9511-132 (BLCK)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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. rtfi.11i57 B
License # Lic. Class Exp. Date
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm 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 ;r i', 1<uia13 Policy No. 2,2993F+11
(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 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, intarest 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 application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, 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 for inspection purposes.
Signature (Owner/Agent) Date
ALCM
BUILDING PERMIT
PERMIT��I-�
DATE ✓� l✓`'*
VALUATION LOT TRACT
JOR SITE ADDRESSAPN
:, .'545 RMI KA
OWNER
CONTRACTOR
Tk(!TC FF)WARDS
lL.Oj;1::li'1' & KIMIA-R SE'C, T
81'A 11 PFC OS PLACE
SAME
INDIO (,,'L 92201
LAQUIN`fi'A CA 0229
(614Vr:`S-Y433 C HI,1e kN
DESIGNER/ENGINEER
USE OFPt:RWTJJAV1.1' Itntx3I.i1.. AI t
H W,E. EX18TIuNO W001) 01) iLA1V)4al�'1`CI('C'C WALL 24" 14* A 1'(11 ✓�1, ur' 1S'.
FEE DESCRIPTION
FEES
C(aiv l.t W# 'I AT1IOUN 1 1t1k9.t)t) L
1!;S'1.'1n'it\`il ED COST OPCONSTRUCTION
101801
PERMIT FIVE Sit) M_MARY
t`.C3NSTItOt;TION rFK 11)1,0()(3.1318-000 115,00
SU13-Wil'AL C'OPlSTP- rtr"I"(Or:AND PLANT t,tlll.CK
$1 1;
JA,'8s PRE-I'Af1-) VECS
V00
'iCFLU, T'� RMU jE F ES 1)i `F; NOW
0411.100
TOTAT, PR0 T :CT 1'ir:RM1T F'.EFS
15.00
>, a
REC BPT.� .- ;
DAT +
BV
DATE RNALED
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 `j
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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 Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
PHONE NO.�2.
-
PGA W98T n RESIDENTIAL ASSOCIATION, INC.
. P.q, Sox 1282 + La Quanta, CA 62253
August 30, 1995
Robert K. Scott
12 Burning Tree Road
Newport Beach, .Ca 92660
RE: PGA West II Residential Homeowners Association
56 545 Riviera .
Dear Mr. Scott:
Per your request to my assistant I am writing to inform you that we
have received no objections from your neighbor, 55 525 Riviera, to
your architectural request to raise the height of the adjoining
neighbor wall by three courses.
As you have met the requirements of the Architectural Committee and
the CC&Rs Of PGA West 11 Residential Homeowners Association,
approval is given to proceed with changes you detailed in your
variance application.
If you should have 86y questions, please call me at'(619) 360-4161.
Sincerely,.
John H. Handel
Association Manager
c: Architectural Committee Chairman
FROM :' BOB AND-KIMBER SCOTT
1
NOV.27.1995 1:46PM P 1
PHONE NO. : 714 342 5656
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. Box 1.282 - La Quinta, CA 82253
August 2, 1995
Bob Scott
56 545 Ri'v'iera
La Quinta, CA 92253
RE: PGA. West II Residential Homeowners Association
Architectural. Variance Request
Dear Mr. Scott:
This will confirm the approval of your Architectural Variance
Request, except for your neighbor's consent form, which was not
submitted as part of your architectural variance package.
You may proceed on the front door change, and wrought iron gate on
the, side of' your garage. The .only item requiring neighbor approval
is to raise the side perimeter wall -three courses. We have sent
the necessary form to your neighbor Mr. Anthony 'Robbins for his
immediate approval,, and I apologize for the delinquency in
notifying you of the Committee's approval.,
Thank you for your compliance with the rules and regulations of PGA
West 11 Residential.
if we can be of any further assistance, please call ( 519 ) 360-4161.
Sincerely,
.rte
N jfyc. � vt(.f�
John H. Handel
Association Manager
c :. A.rchitebtutal Committee
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