9907-590 (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 # S q,.Lic. Class Exp. ate
bate IL2SIL 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:
( ) 1; 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).
O I am exempt under Section B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION w
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 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 loshould become
subject to the workers' compensation provisions"`�
of iidon 3700 of the Labor
Code, I shall f rthwith comply with those prov siovt
Date: ' Applicant
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 applicator 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 becomesbull 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 Stateda'ws relat�i�q to the building
construction, and hereby authorize representatives of i.ig ity to enter upon
the above-mentioned property for inspection pulpgses.
Signature (Owner/Agent)
PERMIT #
BUILDING PERMIT
DATE—" f1, VALUATION �3 � ) LOT � TRACT
� na
JOB SITE
ADDRESS �r.,�I� .O1F�':n�'r APN
OWNER CONTRACTOR / DESIGNER / ENGINEER
NFMW EVES CALIVORNIA.°POOLS &S -PAS
54-813 INVERNESS '74-725 �Olqf DRIVE, #A
LA Qt iN rA Chi 92253 PALM DESERT CA WNW
I USE OF PERMIT
POOL .ATKilt4,.5>rZ `SPA.
€tit' ;+kkr-nl.,hSM.i?..iNSPEC 1'10N.
FOOL ANUVASPA
13,xjo.o+o I's
kkraflff FEE SUMMARY
PLAN C[EC1K t'.(Es ifll�CIt31I-1t3�-3343 �>?j. l�
C+.":'JNSTSRI K7fON ON
;'lVt-`TTANfCXL ROZ,—K)O.L M-000-4.21.000 $�r1.0E2
.1JLUIV11133f40 t'HL --POOL $1:7.00.
I.,IxS; ;PRE -PAID laME,
FEES DUE NOW
RECEIPT DATE BY' a DATE FINALED INSPECTOR
A.
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-:o Wrap
F.A.U. ,
Framing
Compressor
Insul tion
Vents
Fire ce P.L.
Grills
Fireplace T.O.
Fans & Controls
Partv Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Hacks
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
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)
..ua aJ JO uJ: -rid J' J. 1/elv1Q GV@3 ,.}1— fJ4-141Q P. j
9A
PCA WEST
RESIDENTIAL ASSOCIATION. INC.
July 12, 1999 --
David & Carol Eves
54-813 Inverness
La Quinta, CA 92253
- RE: Architectural variance for'54-813 Inverness, l,a Quinta, CA.
Dear Mr. & Mrs. Eves:
Mr. Dan Shepardson, Architectural Committee Member, has reviewed your request to install a BBQ,
pool & spa, remove one tree and install one window at your 54-813 Inverness residence. Approval
has been granted on the condition the following stipulations must be satisfied and/or adhered to.
I. Any electrical ,Niring exposed during construction must be reported to the
Homeowners' Association.
Any trees removed must be. replaced or a fee of $200.00 will be charged to the
homeowner.
3. All drains must flow to the street, only sheet flow is allowed to the golf course.
We reserve the right to make a final inspection of this change to make sure that it matches the
original request. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
We -appreciate your cooperation in submitting this request for approval. If I may be of further
' assistance, please contact me at the HOA office, (760) 771-1234, Ext 15.
Sincere/ ,
C
Mcoal liard
Operations Manager
cc: Architectural Committee
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
i;.