9803-176 (GRES)LICENSED CONTRACTOR DECLARATION
c�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
/Date Signature of Contractors
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. 1t
(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 provision9`of Section 3700 of the Labor
Code, IIshall forthwith comply withJthosef rovsiohV ,
Date: i. t 5" 7t, APPlicant C f �{ .. r 4 .;c. •�
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 authorise e'presentatives of this City to enter upon
the above-mentioned property for irr pection purposes.
VSignature (Owner/Agent) t , � t A Dately—
BUILDING PERMIT
PERMIT #
CONTROL.#
DATE i VALUATIONLOT
TRACT 7003
JOB SITE
APN
ADDRESS 56-:040 .H.1V1FKA
701-461-W,14
OWNER
CONTRACTOR / DESIGNER / ENGINEER
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RECEIPT
DATE
BY '
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE.
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set BacksI
Underground Ducts
Forms & Footings _ a
�(
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck ,�
Exhaust Fans
O.K to Wrap -
F.A.U.
Compressor
Framing ,¢ -
Insulation -29_
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
POOLS -SPAS
BLOCKWALL APPROVALS
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
COMMENTS: . Q�
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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
i
Final
Wility Notice (Perm)
P•iHFC-z 1 -ye YU'E 1 0 3e ME:SA C0 _ L 11 F' . 0 Y
AW. A
PGA WEST it RESIDENTIAL .. ASSOCIATION. 1Nr
P.O. BOX 1282, LA QU1NTA CA 92253
(760),776-51(Z IMAX (760) 776-5 i i I
Marcli 27; 1998
MT . Joel. Rabic
-4105 -E:. -Broadway _# 1.3.0
Long Beach; CA. 90803 -
RE: Architectural Change Request, for 56-0130 Riviera
.Dear Mr. Babic:
The Architectural Committee is pleased. to .inform you that it has apprpved your
request for the addition of a Golf Cart Garage at the above referenced. address at
PGA WEST.
The Association requests that you contact its Landscape Maintenance Contractor,
Valley Gardening Service at (760) 399-1844 to coordinate any irrigation changes.
Please be advised that this approval is good for a period of six months from this
date, if work is not begun by September 30, 1998, a new application will be
required.
Please contact me at (760) 776-5100 to schedule an inspection of the project
upon completion so that the Association may refund your performance deposit.
Sincerely,
For the Architectural Committee
John J. Monahan
Association Manager
CC: Architectural Committee,
Board of Directors
J