0403-049 (RPL)LICENSED CONTRACTOR DECLARATION
1 -hereby affirm under penalty of perjury that I am licensed under provisions of
"thapter 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
177916ti AB ��a iOy0 f 1 PV%r..
y
,Date --� I�f� 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).
() I am exempt under Section B&RC. 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 FUND Policy No. 1689467-2003
(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 jSection 3700 of the Labor
Code, l stra�l forrthwith comply with-thos provi'slons.
Date:"' Applicant e' c `' '` '
Warning: Failure to secure Workers' Compensation coverage is unlawf
shall subject an employer to criminal penalties and civil fines up to $100, in
addition to the cost of compensation, damages as provided for in Sectio 6
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and et
for a permit subject to the conditions and restrictions set forth o hi
application. I t
1. Each person upon whose behalf this application'is made & each pers
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
c�Dstruc It on, and hereby authorize representatives of this City to enter upon
the above-mentioned property ;for�ihspectlon purposes.
Signature (Owner/Agent) Date"
BUILDING
.PERMIT�PERMIT������
DATE V, vnin'l�aw VALUATION $221=1100 LOTS TRACT
JOB SITE �•�
ADDRESS +1Qf
APN
OWNER
CONTRACTOR / DESIGNER / EN INEER -
1dL
CANYON M"IM ?C7tr+ 118
9 VJNOV'Rok-T
229 5 L. 7."1'-aMA W., W
COTO Dit CA& A C& 92675'
RAUV E'a�RIM08 Cis. 92262
�60j?i8.2700 031,A,C 2951
USE OFPERMIT
POOL tyVOR i' PA,
PCW)IJS'AfBDQ-,AN31Z123/I0 LF T UTA)CKWALL PFTs. CITY S'3AKOARO.
FIREPIA&CF, BY S.EPE12ATIE PEEWIT. 7,001 M.
}
POOL .P.1dD OR SPA 22,,000.00 LS
.C_S.1II.!i'858IND COST M CO [/�.d..fi.6.+4r1101\
=11 0 /C OU
ayg �7�+y, `��rt��
i� A7aQ'1c s FM GiUNUAA N! sV LLI
P1,,AN CHICCK: fes:. 101-000-439-3181 1 $146,23
C:O NSTRUC;TION2 11,27,I01-O{}ii «3, 8-000 P 3 $225.00
NFC-34MI at. FEE -• POOL 101.000.4? 1.000 P 141 $24.00
ELFC;TRIC:AL .IpI.Cg , POOL 101-000-420-000? 2. ' $4100
PLUMPING FEE - POOL 10`i.-000.419.000 MIN
a o_
MAR 2 4 2004
ITY OF LA QUINTA
FINANCE DEPT.
802 1 OTAL C:ONKR:t1CM710114 AM) CH C:yC�
yy�i��1�:pJt4l�
M{{i:"�yy/(��
' 101.1"AL ,KWI M .T ITES D11F.I OV1011
$46725
RECEIPT
DATE• BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings 1 G
Bond Beam f ptl
Main Drain
Approval to Cover
�p
Equipment Location
V.
Underground Electric
_
Underground Plbg. Test
_
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
03103/2004 16:44 .760-320-3667 CANYON_V]EW/SAUNDERS PAGE '02
MAK/UJ/2UU4/WEE , U4:4b F9. KDAK 9 A(;WL rrlNG YAX No• IN Y•Ib 5111 r, UU1/UU1
FAIRWAYS ASSOCIA:'rION
March 3, 2004 A
Mr. & Mrs. Michael Salas :
50051 winged Foot
La Quints CA 92253
RE: PooUSpa.ArrhitecturalImprovement .
Dear Mr. & Mrs. Sala$:
On February ie, 2004, the ArchkecturaULandsalpe Committee reviewed and t`
approved your submitted plans with the following conditlons:'
You must obtaln a Erre foot easement agre��m0nt from KSL_ You may da
t
this by contacting9 rbara Larsh, KSL Ptoperoes,` 50-905 Avenida
Bermudas, La Quints CA 92253.
•
Confirmthat your BBQ facies your property and not your neighbors.
The" fireplace must be gas burning (no vrood burning is allowed) and
submit. plans idertWn9
specificadie fireplace as gas burning along with
tions for the comporiernts. .
If you have eny.:questiona on the above, please contact this office
$if1Ce .
�'.
an Duane;_ CACM; CCAM
Associafion Manager
ND/nap
.CC: Canyon View Pools
Post office Bo 1638 LA �jN Catiforda 92B3 Pbonc (760) 776-5.100 • Faac (760) 776-511
,
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