9909-160 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Coagter 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
35167.3 C-53 00311.2N
„Date ,7 Signature of Contractor �" �r
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that.l 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 which this
permit is issued. My workers" compensation insurance carrier & policy no. are:
Carrier ms 7a1 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, tend agree that if I should become
subj � to the workers' compensation'irovisions of Section 3700 of the Labor
Cso�, I�hall fbhhwith comply with�those�ProXiIon r
t4ate: t t " Applicant i / i't //1 k •k
t t J .
Warning: Failure to secure Workers Compensation coverage is unlawful and
shall subject an employer to criminAp,enalties 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 al! City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the+above-mentioned prope=rty for icti on 77s.
7
OIgnature (Owner/Agent) \� I Date
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
SS 47-MVi.1k MONTANA
APN
ADDREJOB
OWNER
CONTRACTOR DESIGNER
T A LLP ,1 ! {��J9Th d,t t..l,1R X2 c�'f ily r' {':4 ?' t (^+
q [ T� p ryr`
t.,qc
N111y11. ry+� A
.� 04 L:A Jw
t/
�/�tENGINEER
19 .i.-A:Tl C, �h 1Jl ,n�7.
ut
+,,,,�.�•--n��y�ry���la y yl hey L1q.. �s.,
,
357.0 AFe9Jt>.4A1"&�1F.i A..O IA:I� Et. I�+���.208
^ear
(6r y t ��^yul�trlA.
1 22 J..�+..•`DTfiJ,DS N ROd' D
ROAD
S:AANf1'A ANA. CA, 92705
LUCEi<: E VALLEY CA. 92 356
(76-0)UR-045 J1335
USE OF PERMIT
POOL si:, .(;PA ONLY . ivLAitAdi&il:MUi HR3.4'f'.(KJ- BE ?3+1 PL,%..0 AT
PKV- 1r3.+JVTeF t 1NSI'I i. x'it�>�i
POOL r�"t3^s+`i;ii2 SPA 0"s'K "00 LIi
Y}+'+•Y'a:F 6 `Y•9��IIo"+i'05`.D �C'+�r7 +"Sr"9aiiFM•�►Y" +'E i�A'A1
a., s:A:axr.Bo.�;�ar �e,ra:r.c c.ra+ �auer.s..aral`;•,.�r. rav
v ,x 6LtNi O�t►
x"nrr�vun tr
PEIRMIY FEE SO 1% MARV
,'L AN CkIF:; K YE 101 -000 -43V -31X $93.w
crlw,ny.Iti'-rTrw'4,TM', 10f.VI00_4€ia~IM $!X34(10
ZtifiCl3e l+ti(";/,3.5 -K)OL 1(?1 00.421.000 S •J.(;a
... C a
EI..:Ei.'T"€k CAT.s - f�% 011
PLt11'�1,t1. NO 11"HE -- N X� f 01�fttiiJ-:#3-fDt}(9 $'�*7.49V
r ,
.1. —A
' ..
t•is
Sl A3- I T"i1'AL (.0N8'fTA'J ;'r`€,0N AND 14,XN `'H t V
$33160
LESS PRE l .lUD FEES
$0-00
I` )T!• L P.f'.A'hIM IT FEEN il➢L.lE NOW
5333.0
RECEIPT
DATE
By �"
D ALED
INSPECTOR
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 Wall 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
Final
PLUMBING APPROVALS
Underground Plbg. Test
Gas Piping
Gas Test
_
—R
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:
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)
SENT BY:Classic Office ; 9-10-99 ;10:15AM Bob Hope Chrysler-► 7602482919;# 1
September 10, 1999 r
Mr, Gerald Hampton
Vacation Pools ,
Dear Gerald,
The Lake La Quinta Homeowners Association's Architectural Coramittee met and
approved your three (3) pool 8t spa projects.
Please note we ask that you adhere to the HOA's 5 foot set. back restriction from the
lake's edge and side property lines as indicated in your planes. Also, we ask that the
lighting plans conformed to our lighting policy.
One final question. Where is the pool and spa equipment located- on lot 226 on Via
Florence? The other plans included the equipment's location, but the lot 226 plan did
not. Also, as a reminder, once the projects are completed the equipment must be hidden
from the view, of across the lake neighbors,
Call with your questions: -760-346.8184 (work) or 760-771-3640 (home, after 6 pm). ,
Best regards,
Rich Lane
j
FROM AVE S MAIL N MORE PHONE NO. 285 4318 Sep. 10 1999 10:58AM PG
FROM-: AVE S MAIL N MORE
.. N
PHONE NO. 285 4318 Sep. 10 1999 10:58AM P7
VACATION 1"00I,S & S13AS
9522 Donaldson Road
Lucerne Valley, CA 92356
1760) 248-6045
(760) 248-•2919 FAX .
Lie. #C-53-351673
..�.�---•-----� t � - Sales Locations
Bermuda Dunes, Irvine,
-.-� California City, Rialto,
F Lucerne Valley
.1 800 999-1811
G
^ _ 0
--- - - 0
• 1 ' ' • 00
IL
tj
i a
Y .
=11
GASLINE BY FT.
_—
POOL LIGHT CLOCK -
ELECTRICAL BY FT-�
_
AUTO CLEANER
-
CHEM. FEEDER
_
PLASTER COLOR .-
DECK BY
DECK TYPE�'W �+
STEP Fr
SPA SPECS.
a J: O SIZE RAISED
` LITE WATTS
Wq.(�t b�1Al. LEVEL SEATS T....
DAMWALL
r,ft DAMWALI. TOP
SPILLWAY _SIZE X _ WIDE
c coNTRAC c of assume responsibility for DATE SPILLWAY_.
damage t s, sidewalks, driveways, cement
WETS
slabs, sew , lawns, trees, fences, retaining walls,
sprinklers; telephone lines or shrubs. Name:
When access is madethrong a neighbor's property
it is understood that you, a owner, have that Acidres, ;
neighbor's permission and surae full rosponslbllity.
C (,.r} Qu ; N �9
DAT E
SIGNA7, TRACT 1-1014 �N�9 �,�T � � 76
.... zl `.