0401-154 (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
614611 C53 09810/11
Date �F' i "f Signature of Contractor /21AL I"
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).
( ) 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:
Carver 114SCORP Policy No. 1C 000035900
(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.
Date: E, ? -.. r';'1 Applicant 1e 3%O e
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 above-mentioned property for inspecction purpose.s..,n,,•..
Signature (Owner/Agent),��.. �, �--" Date —t Z
BUIL ANG"PERM:IT PERMIT#
04014
�'
-It
DATE / A VALUATION , e•� rtK LOT 43TRACT
JOB SITE _
ADDRESS 90•:820 •:38x0)P'9`
APN
—
OWNER
CONTRACTOR / DESIGNER / EN (NEER
Cl° RTSTCtPMIR 8CFAXI m
14Mi"TM POOLS & SPAS
s�fy.82E,i �r 9e ()1+'k
F.P.O. BOX 1791
�..A.0 UINTA CA 9225?
LAtC�T. MA CA 9225
(760)360-3585 CBL,'# 1945
USE OF PERMIT
POOL I•t2J'ifi OR. SPA
POIDI SP.A. AL t2MS0€fA12121 P "' TO 59 IN PIACZ,e T PR ..PL,ASTER
Y143P, EQUIPMENT 914CWSXJR.ENOT INi LUlCkED.
POOL .€ NDIOR SP 15,Ot�4,Eitl i+:� .
FINTLii'BXAi.9C..9> Ci,ly OF Lrti✓MMcl'ia./c O
.65el.7b7F1 oo
PILI.1d. IMT,1' HP. +,''TJM"Pty
PLAN CHECK FEE 101.000=439.318 SIC-5,301
CONSTRUCTION Fqui: 101-000-418-000 $162.1114
MEC.'11AMC AL FE POOL 101-0004121.000 624.00
if -LEC` TICAL ME •• POOL. 101-000-420-000 $35.00
PLUMBING FEE -- POOL 101.000.419.000 =00
3UB401 A1:, C0k8MU=.O1, PUN IMP=
6`363.30
7,��154 :PP ..PAID TW -13
$0.00
gay •}�p�/•��gy
iSl.1E J.fOYV
��11a
"H&A,NCE
RECEIPT DATE
BY k/j/
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 Wail Firewall
Exterior Lath
Drywall - IM. Lath
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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
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.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
SCHALLER RESIDENCE
LOT 43 _
LA QUINTA, CA.
cansmicrnHsacaAusr7-
m360-3585. /
1
v (,U-CrS) RC3 �
FAIRWAYS ASSOCIATION
I
January 2, 2004
Mr. & Mrs. Chris Schaller
80-820 Weiskopf Way
La Quinta CA 92253
RE: Application for addition of pool and spa
Dear,Mr. & Mrs. Schaller:
Thank you for sending in your application. The Architectural -Committee approved
the plans as submitted with one provision, prior to the beginning of construction,
the color of the concrete intended for the decking must be submitted and
approved.
Please note that the followirig documents must be submitted:
• Neighoor comment forms with signature on copy of plans r
• Photo's of all landscaped areas that will be affected prior to the start of
construction.
If you have any questf:.)ns please contact me.
Sincerely,
1
Nancy Duane, CCAM
Association Manager
12/29/2003 phone call trorn Mike Polk of McIntyre Pools indicated concrete
color to be -San Diego Buff, which is an acceptable color.
I
Post Office Box 1690 L Li Quinta, California 9?253 0 Phone (760)776-5100 9 Fax (760)776-5111