/1ON. P4Vt'W`dlTgTMW1I04JirHOT}NCLLf?hlD€t,C,.N�oS'fA �r,:
POOL }4 NDIOR SPA
PLAN CHECK WE 101.00(439.318 $134.5
0ONSTRUC1100 FEE 1011-000-418-000 420 -ma
MECHANICAL TCHE I;- POOL 101-000421-000
E U.0C TPJC'A1, F82 POOL 1 f3'''�t4i 4, 42.6. 306 S45.00
P1,.0mviNo F v; .,. Po*s 10
D
JAN t�l
IO AL Paws.vu.s Du Qw.
RECEIPT I DATE�r'; ,+�� I B I DATE FINALED INSPECTOR
2.0, 3.00
$437.53
$0,00
T437
7.
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air r
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. 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
z BLOCKWALL APPROVALS
steel
POOLS - SPAS
Set Backs
Footings
Electric Bond
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
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:
JAN -14-02 05:52 PM QUALITY MANAGEMENT 7602009521
ALISO Xr LA QUINTA HOMEOWNERS ASSOCIATION
C /O QUALITY AIANAGEMENT OF THE DESERT
42-335 Washington St., Ste #F-427
Palm Desert, CA 92211
(760) 200-9520 FAX (760)201)-9521
Marty Buller Joyce Montgomery Matthew hiefenbach Rod Grinberg Kenny Felkel
Resident Vice President S.crelmy Treasurer 0ireetor
P_02
January 14, 2002
VtIV�
Mr. & Mrs. Jason Gilroyed
45-905 Las Colinas
La Quint.a CA 92253
RE: 45-905 Las Colinas
Account # 21
[leer Mr. and Mrs. Gilroyed:
Your Architectural request that was received today requesting approval for the addition
of a pool in the backyard of your home was reviewed and approved by the
Architectural Commiltee.
It is understood that.the wall and the landscape will be restored to its original
condition. We trust that a licensed and insured contractor will be performing the work
and that all city required permits will be pulled prior to the commencement of the
work.
We thank for your cooperation in following the guidelines set forth in the CC&R's. If
you should have any questions, pleas: feel free to contact me.
Sincerely,
Quality Management of the Desert
1'OR ALSO AT LA QUINTA HOA
6.
Martita A. Osborne
Froperty Manager
Mao
JAN -14-2002 MON 05:47PM ID:Rembrandt Pools and Spas PAGE:2
JOB y� _ CITY OF LA QUINTA SUB -CONTRACTOR LIST
O ADDRESS /OJ �LINH % 'PERMIT NUMBER Zo _ OWNER *this'
DER
This I s w' h B i rd all 'm i ns ous place. Only persons appearing on r their employees are authorized to work
on this job. Any changes to this list must be approved by the Building Division prior to commencement of work. Failure to comply will result in'a stoppage of work and/or the voidance
of building nermit_ Fnr Parh nnnlir-ahlai trnrin X11
Trade /Classification
ContractorState
Company Name
LJ19 LU,,,r„1U«„
Contractor's License
Classification License Number Exp. Date
(e.g. A. B, C-8) (xxxxxx) (xx/xx/xx)
Uy OpPlIUd„L. vii rile Is not an acceptable response.
Workers Com ensation Insurance
Carrier Name Policy Number Exp. Date
(e.g. State Fund, CalComp) (Format Varies) (xx/xx/xx)
� � � _ C)O C)G,6 . I I • a _,
-Dz
City Business License
License Number
(xxxxl
Exp. Date
(xx/xx/xx)
EARTHWORK 1C-12)
CONCRETE(C-8)
A.
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ZCONCRETE
6
FRAMING .(C-5)
STRUCT. STEEL (C-51)
MASONRY (C-29)
PLUMBING IC -36)
LATH, PLASTER (C-35)
0D
_D1q
3 C
DRYWALL (C-9)
HVAC IC -2011
ELECTRICAL IC -101
C
b co
ROOFING IC -391
SHEET METAL (C-43)
FLOORING IC -15)
GLAZING (C-17)
INSULATION (C-2)
SEWAGE DISP. (C-42)
PAINTING IC -33)
CERAMIC TILE IC -54)
CABINETS IC -el
FENCING (C-13)
LANDSCAPING (C-27)
POOL (C-53)
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