9911-140 (GRES)LICENSED CONTRACTOR DECLARATION
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
nB�TFiS'l . E3 t j t 03a" 1(2(X
Dato `iSi nature 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.
(.V) 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:
CarrierrATfz :uNbPolicy 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, an> agree that if I should become
subject to the workers' compensation,ptrovions of/Section 3780 of the Labor
Code,. I shall forthwith comply with tlose.pJowslonst.y
Date: t 144 -4K Applicant;
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 authorizejrepresentatives of this City to enter upon
the�above-mentioned property for ins pektion.pu'poses.
,Signature (Owner/Agent)d®aJ wY�
BUILDING PERMIT PERMIT#
!1�►Jl�N�.<i4}
DATE VALUATION S'3.82Zt09 TRACT
YLOT
JOBSITEt
APN
ADDRESS
OWNER
CONTRACTOR / DESIGNER/,ENGINEER
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LA (fit INTA CA 92"1'5.3
LA QUINTA CA 922,51
(76.0)-M-'iT> l CRT,ff 1212
USE OF PERMIT
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PLAN 0IfXK FFX-. $40.95
CONI I°I'tt1;J(IW?N PINI: 101 4W -4484W S6100
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12335
LESS .PRE-T'AID FEES,
$000
R,'1111TAL 11UR1V1 IT F f;.&S 1iUF, IN0. %Y
f
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
;0x
INSPECTION RECORD
R
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
E/i/:-fe
Ducts
Slab Grade
Return Air
Steel _ I
Combustion Air
Roof Deck 11fl"WIf
Exhaust Fans
O.K. to Wrap_ L
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 G�
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:
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)
October 1, 1999
Mr. & Mrs. Hobert Widstein
56-125 Riviera
La Quinti, CA 92253
REFERENCE: Architectural Change Request
Addition of Golf Cart Garage
Dear Mr. & Mrs. Goldstein:
Thank you for attending the Board of Directors meeting on September 27, 1997. Based
on your appeal, the Board wishes to advise you that your plans have been approved for
the addition of a golf,cart garage subject to the following:
• Per your proposal at the meeting, the Board is requesting that you redesign the
extension of the cart garage beyond the main garager toward the street from 41/2'
-to 3-1/2'.
• Your compliance with items 2, 3 & 4 of our August 19, 1999 letter, copy enclosed.
If you have any additional questions or concerns, please do not hesitate to contact Carol
Fuller, Association Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Board of Directors
Carol Fuller
Association Manager
Enclosure
cc: board- or Uirectors
Unit File