0209-107 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am'k nsed 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-_gate,
Signature of Contractor
OWNER -BUILDER DECLARATION
1 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).
( ) . 1, 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 STATE FUNK). Policy No. 13440321.02
(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
_o
subject to the rkers' compensatiob pr .visions of Section 3700 of the Labor
Code, I+>;h rll�foithwith comply withihoge provisions.
Date: ,r. V4 ` Applicant,'
Warning: Failure to secure Workers' Compe sation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. +
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is'performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance. of such
permit, or cessation of work for 180days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City,.arfd State laws relating to the building
construction, and hereby authorizerepresentatives of this City to enter upon
the above-mentioned property fori&pection purposes. f
'Signature (Owner/Agent) %t Date/ i
a
1-M.1 PERMIT PERMIT#
BUILDING
DATE v.''.VALUATION LOT$ ' TRACT
JOB SITE,,--APN
ADDRES16 464I j ; fEMA
OWNER
5.6-405 R.1041KRA
USE OF PERMiTZ
CONTRACTOR/DESIGNER/
i�".�vfIL Y P(7OUS! C;G�13 1 f" 1'1f37,T
j310pT AWOOZY-,
(7 p)a-W -55 ;' '(:t3-41 2893
- t
SPA ONLY. A.LARMSIVA1rRON-I'S SHALL BE IN PLACE.A•.' 'P11FK-iT1�i4::la`=
W:6)'1tOM.M. i?OUIPM&T ENC1.400,40 T dNC1,,:1,IM, 1 i D IC4i--
6� 01, d'J.CYlJ 01 M��A 1 00.00 US � � 1YJ 7 �- e r G. V J L
: 1...
t.. - C TY OF LAQUINTA
' FINANCE DE"
' as
1rSIER+li�iIrElD (,Q1"T Ci:t1' COR511RUCTION
PLAN L"Hi.�GKKT, 101-000-439-318 $ta)w:30
CaNS:r`RUC.TICON rRX 101--000-418-000 $163.0
BAECHARIC.A.L M -- POOL 101x000-421,000 S24,00
h'l.3,?i TR.ICAL FEE KN POOL, 101 C',L� i �,•2t?-(3fJQ $�3,Q0
PLUMBING IIP. _P001, 1.01.000-419.000 0 1x`1.130
f3T.T,6,-1"i31Pel CO-WRIM`u1;IfMMAITOP:i..A I0
US30 T�R&PAMFKXi to, 00
RECEIPT DATE / II+ Byy.I' DATE FINALED INSPECTOR
INSPECTION RECORD
• OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
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
Final
Final
BLOCKWALL APPROVALS
Set Backs
steel
Electric Bond
POOLS - SPAS
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
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
Sep 13 02 10:21a BOB EDWARDS CONSTRUTION 760 775 9093 p.2
FROM MONARCH- R40NE N0. :-760 776 5111 Sep -13,2002 10:20AM P2��
t PGA WEST I1 RF,SIDFNTIAL ASSOCIATION, INC.
P.O. BOX 1282; LA QUiNTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
December 20.2(X) t
Mr. 71tomas Mcfldnicl
19601 Mayfield Circle
Huntington Reach, CA 9264%
1
Refercuc:e; 5Cr40i Riviera. La Quinia. CA 02253
Archilamral R quest - Rooth Addition & AdditiAattl l-aiulsc;,ping
Dear Mr. McDauiiel:
The Architectural Comnlitxee reviewed yow• revised phais at the Ccxcuibor 1.0. 20K) hi eting. The
committee dianks you for submitting drawings to show both sctbackc (IT -8 5MV' and 151 so they tvcra
able to review the impact of tthc two dimensions.
In mvicMingyour revised dn:wir; tltc iiCly of tt>` south and wcs: eppzrr to be enclriulgeci and t:^.c
t:011191itteee =5 no alllp:Ki, using the IS' wlirtck. in ft rir%Vh ec !chid 'ityge Screen T. V. sc:. The ,C-4T.S u,
die bar stools and bar area. s(iil ;tpj= ;u he adc gii;ite.
- t
We have res•ic vcd.Gre two propetiles as dc.-tri'taed in the leiter ftom Bab Fdwards dated Decembor 10.
2001. Plessse note tlti,t 55-515 ili4icra is in Residerrti tf l:.xhich hay coil iaH (n tlo :� itlt itesicktuial l 1. RES
1 is self -managed, have their own documents and approve applications in their Association. The other
• pmjcct. 57.083 Merion: was approved some time ;tggo ,Ind since that tithe anew set of Architectural Rulcs
was established and mailed to all RES 11 hotricowners. Thew two pmye;ties have no intixict oit voter
application.
