9604-131 (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
ProfessiG,aals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
514)a'l�" iy A\
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, lousiness & Nroiessiul lalb Cude).
( ) 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 sM&!'My§f'workers' compensation insurance carriW-&`06licy 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 sf all fprthwith comply with th,9S,q o �4ris:
Date: �� "' f Applicant,_ �;j
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 f r'inspecti {.purposes.
Signature (Owner/Agent) Date/,;
BUILDING PERMIT : PERMIt�CONTROLN
�))�„3
3205
DATE �ilM6 VALUATION S36,f;11)p,a?)0 LOT TRACT
JOB SITE
ADDRESS S. -MN) RIVI A
APN 769-411443
OWNER
CONTRACTOR/DESIGNER/ENGINEER
:E110, D 1' & A” nrLI, G REEN
1;2i"DC;DSC)1%, £T K,
550.0.0 RIVIERA
C:+#ti.'303A PERIEZ RD. H-9
L A t jU1N1 'A. CA 92253
C AT1 E D-RJU, CITY CA 92234
(f i�ls2�t.t2�? C131.01104 #
I IIF nF PFRMIT
POOL ANUok RPA
F°lJ:.➢Y,. i1.t'7 Y&dtE 7'!1.' Y.O,L U.uv 1.�
ED CtDS`r OF (:(31vIS°! RUC'f IONN'
1610 01.00
��'�yypp��/ ( +�/� ,y pES'3.'t��A"_1
PERI M I[T 4+` ,,W' Ntl�JA 1 N1�t1.i\ .l[
`
,M3 101-000-433-318 $tit.is
`10NSi'E2UCT.(ON DIRE 1014W.418-000 $171.00
MEClriA`NICAl.FL1-POOL 101 -000421 -WO
EKLE-IRfCAL FiW -- 1`1001, 101-01m-420.000 3.t3f)
Pi:[t[v1RtNO k'3.?I:+ ..PeYX 1(}IAX1 4,11) lW0
.S.W3.7n,T. 1. COINSTRUC IiOA3 ;t3ND PLAN CHECK
S37S.15
LES,, PRE-1IAIl3FE, WS
$0.00
TOTAL PtAMI`!' TEEN OSIF NOW
$379,15 F..
RECEIPT DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
'OPERATION
DATE
INSPECTOR—.
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Bay.:s
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 Wail 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 AV ;112
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:
r
64/23/1996 14:36 6197715125• PGAWEST
r
ARCHITECTURAL,/LANDSCAPE VARIANCE APPLICATION
1 PGA WEST E411)ENTTAT_. n54SOCTATTON, INC
PAGE 61
Please complete and include this request form, along with
four-(4)set3of your proposed home improvement plans•to:'
PGA WEST RESIDENTIAL. ASSOCIATION, INC.
P.O. aox 1.060
La Quinta, CA 92253
or, 55-940 PGA Boulevard
La Quinta, CA 92253
Attn: Property Manager -
NAME : Z. • 94 . /'C (S /a- eC'�J DATE .
ADDRESS: _ SC17n �- rr?'-A—
PHONE :
PROPOSED -STARTING DA
APPROY,Zk�TE -COMPLETY
/7 rte' sn W1 S"
Homeowner's Signature v
The -following appropriate information should accompany your
completed application:
1.. Four (4) sets of complete plans to include:
a. Improvements and/demoli.tions
b. Plot plan.
c. -All dimensions proposed
d. Relationship to neighboring -units
e.. Material and color scheme
f... Planned modifications of all external systems (landscape,
sprinklers, gas lines, electrical, etc.)
2. Agreement. and .Covenant Running. with the Land completed .and
notarized. Two (2) -original.
