9610-027 (PAT)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
L6/at e t�.
atSignature of Contractor __J A&
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 Issi 9RI My° workers' compensation insurance cdr'n9 {& 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 if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
Code, I sh II fo hwith comply with those proui to S. `
ate: tsn q Applicant �:t� � >L t..�
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 & eachperson 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
cona°truction. and hereby authorize representatives of this City to enter upon
the above-mentioned property for, inspectikonpurposes. �^
\,Signature (Owner/Agent) _ _, `1_ �"! _Z _ _Anti,' Date
J_ —
C°NT4
BUILDING PERMIT PERM' y�
�z7 19
DATE VALUATION �,�(�,(! LOT TRACT
JOB SITE:54-40 UWWMA
+V'�
APN 7G� 501a1l54i
ADDRESS
OWNER
CONTRACTOR / DEESIGNER/ENGINEER
4�i�d SI�A.sl?4l, �`�•. 1ACll".-.e�.L 7.f-iP\{4i
C/CBUIyLR(
54400I21it1E3tA-'
32711 V LA•SCO
LA f, UN'1'A CA 9A?33
LA Q),U NEA CA 92?51
de;'S644309 C'"TRJI, 402
USE OF PERMIT
6 E NEk.AL l:it If)lN6'
EXi.IVNI) PA3.'10. tVA) Yi.3 C,£r. 201' 111011 BLOCK WALL
la:.`s'i'l:ilghi'C.EZ COST OF C"(iN ►`3'121,7{."l'3.ON
2,1.#�3(I.i1li
;7'.i+A1( UIG' 1.i'1±W ti1)iVNNIARN
t.'.:;�iV;i'Ctf.1�;1"I.c:ti+tl>F?1 tl)1.-tN.lti-41f4-4!fltf �?il.fi0
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►t3•`l `t zl it s'� )N�;'t 11(rC 'fat AND P4AN rIMCK,
q,�t?.G�
t, V,SS PrO.; Polls FEES
$0.00
n
RECEIPT
DATE i�+ '/�.+�iy {/
BY+{(
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APP O ALS
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
42
Final
Final
BLOCKWALLAPPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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 Condult
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
, te
� ry •
PGA WEST
RESIDENTIAL ASSOCIATION, INC. ,
May `31, 1996
Mr. & Mrs. Paris
1020 E'. -,Columbia
..Weatherford, TX 76086
i
RE: 54-400 Riviera � y�/,
Dear Mr. '& Mrs. Paris:
`^/
Please be{advised that.your plans have been. approved provided you
follow the additional requirements'. below:
xf - `
1) Owner must.get.a dity-permit for the, -gas line and a -copy of
the approval must_be_submitted_ .ri.o.r t.o�any wor-k=being done
2) Demolish the existing grill and rebuild with steel studs and
concrete boards:` '
3) Stucco the sides and match the color to -the existing walls.
4) Tile!the top to match the pool.tile:
5) There must be vents -at the bottom on both ends.
If you have any questions or comments feel free to contact
Don Adolph at .(619) 771-0577.'
Sincerely,
Michael L. Wa ker, AMS CCAM PCAM •
General Manager
,
CC: Don Adolph, Architectural Committee Chairperson
P.O. Box 1060, La Ouinta, California 92253, Telephone 619-771-1234 FAX 619-771-5125
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