0308-202 (RPL)LICENSED CONTRACTOR DECLARATIOK
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
779165 G5 A 13 RIC 05/31,e2ll:
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 isnot 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 STATE YUND Policy No. I6M67-2003
(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 should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code; I shall forthwith comply with those provisions. -
/""�
Aate+'r ' 's 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.
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-a6ove-mentioned property for inspection purposes.
Signature (Owner/Agent)y w �" Date
, 4P
M PERMIT#
BUILDING P&MIT
DATE VALUATION MOM LOT .OWS-202 TRACT
JOB SITE
ADDRESS tfJ-�I"
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
WIVE -
CANYON V POOLS
$0.810 WIMIOPF
22951% TA)AMWX r,,
LA Qti2 I A CA .92753
PKIM SrPIZINGS CA. 92Z62
(760}778-; 700 i BLO 2951
USE OF PERMIT
POOL ANWOR EPA
POID' USPA,, 8hQ. 6 LY. 4' 11108.1 BLOCK WAU ALARMS/8ARtRIERS
tiAI.I. OF 1N PLAM, PRIOR TO PRE PLAS 'I:IZ 1145PECTION
4 FT. W.A14L 6100 11F
POOL ANWOR SPA us
E"i'1.'MCA'71J COST OF COMMiM'1<"I:ON
Z«�,000.t�fi
PT- MV1• I M. ;hum -m y
FLAN emacK .FSE 102-000.439-318 $163.00
COM ►'1'RUC TION F9Z 101-000-418.000 Sd5Z00
MWHANICAL FFE --1't 01, 101.000-421-000 $24.0
ELECTRICAL MZ,- ,- POCIL 101-000 120-= $45.00
PLUMBING ISE 101.000-419.000 $27.00
SUB-?OTA1, CONMUCT09 AND MAN CHH
SS 11.s€a
' 1Y,23 P,n1 -P FEES
0.0t�
:A7�''.1u1V13+.I:tiXVC)4��1.8ii
ftUG 2003
CITY OF LA QUINTA,
FINANCE DEPT.
RECEIPT
DATE
BY ^ --
DATE FINALED
INSPECTOR
./ 0 ,;
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
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings LZ
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
OX for Finish Plaster
Sewer 5 r -al
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.-
.F.I.Smoke Detectors
Smoke
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
07/28/2003 11:26 760564232
PGAWEST
r•�
FAIRWAYS ASSOCIATION
Mr. & Mn. Tom Blue
2990 S Sepulveda Suite 304
Los Angeles CA 90064
g10
RE: 80-x' Weiskop£ Way
Ar
Dear Mr. & Mn. Blue:
PAGE 01/01
July 23, 2003
At the July 21., 2003 Arclutectmul/Landscape committee meeting the plans you submitted were
reviewed and aoved with the following condition- you need neighbor sign off on the plans.
If you have any questions please contact me,
Sincerely,
*onnaaccio, CMCA
Association Manager
DM/acp
Post Office Box 1658 • La Quinta, California 92253 - Phone (760) 564-3858 Fax (760) 564-2329
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BLUE RESIDENCE BUILDING & SAF:ut44) OIO APPR0
La Quinta CA 92253 uAsn'Rs SERM. FOR�0NSTRUCTION..
GENIERAI SPECIFICATIONS
DIMENSIOm- rool, SPA
L-k9aL 38.0Tv
Widal: ITO 7'0`
Sudow Area: 420 SF 31 SF
Perimeter. Itm Fr 23 FF
Dq)ft Vur W SV 42" MAX
Deo:
CD11trett- NIA
Sod f Grave]: Wh
40 IY
=V= valin: YES
Dedkaled Vjh- Lin.: -lu
Gas Lim E� : go, LF
chs Limb rw BB4WFtvC Piu 15'
Six Jets: FIVE BACK IM
IMN*I=
00 Emu: 16301E DECKM CAP @ RAISED SPA
Cmaftm Edge: 127 LF/ SMOO114 BAND TRINI
3- DoA- Dmims (per M: 40' FS X +18:'2CI'LF
Stop Riser (Pa 11): NIA
Dam WaR
Railed Barad Be=L +lIr PRASIEFLS
uu&oh sweve: YES @ TANNING SFHAX
TNA09=
Bask IMe Gmup: 1271E 6" GROUP I 0R. 2 IILE
Q0atla1E G'Wateffinv NIA
Step Trim- MIA
7& Raised AFW: 17 SF
pd[Axom:
souwa)-- 6 FT QI)ARTZrFE SPRLWAY
1%,junw: NIA
BBQ-' BLOCKSHEILO)ON L0MTFR0M0%q4EfL)
Fueph: KIA
BDLOdws: X(A
Acoem WakmiOVE AND REPLACE BLOCK WALL
BqWpm= Aa: 41 X6, W
Paimusmoodplaster S-tuoM @ RAUED SPA EXT
pool Finifft
vaft Pool Plaster: NIA
PAN. Pod: PEBBLE FDUSHPLASTER.
P0133p: HAYWARD NO)LIRSTAR 2 IIF CJRC-5PA
PUMP- 14eA
Filter. HAYWARD 300 SF CAFL-IRWGE-TYPE
Heater HAYWARD 400 InU LO-NOX
comtrollar HAYWARD POOL ROSS
Rav—rdNff%ipt- NIA
Pool Light: ONE 4(65-NNATr
Spa U911L ONE 100,WATT
PadOwdull System: NA
WaWFkSbtM CAW-ADE(2)FERDESIGN
LwidKSM NIA (SEE SEPARATE COSTING)
Palin Quayr, MIA
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VZIgCknon.
ALARM-
, & SpRji,.,GS PER CRY CODE
Suyv [5 ecrme that orv3 repremtofina or epmdan by elOjex pany Is bg blwiiDa
mles; da&IJBd and ikmed bybi.%vr and seller.
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BBQ
decki reg
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3-
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light switch
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760-778-2700 760-320-3667 FAX 2295 East Tamarisk Road - palm Springs, CA 92262 - License No. 77916!
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760-778-2700 760-320-3667 FAX 2295 East Tamarisk Road - palm Springs, CA 92262 - License No. 77916!