3. Conditions -.of Approval and.Disclaimer form.(signed)
4. Facing and Adjacent Neighbor form (if•applicable)
S. Construction Regulations form (signed)
ELECTRICAL [_.] Approved [ ]-Disapproved
Signature' Date
LANDSCAPE [ 1 Approved [ ] Disa
pprcved
Signature Date
ARCHITECTURAL COMM E Approved [ ] Disapproved
Signature Date l
1 ` • [ `.�_ ^ '— {`ate •. • ~ ` .: w. ♦ ^ •. �_... • . ` ♦ • f . •` JL`. L I 1 . M\ /1 TJ = :a r v./Y `- ,JEPTH�. 1-1 1 _,, _•r•• NOTE: �1LI: $pL?�.DL'P.S TO BE i'1,ACED RANDO-N LZ'� -; } ��' _ T RNSED. AT VRADk% -3
' FORA "V,�TL2RAI_: U.iSIS"•LOOK i yr , t" n LITE 1OE� WATTS :SHAPETSTPERIMETER 33'
•y �_v I F GROUP 3--7= _--
HT1 p -� _ <, �� - • i . - t TRI LJBIEL SEATS Y ES T.L. S'Z_ '
� 11►1DV1,'FUk "TJPRIt�HT'-OR 1•'E3tY. THItK" BO LDUS•- _ ;'> . ' i r 2 ' T.LE C�_o!~CHQTCE 1 --r
- 22' �4' _ 2% '
_ VO'E. PAIS= SAM! NOT-' ""`�'Y`�'
r `3AkfAALL YdDTH
i. JR 'FLAT OR LESS THICk`' BOULDERS IE _SPI_LWAY 57E NO IR 'WING ]ATI RAL STONEr �p
CZlii�O SQA CAPOkCRY 147a aALS \I '
p -1 -WALL aPEI� LOSED PUMP CAPACITY go ^v,M �W
lY COLOR { ' ' JE -S. S 1.1CTroF. iiP - -
_ PLAS'rla R / -
• 'V1+ATERFEATCI2E W/BUBBI Il G SPRING / NiC}TOR HP STA MAX 2 '- HP 1-� �
`AT+?A'`ABOVE SPA 1-L%'Ei. ' S SF'A TEiS'1O BE,` . TI
MOTOR HP STA %IAX « '.HF 1.5 • `< [
J
- pOSMONED AT ' 4
_STIL�� bFCt'I.TI LEVELSM. _ �
t FpOR BBQ 'h. 5' w I r "; EXIFST.. _ J �; ;� -� , + Fr grER S7'S I'?aI 3 30E1 S FT i_
[1I 1 B�� �vMAll i S t_at r J BL�� �J J �- .. ' ' _ FIL 1 C (� �/�t- .' 101, GFI
_ OTBERS' s��EGST— '. �� Rr►OVE3 - •`f-• .1 HaS
�. TREE~fir . V �� -
s II ;
RETU�IJ LIKES. TO NETS
IBES
\� ! SKIMMER �1rJCE'_ DUAL PORT
10 > - I 1 -
«4+; `1 rIl 1 '_ _ 1 l r REMOTE'rONFI2OL HEA -ER LAAFS• SIZEd04i4[1�3 BTI
' LOC 4XION TO BE
T ` f ` II .DE'fEk:.v10��D _ 'GASLIN€- _D.�-_..W1 3. S I
SGNIERC) S ARE - - Y t �, I�`� SPA LIGHT 1001• / -
SLBNMRGED STEPS " `. CLOCK A L�LII��i � SE.
;r £
r -
£.• i �12E��S01'E 9' OF , " £LE^TR'c
1 F ISTLNG WALL t F1 ECT PIcAL $ONDNG 5Y: H
TILE AND COPING S.D.C. na
- ` DEC«dG gY NONE
��� f CCI. -IX-TOP mnno assume
_ IIAI�v E." LAVATION' ;t _ y u F G 1 YZ re`spb•isbihv for c'amage to
" TE ..f< - <`: i r $;, } I i � TAr rv' Vis: sidevrdlks, Grweways,= `
SAFETYDEDA . r_emerTt stab;~ sewers, _
RTM .�� to s,trees `te�ces, I:zta.nn� ra` • ci
' vim
MNA
LY w2 sprini;le's, t elephone lines - 0 `
ftrT IrfSv 1 iC ' `� w: w W ACC E d' r
L
F �® r� ru�5. When access ;< rra�e •,1-
Z. ;CONS C �11i�C RON th u, h a r'e'g�#►�r'S propertj' s f
it ri
SdJBJECT T®.INSTALLATION u, erstood that you, tte Owner,
. M
J.
,4S PER Dry h2�rz tfia[ regrb� r'S per! Fission a �.
f ' a assume `L! msponsiba tv.
4-10 : t
Y' - - I, s' _—•1 A"��'raBaB ' Greens - =`
• i � � r ' • _ - . �, ' • ' , � ' i F� DATE.. � ---. � _ • = } i "^ . l - . , ,
EX -1 1 iN \ _ 74LA IfENT A C.A.
COLUNIS
PG
Aw
711
Pools
F.T�T1iY _ J
U.arr_ -T+ ~� MAIN_ "'r; SNOVY ROOM
$ EJ�TRY `` 73011 GrUhFT71'_CL�.BC•P.J0F—�, f_
,.+
BALM DES ET , CA. 132? 60 ?
•] V �! r Z �PH-;1KE 'c.t91 346-3052 1 .