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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
AB MT ; 5t,2,1104
,.Date �' 'J` Signature of Contractor0'
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.
(Y) 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 STAT PION;) Policy No.
(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: 4' 13 `t-° 'Applicant_;•>y:� �=.*a�•'i✓'a —w... -vim
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
b construction, and hereby authorize representatives of this City to enter upon.
the above-mentioned property for inspection purposes.
t/
Signature (Owner/Agent) i� ! Y Date
BUILDING PERMIT PERM'yfs
DATE &ij 3,10.4 VALUATION M -'j t K),(PQ LOT TRACT
JOB SITADDRESEQ )1 HKIRdNUT'A E
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OWNER
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CITY OF LA QUINTA
FINANCE DEPT
SUB 11J: t3Cl°4� lid E`::�jl`i 'i?�*.;t'��d' CTMUK
+12:60
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
OX 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
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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 Lateral
Pool Cover
Sewer Connection
Gas Piping
Encapsulation
Gas Test
Appliances
Final
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)
:COMMENTS:
MR.&MRS GREW KI:1� .
90-812 -BERMIT.,AGE (Lot 26)
La Quinta CA 92:253 RYDER COLLECT.
GENERAL SPECIFICArHONS
DIMENSION_ S: POOL SPA.
Length: 31'0" 7'0"
Width: 18'0" 7'0"
Surface Area: 418 SF 38 SF
Perimeter: 96 FT 23 FT
Depth: 3'0" to 5'0" 42" MAX
Demo:
Concrete: EXISTING PATIO 200 S -F.
Sod / Gravel: EXISTING SOD 500 S.F.
Plumbing:
:Extra Spa to Equipment: 25'
Raised Spa Bypass w/ck value: YES
Dedicated 'Vac Line: NO
Gas Line Extra: 15' LF
aas-:L- so;r 'ire Wit: _25,
Spa Jets: FIVE BACK JETS
Deckin :
Color w/salt finish: 650 SF DECKING, CAP (2, RAISED SPA
Cantilever Edge: 96 LF
3" Deck Drains (per LF): N/A
Step Riser (per LF): NIA
Dam Wall: +18"
Raised Bond Beam: N/A
Umbrella Sleeve: YES (Q TANNING SHELF
Tile/Stone:
Basic Tile Group: 119 LF 6" GROUP i OR Z TILE
Quartzite 6" Waterline: NIA
Step Trim: N/A
Tile Raised Areas: NIA
Masonry:
Spillway: 8 FT QUARTZITE SPILLWAY W/BOULDERS
Waterfall: NIA
BBQ: OWNER TO PROVIDE UNIT (SFO L ONLY)
Firepit: N/A
Boulders: HONEY QUARTZ
Access Wall: REMOVE AND REPLACE BLOCK WALL
Equipment Wall: 4' STUCCO TO MATCY
Paint/Stucco/Plaster: STUCCO (d RAISED SF A EXT & RBB BACKSIDE
Pool Finish:
White Pool Plaster: GREY PLASTER STD.
Pebble Pool: N/A
Equipment'
Pump: HAYWARD NORTHSTAR 1.5 IT CIRC/SPA
Pump: NIA
Filter: HAYWARD 400 SF CARTRIDGE -TYPE
Heater: HAYWARD 400k BTU LO-NOX
Controller: HAYWARD POOL BOSS
Hayward Navigator: NIA
Pool Tight: ONE 400 -WATT
Spa Light: ONE 100 -WATT
Purification System: AQUA -RITE SALT SYSTEM
Water Feature: N/A
landseape: lel'/A ( SEE SEPARATE COSTING)
Patio o_ Cover: NIA
Fencing: NIA
MISC. SPECIFICATIONS: ALARMS & SPRINGS PER CITY CODE
-- ���-Oatinn nr Pynression by either party is not binding
60 39dd 9N3 S83GNndS
760-778-2700 760-320-366`
L99£ -0Z£ -09L 60:0T £00Z/ZZ/50
HONEYQUARTZ
BOULDERS STUCCO BACKSIDE
GOLF COURSE quartzite SPIllway
P/L
LAWN 76
LAWN
Spa *18
3'
PLAN -TER pool _ PLANTER
AREA AREA
!4' 3 5
existin wall
A 5
umbr Ila sleeve
cisti ng wall LAWN
TANK NG SHELF
PLANTER. � n
AREA !B'O1eCking
— — — — — — -- •---- ---
_I
EXISTING PATIO REMOVE ISTING DECK
� I
/L KLUSAAAN
RESIDENCE light switch G/E ��' W/Ojq
)cat access APPROVED BY CON,)TRLJCnON SUPERINTENDANT
DATE F
H
APPROVED BY DES)ONER & SALES PERSON
P PI
/L
DATE `
APPROVED BY cvs TOMER GATE
DATE
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ILX 2295 East Tamarisk. Road Palm Springs, CA 92262 License No. 779165
01 39bd JN3 S83QNndS
L99£ -0Z£ -0U 6"T £00Z/ZZ/50
05/23/2003 08:46 7605E"329: PGAWEST PAGE 07/08
May 22, 2003
FAIRWAYS ASSOCIATION
Mr. & Mrs. Greg Klusman
3325 Pageant Court
Thousand Oaks CA 91360
RE: Pool, Spa, and I,4ndscap*
Dear Mr. & Mrs. Klusman:
At the May 19, 2003 Architectural/Landscape committee meeting the plans that your
submitted were reviewed and approved with the following condition.
• The equipment room needs to be enclosed.
• A plant legend needs to be submitted.
• An irrigation plan needs to be submitted.
• A mow strip or planter bed needs to be installed behind the pool.
• No hibiscus should be planted.
If you have any questions please contact me.
Sincerely,
M ' o, CMCA
Association ger
DM/ncp
Post Office Box 1658 • La Quinta, California 92253 Phone (760) 564-3858 • Fax (760) 564-2329