9909-161 (RPL)LICENSED CONTRACTOR DECLARATION.
I hereby affirm under penalty of perjury that I am licensed under.pr0visions'of
�'d
-iapter 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 ,
351671.C-53
Date 'Signature of Cont actor �
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 orxoffered 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). ,
O I am exempt under•SectionB&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 buthe. 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
rya t, s v vi �.a �'w Inti = a•s
(This:section need not be completed if the permit valuation•is"for,$100.00 or)ess).
O Icertify'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 w rkers'. compensation/provisions of Section3700 of. the Labor
C,Pde„I�sbhallijbwith comply with those provisions i ”'
iDate: Applicant >
Warning: Failure to secure Workers' Compensation coverage is. unlawful. and
shall subject an employer to criminal penalties`and civil fines up to $100,000,' in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is.hereby made.to the Director of Building and Safety
for a permit subject` to. the, conditions. and: restrictions set forth on :his':
application. 2
1. Each.person.upon'whose behalf this application is made & each' person at
whose request and for whose benefit work is performed under or pursuant.to
any permit issued; as. a.msult of this applicaton,agre,es to, & shall; indemnify
&-hold harmless the City of La Quinta,.its officers, agents and employees.
2. Any permit issued as a result of this application becomes null'and void if
Work' is not commenced "within 180 days from date of issuance of such
permit, or cessation,of work for,180 days will subject'permit to cancellation.
I certify -that I have read this application and state that the above information is
correcte`l agree to comply with all City, and State laws relating to the building
construction, and hereby authorize rep' seniatives,of this City to'enter upon
the above-mentioned property for -inspection purposes: '• ��`
c
J
° gnature (Owner/Agent) �.'� '•jti• Datey'
•.-._:..r--.. =rte-'° .. _ _ .. .. : _,
PERMIT# -• +
BUILDING PERMIT.'.
DATE / VALUATION � aLOT ` TRACT
JOB ADDRESS 47-640 f� j�'1�4iNT
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
1570 B1t00x.H0L1.0v$_-) r:V.Cn Soju 208
9522 D0?4iLL.DSrJJN ROAD
S.AtIWA ANA,, CA. .92705
,; •I:.UGBR N2 " AUX,y C..1% 93356
(760)2?'48 45 C BL# 4335
_
USE OF PERMIT
POOL ANDOR'SPA
POOL di SPA ONLY i: BE I0_.l��
IN.31118CTIO NO
POOL IM10F. SPA 1-100:00 LS
' ' .. ,,tl:.e9.Sel. P•E,.iLAt!''t.IlA9 wrX\Vf\,��'9.i.9f�!
1''o:,QgC`itNti:ls'tiF IEE
x`04?? °�� MCI '1B: N T,101 • 1�C.f�t�(A «9.j�.ii!/!T $144.M
i!`JFSCR: �Agtl ^},,.f Rlr 11M —POOL °191.'ti•�4e-.i,'i%i1!/ - .per '.W
r •i' 6•'�-'� .
l,,Ixa "a31(.lw�s�Ca ..ii3f, iIPI'G`0D•0J(}fi7.a1''
,r,vj ifs t. xiFai..1?ool,
_
Gtf�-'�5'F'/>:f.f�'�J��'�i:r��L�4�.`"i'�(7N:t�,�►.s'�'.1!�.Nd1�-i�.`s�%��.
4;:4'i�t.�3
LESS .!"Zk:-.PADA �FE8
COTALA4,
'RMT FEFS DUE NOW
MIA)
RECEIPT
DATE '
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
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
Steel
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
— &0
Gas Piping
,
Gas Test
Appliances
Final
�C9G
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: 1 50J. Bob Hope Chryslers 7802482919;ii 1
t-
September 10, 1999
Mr. Gerald Hampton C-7& o
Vacation Pools
Dear Gerald,
The Lake La Quinta Homeowners Association's Architectural Committee met and
approved your three (3) pool & 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