0306-276 (RPL)LICENSED CONTRACTOR DECLARATION
` to 1 hereby affirm under penalty of perjury that I am licensed under provisions of
H *Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
N C" _Professionals Code, and my License is in full force and effect.
0 =) ch License # Lic. Class Exp. Date
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LO E�:���:2t? C53 RIC
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Z r- Date :<) .n. Signature of Contractor
J U C:) OWNER -BUILDER DECLARATION
W W r- I hereby affirm under penalty of perjury that I am exempt from the Contractor's
F- a License Law for the following reason:
U)
Z_ ( ) 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).
co () I am exempt under Section , B&P.C. for this reason
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N Date Signature of Owner
ON
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Z WORKER'S COMPENSATION DECLARATION
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2 Z I hereby affirm under penalty of perjury one of the.following declarations:
Lo Fes- O () 1 have and will maintain a certificate of consent to self -insure for workers'
X w �= compensation, as provided for by Section 3700 of the Labor Code, for the
Oro - Q performance of the work for which this permit is issued.
Q U (,) I have and will maintain workers' compensation insurance, as required by
du Q Section 3700 of the Labor Code, for the performance of the work for which this
H permit is issued. My workers' compensation insurance carrier & policy no. are:
? Carrier s,r,&s.TF a,)m1'NmATj Policy No. J 6 zilo ;c #L'3
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I Q (This section need not be completed if the permit valuation is for $100.00 or less).
J ( ) 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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions. !�
Date: / r+ Applicant ,y %) 7 /1 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 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 foNnspection purposes.
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Signature (Owner/Agent) f s ✓ � Lq Date Le� f921
BUILDING PERMIT PERMITp
16
DATE DATE / VALUATION'LOT TRACT
y , J S18,()00,2!5.. .. ,
JOB SITE APN y
ADDRESS w F1fbiYr��.�Y Z�.
OWNE��/rtR��' WYw /^`R C9 (9 y
90-4441AX.PsNirfA(Y&
LA C1UIl4' A CA 92253
USE OF PERMIT
WXYL AMh011. SPIA
/ DESIGNER /
OALFOR)�-V,POOLS (TOP MAN
136-101D AVnTP-A K4. ,
COACHELL.A. CIL, q?.? 35
P001, SPA, $ 50. 5' CiA.tt�: ZN t.A+4Af,1., CITY
STA''KDA I.) !',,;;Rhil A3{t.Ri,iERS SHALL BE IN .PIAC H AT PRE.- PLASTER
1P,auALY.CTIt. N
J J'i. WA!'L
PW, LAN DICIR SPA
OwIMATETt Cas 4, 0,'1° 4'O:NSY"Ru't:°lsom
C0"l'IZYJC"T10N tail» 101-000-418•000
M CIIA ICAl., l{is'Z .- POOL 101-000-4'M1_11100 Jd�I;OtJ
ELECTR1CA1,FRIE POOL 101-00074' Q-WID �ce�,ilo
PLUMB I'N a RE -• POOL 101-000-419-00 517.00
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IND
W:'.'2.70
U JUN 2 0.2003 LD
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CITY OF LA QUINTA
FINANCE DEPT. 9
RECEIPT DATE BY D TE 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 8 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
101
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
1J3
Gas Piping
Gas Test
Appliances
Final
.O
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring:
Fndures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)'
June 16, 2003
Mr. & Mrs. Bill Poulton
2996 Deer Meadow Drive
Danville, CA 94506
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 80-444 Hermitage, La Quinta, CA
Architectural Change Request — Pool, Spa, and Patio Decking
Dear Mr. & Mrs. Poulton:
The Architectural Committee reviewed your plans to add a pool, spa and patio decking and approved your
application.
Review by the Committee is only for general conformance with the architectural guidelines. It is the responsibility
of the owner to fully understand and conform to the architectural guidelines criteria whether or not all deficiencies
are noted during review. It is also the owner's full responsibility to field verify all existing conditions. The
Committee's decision with regard to project design will be final. Please refer to the Architectural Rules for all
required submittals.
Approvals given by the Architectural Committee are good for only six months from the date on the approval letter.
If construction has not commenced within six months after the project approval date, a new application must be
submitted.
Please contact Javier Contreras, supervisor for Valley Gardening & Landscape at 760/776-6667 and Carol Fuller,
the Association Manager, prior to any irrigation modifications associated with this change. Damage to the
landscaping, i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The landscaping must be
brought back to its original condition when the project is completed.
Please have your contractor warranty the shrubs for six months.
Upon completion of your project, please complete and return The Notice of Completion of Architectural Change.
The committee recommends that you review the enclosed specifications for the PGA West concrete mix for
consideration prior to the installation of your patio decking.
If you have any questions, please do not hesitate to contact Carol Fuller, Association Manager, at 760/776-5100,
Ext. 20, or Cathy Clark, Assistant Manager, Ext. 18.
Sincerely,
PGA WEST H RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller, CCAM
Association Manager
cc: Board of Directors
Unit File
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