9701-067 (AR)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
68.1857 t3 53 1/98
ate 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.
( ) 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.
.3 Y'NI NIT, F t1Nt3
(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
worl�ers' compensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C9�de, I shall forthwith:.comply with those provisions.
Date: 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 authorize representatives of this City to enter upon
tabove-mentioned property for inspection purposes.
S�i/ionature (Owner/Anent) Date (NI
BUILDING PERMIT PERMIT#
/fir=1 PERMIT
CONTROL#
1701-067
4661
DATE VALUATION
Rta�{ LOT. TRACT
JOB SITE
ADDRESS _5&180 RIVE&KA
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
36,180 k2fY.IEP A
79.920 FWSTik DRIVE.
LA,QUIN-f'A.
(111V 921,153
IAQ{.J1NIA. CA.
9225:1
(iil9)77g.7e CBIJf
:3212
USE OF PERMIT
000 ( AR.1'{3A?tAO
i74,00 SF
USITIM-AT ef) {..01317 OF CON ST.RUIC A ININ
3.410,40
PJ74611'117 V ICIA, SUMMARY
PGA N 3 Rc;.4 F-6111
1 U? -000439-,31 K $40.
!0# -OW -418 V
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faR
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S - � D FEES.
LESS PRE 1 s�i. .,
T'1#3.00 .:
R A,�®
S122.93. '
JAWS 1
yon,
RECEIPT
DATE
Q
'BY
DATE FINALED
INSPECTOR
T'T a T
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Fors & Footings A
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K to Wra 1,111711
F.A.U.
Framing 4WA62MCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
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:
/�r�%) ✓� Z�Z��
/� l
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 (Per)
PGA WEST 11 RESIDENTIAI- ASSOCIATION, INC,
P.O, BOX 1282, LA QUINTA, CA 92253
(619)7'76-5100 FAX(619)776-5111
PGAWEST.
Y EST.
January 30, 1997
Mr. & Mrs. Francis Ferraro
56.180 Riviera
La Quinta CA 92253
Re: ArchiteCtural Variance • Cart Garage
56180 Riviera'
Deir Mr. & Mrs. Ferraro,
I am pleased to report that the Board of Directors of PGA WEST 11 Residential Association
has approved, at the recommendation of the Architectural Committee, your plans
submitted for construction of a cart garage at the above -referenced residence, with the
- following conditions;
t , General Contractor must Interface with Assoclation's Landscape
malnterioce contractor (-Valley-G. a rdening.•_contact Miguel Valeniuela
at 399.1,844), to Insure that changes in Irrigation system is eornpatlbie„= - 4
.with HOA common area Irrigation system,
2. Per Board resolution adopted on November 27, 1996, as amended in '
the Association's Architectural Guidelines, any future garage or cart
earage door installation must match the original facing design of the
existing ¢arage door.
t<
Thank you for your submittal, and should you have any gUestions, please do not hesitate to
have your contractor call me at 7765100. Upon completion of this project, Please
contact my office for a final inspection and reimbursement of your construction.
performance deposit,
Sincerely,
TGA WEST II RESIDENTIAL ASSOCIATION
John H, Handel
Association Manager
cc: Don Troy, ArChite4W,11 chair
john Monahan, Asst, Mana>ier
Bob Edwards, Generei contmtor
T�tlguet Valer lVela, Valley Girdenln$ Servlce
;,moven:hbiacrslj�hn`pgares2!fcrraru f a,r 11. 2PPi o : si 1.i0.97.dnr