The committee unanimously approved yoar revised drawing with tete 15' setb:rk. Tbc roolline em) axlend
rto t'urthcr than the a:cjt tocturtl feature.
Review by the Committee is only for -gc neml confot rtrdnce iiith the architectural guidelines. It is the
r"Ponsibility of the oivmr to fully understand and conform to the ardtitcourdl guidelines criteria. whether
or not all dcfieieneies are noted duri"- review. 11 is also the crvncK's full responsibility to field .-,nfv.L311
axisting conditions. The Committee's dc66oa with regard to project dcsign will lac firue1. Please refer to
the Arehitwural Rules for all required cnlrnittals.
Approvals gitin by the At hitcx)(ut�i Connrdtn t urco0:f for oatic six months frsnl die dale on Ati
approval letter. Afier thin time a now applicatior, must be. sabntitted.
ilte following items arc not on cite Recommended Association Plant Palette. Scgo Pim: Mcycrs Fera,
Sword fern; Lily Turf, Mondo Orrsc, Scotch Moss and Baby Teary, The conunittee rccomincatds that .yoo
choose items Froin the Association Plant Palette, o►py enclosmd.
Please cotnnct Javier Contreras. supen•isor for Valley Gardening Service ai 760/399-IKU anct Carol Foller.
the Association Miautger. prior to any in•igtttion modifications assoeinied with this eliange. Awnaggc to the
iandscapiatg i.e.. shnibs- trees. flowers and turf is the Msponsibility of the CeOM Mr. 'The landscaping
must be brought back to its original condition when the project is completed.
L Sep 13 02,10:21a,.'. BOB ' EDWRRDS CONSTRUT I ON 760,775 90931 P.1
FROM MONARCH .. PHONE NO. 760 776 51.31 Sep. 13 2002 10:20AM PI
{ PGA WEST 11 RESiDFNT1AL ASSOCIATION, INC,
PO. BOX-1282, LA QUINTA, CA 92253
• , ` T. _ (760) 776-5 100 FAX (760) 776-5111
PGAIVES
lamtnry 29.2001 '
Mr. Thomas McDaWel
1%01 Mayfield Circle
Huntington Beach, CA 92048
Reference:. 56-405 Riviera_ La Quinia, CA 92253 _
Architectural Requcsl - Room Addition & Additional Landscaping
Dear Mr. McDaniel:
The Board thanks you for attending its latutary 29" Board Tneeting.
Mer discussion and review of boib drawings (setbacks of 13'-8 5/12" and 15'). the Board ttnattituously
up]wJd Ute decision, of the Architectural Conunince. Tlicmfore, the lener dated December 20,10( from
the Architectural Committee will serve as your approval letter.
tf yorr Uavc any additional questions or concerns: please do not hesitate to contact Carol Fuller, Association
Manager, at 760M6-310. Ext. 20.
Sincerely.
PGA WEST II RiESIDL-NT1AL ASSOCIATION
For the Board of Directors
Carol Fuller
Association Manager '
ce: Board of Directors ,
Unit File
'
L.
1
A RE -INSPECTION FEE OF $30
!fSILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
't}NIEL f"10/,0111f
Cwt} WAST
vr-r1<.1 C.&(,--�
CITY OF to QUINTA
BUILDING & SAFETY DWr
APPROVED-
CONSMUCnON
Ole k � � " 1,�,
Z hp Purr (dre, 4)d-1)
> hp Pww (6jd,)
2 hp Pure "dafdl)
G#„Gt, ° 4000 "a
40000,,000 ConstructionConstructionM,�1�da
wl--;Ipa 1-14 Pools Spas Founfain5
O O
Ui &-�YZA
�; ,
pa
Pa
A RE -INSPECTION FEE OF $30
!fSILL BE CHARGED IF THE APPROVED
PLANS AND 10B CARD ARE NOT ON
THE SITE FOR A SCHEDULED
INSPECTION.
.NO EXCEPTIONS!
't}NIEL f"10/,0111f
Cwt} WAST
vr-r1<.1 C.&(,--�
CITY OF to QUINTA
BUILDING & SAFETY DWr
APPROVED-
CONSMUCnON
Ole k � � " 1,�,
Z hp Purr (dre, 4)d-1)
> hp Pww (6jd,)
2 hp Pure "dafdl)
G#„Gt, ° 4000 "a
40000,,000 ConstructionConstructionM,�1�da
wl--;Ipa 1-14 Pools Spas Founfain5
O O
Ui &-�YZA