9903-267 (RER)LICENSED CONTRACTOR DECLARATION
.,,!-hereby affirm under penalty of perjury that I am licensed under provisions of
Ghapter 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
a "4857 13 � 3/3-t100
—261 c
{,Date 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.
(ye?) 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:
Cahier Policy No.
STATE -FUND 229-99-0(V"VA
(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' compensatjonpTyislons�, f: Section 3400 of the Labor
: Code, I jha�lj, o . Ith comply with, th��o' sa. rov §ion -
✓"Date: ADDlicant ( 4`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 al, Pona representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) t�/
Date'
1
PERMIT#
BUILDING PERMIT
DATE VALUATION Q��l�sf1 LOT TRACT
JOB SITE
ADDRESS 54-374) s�t..1 IE
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t�441+5? CASEY
80.14 MI' AKDS CONSTI;IX11,0N
54-370.i JVW%, A
79-920 FI&S'IA x3kt.IVE
L.A.QU1114TA C.A. 92253
L.A.QtAWI'A CA. 92253
(76(F)775-7 933 CBI.14. 32.12
USE OF PERMIT
Y t
i.:.bSe�,KAt� �IV�GL'lEt;llj
4' X 11' SKY1,101- INSTALL ATION OVER KITC1-f`Tif3 .F1R1"sr\
' VrA1 i.f'A.'1'i;, 'N' mss. OOO.00 LS
°q+',.Y I�itATIL s)°b 1 'i�c�ix0.�'
2,.{ii�
�. {� f $�Vry1 r�/�
Kv
PLAN L,'HECK FEE 131-000-439-318 $29.23
f':C.t1V.S''`fi,lTCTIC'N FFR 101-41 U( 4J8-(.)011 $45.00
:3'i'1.CONG NIOTION ITE F. - IC4afD 101-=-24t,000 4a •000 ;$m
Sk -TOT M.. CON,9317RUC°t'4(zN AND MAN CHECK
$743S
TIESS PIREEAR 1 D FEES
V;I.(~,t)
T:Y bU., PERliOT FEES Dtl.0 NOW
��' ' $74.75
e
E6EI
DATE
BY/ ✓
DATE FINALED
INSPECTOR
J
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
3 Ag6
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 APPROV LS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
I
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
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:
RAF 5W
-CAZH.j-T-r;-- -14&,0FYL-j
MZ,- 5270
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OVOL
5K�L I G HT
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.._-.fYp14irAl- ejMiGHT cdit- 12IM -
Sent By: PGA WEST RESIDENTIAL ASSN INC; 760:771 5125; Mar-26-99 12:19PM; Page 2/2
PGA WEST
RESIDENTIAL, ASSOCIATION,. INC.
r
PGA WEST RESIDENTIAL ASSOCIATION; INC.
Notice of Architectural Approval
This shall serve as written notification to the City of La Quinta that Mr. Cabey of 54-370. Riviera has
gained written approval from the PGA West Residential Association, Tnc. Architectural Committee
and from a Management Employee of the Homeowner Association. Specifically, Mr. Casey has the
approval to proceed with the installation bf a skylight in the kitchen of his unit, This signed approval
must precede the issuance of permits from the City of La Quinta.
L—zx 02
Architectural mmitt Date
HOA Management , Date`
P.O. Box 1060, La Quinta, California 92253, Telephone 760=771-1234 FAX 760-771-5125