9809-080 (RER)LICENSED CONTRACTOR DECLARATION
)j.he.;eby 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
590690 3/31/00
/ f
`Date ,� t `� l 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&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.
(, ,)• 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.
STATE 1'Cltti`f) 12977971 -?,f
(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: t t Applicant af7 4r 0 0. i n 4
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 for inspection purposes.
VS gnature (Owner/Agent) 1; ,F, 1:� t j �� Date
BUILDING PERMIT PERMIT CONTROL#
9# 0080
DATE NI1l19ti VALUATION J2,(I0() t10 LOT TRACT
8184-
JOB SITE
ADDRESS S4-2201�LIVIEIL
APN 769-501-"0
OWNER
CONTRACTOR / DESIGNER / ENGINEER
E 11,ENI1` Sff. A1)1 r. R.
CALTE.CH BUfi.DrRS
54220 RtVil'RA
52411 "ENI,DA VELASCO
i.A Qi i1NTA CA, 92253
LA QIRNTA CA 9:7253
(760}564-1309 CBIX 402
USE OF PERMIT
ARSII.)M'IAI, yh' fdtt iiJr3,
REPLACE EDCIuTING 6080 F12O2v i DOOR W1 6090 DUAL CLAZFD.
ROJI.I1CH iXRTFIN(J 5080 WIN14) W W/ .50% HN
ti+hi,UA epi ON 2.ix`rt7.(0 L i
sl ; ,is�iL�a�i : ".C':T OF % ;� 'x;�TL ;'d
2. lft.� va
Pi RMI[T FER SUMMARY
PLAN C;.`fiK'K FIT, 101-000-439-318 3a9.�5
(" ONSTRU(TPION FWT 01401-41R-0" Vs 00
s1i:QNu xiorloN im . - ItLmr) 101-wo-2.-u-600
4�e
SMISEfSA!0NS''MTA71 f1 >N ANK) PLAIN C,MECK
S7471,
�!� ! � e s'►r► A>t!tTT. LES PRE -1 AU)1"M
$0.00
TOTAL PERMIT !+'EEN DUE.i� NOW
574.75
s
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 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 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
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:
z
f
TM
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
July 29, 1998
Eilene Shadler
603 Lake St. #301
Excelsior, MN 55331
Dear Ms. Shadler:
Your request for an architectural variance has been approved by Mr. Jack Sandberg, Architectural
Committee Member. Specifically, you have the approval to proceed with the removal of the entry
landing, lowering of the dining room window, installation of a skylight in the kitchen and to change
the front door at your 54-220 Riviera residence. Upon completion, please submit the Notice of
Completion form to this office.
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 change 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, (619) 771-1234.
Sincerely,
Kel lGalliard
Operations Manager
cc: Architectural Committee
lJ+.n evs1�-Amcca Oao(L
oPaS�� S� N G L." L\ � 4\i Com° 0 bv-G "'F'� � E1 wLa Poop,
PrQPt�c�IMaTEi,.ie _ _
Dou.4•� G'.LAg£ _
�T�HEp C �.F\SS
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LA 0 .J I N T
S .i Art; ', t 41 -ION f
AND ALL APPLICABLE CODES
JDAT; �a BY