0109-250 (RPL)H�
l (_ C/)
W
"OCYM
W
oZr`
�00
HC)
W W
EL
CD
CD
Z
M
N
0C\1
UQ
Z
r 1Z 0
XW0 _J �
mUU
O
(I: 0)
Z
0
C)
_J Q
J
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that -1 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
`6 ==6128 C53 HIC r_ 1 Ot.1112
Dat�16 — Signature of Contractor
OWNER -BUILDER DECLARATION �t
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 employer -3 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
t 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 MAU. C01APPMA'd'I Policy No. 94600610u
(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 tho e rovlslo� s.
'n«�,
Date: / Applicants
m.
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 subjoct 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 prope .f r inspectionMOW
1
Signature (Owner/Agent) .,! �, „ ^ Date,��„r
... . .. - .. '.5.. . _ two �.... .. �.... .. ._ .. _ ...
BUILDING PERPERMIT #MIT
DATE / VALUATION $1,9.12"" LOT TRACT
JOB SITE""�
ADDRESS-.`� �4�1~Rc�:i APN -
OWNER CONTRACTOR/DESIGNER/EN INEER
W,
../1,V R18. BLUE CAUFO AI APOCCU 4%11PAS (TOPS MAH C01 V,
M' ,332 MWAL`'1�TAG E 74 X 23 JOIE DIME, SUM RA
PALM DE&M CA. 92260
S Kti4� �li3-9fK30 (•'4�f $ 335
USE OF PERMIT
DIOR SPA
:i0d.hi'""i'.r��j. p6 LIP 4C'cFB3,i i37t:Xpi��:ya4':+`..p3i,;ygI�t'Y STANDARD.
J"i�aY1!f1+..t6.�:0:)9�i.G�>J v�7,�'Ad.t3.a d:�i�547tl .T'i.r�tyrlG .lP6�7. l'C:'Ai'!'�is�S.e.{''iL.l\. �LY,vf�l`.'�i 7'.t�• :.
D e r
:SOI ANDIORSPA: 19,090.00 LS OCT k 8 %nn'
.5 kqWALL 6.00 LF
CifY OF LA OSI mutt
F:NOC DEP). _
TE'RMWA° RED L S,?S'.f O:' €:%'lN'SERV .10M 11".129.90
MUM M11 HUMMAPty
PLAN CHKIK I'VE 101X000-439-318 $1341,55
00"NSTRUC'd'SONFEW BC'1-�?d��ai€f-Qf�iiA MZ00
MECHANIC -Ab MI? __ POOL 101.0104171.000 $24,00
F11211M!'�11GAS., FI s I PO- all 01_0x00_42,..0,-0 eCf $A5.00
PLUM b ING FM - PICK) L 101.00OZ-419.000 $27,00
AND PLAO t'`.y-'FlM1: $431.35
Z i 7� Ea ' fill J F� 11 $0.00
RECEIPT E f BY DATE FINALED INSPECTOR
M,,. r (1
INSPECTION RECORD
OPERATION j
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
r
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Final
PLUMBING APPROVALS
Underground Electric
Underground Plbg. Test
Gas Piping
Gas TestElectric
_ ,(
(a`
Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
Pool Co_vpr
Er, apsulation
Gas Piping
Gas Test
Appliances
!"anal
CUMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterio-rReceptacles
G.F.I. .'
Smoke: Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
?L
FROM CALIFORNIA POOLS AND SPAS
FROM : MONAPCH
:�A
October 18, 2001
Dr. & Ivus. Tom aim
2990 S. ScpuNeft
Suits 304
Los ArW es, CA 90064.3973
PHONE NO. : 7603465407
PHLINE 1-10. - 760 776 511-2
Oct. 18 2001 01:4BPM.P1
Gc-.. :& 2021 I3B:20Hfh F'1
PGA WEST II RESIDENTIAL ASSOCIATION, INC
P.O. BOX 1282, LA QUINTA, CA 9225-
. (76()).776-5 100 FAX (760) 776-511
R aence, 80.332 Flcm'tttge, La QaiW&. CA
Architaxurut change RequUt - Pool and spa
Dc+ar Or. dt MTS. Blue:
m --
The Architechual Comrrrittee reviewed your plans for the addition of a pool, spa and
lith bye "P ea submitted with the u9tciere[Bnding that there will be nv additional landmping, or
Review by the 1241tittee i8 only for g=al corrtbrmar= with the architectural guidelines. It is tine
responsibility of the owner to fatly understand and conform to the architectural b'►udelines cri
or not all de�oncies am hared during review. It is also the owners f;dl responsibiliWteria whether
b
to field vall
existing Conditions. The Committee's decision with regard to pmject desiglt Will be final. Please refer to
the Architectnrai Rules fvr all required subrltittals,
Please contact Javier Contreras, SuporVlior for Valley Gardening Service ar 7601399-1844 and Carol Fuller,
Lite Asssodation Manager, Prior to any irrigation modif earions associated with this
l=dsQ*rtg, i.e., shrubs, tires, !lowers and turf is the
mast re chaa� Datttage to the
'be brp sponaibility 'of lite corttv"Ur. The lan&caping
ugltf bade to its otipnal condition whets the Pm td is aomgietcd
Approvals given by the Architmduml Commiuco an good for only sIr archeus troth the date on the
approval letter. After prat time a now application mast be submitted,
Upon oorapletion of your projeu, please complati and return The Notice of Completion a Architectural
Change,
If YOU have any additional question@ or concern.% please do not hesitate to ontaet Carol Fuller, ASaocuniat
Mang'-- m'7601776-5100, Ext. 20, c
5lnoerely,
PGA WEST lI RESII2ENTIAL ASSOCLkTTON
For the Arebitecrural Committer
Carol Filler
Association Managet
cc; Board of Directors
Veit File
1
L
t