9704-104 (RER)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
66857 13 F 331198
Lf 41
Date 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.
3TXMFUNr> =1997-91'02
(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
subject to the workers' compensation provisions of Section 3700 of the Labor
ode, I shall forthwith comply -with, those provisions.
Date: "+- e� `r fFf Applicant $ .r,� t. " -Xf
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each persont
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and `void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information., is
+' correct. I agree to comply with all City, and State laws relating to the buildig
construction, and hereby authorize representatives of this City to enter upon
`the above-mentioned property for inspection purposes.
; ,, V.
Signature (Owner/Agent) f { '' t" (� Date
U_
BUILDING PERMIT PERMIT# CONTROL#
97"1414 5031
DATE 4R2 97 VALUATION. ' s " LOT TRACT
JOB SITE
ADDRESS 56- 545 .I IVIE,'KA
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
21.LO
DW'I0P'
TEsDIS4 Ni ION
?ti . M�'II'R
79-�i20'Ni:FSI'AI)KiW.L"
LA QUlNPrA CA 9 2253
1,A QUI i► -A CA 92253
(7601775-7933 C1111,0 3212
USE OF PERMIT
SKY JA IO
VALUATION 1.13t
EST MIAT7C1) CW;T O% CONS7:R'UC" &'ION
9"..119
MIM1Vff ("EV, NCIM.1M ARV
PLAN r_`iSRM FE.8 101-000-4-3U-31$ $10,25
<<t;it%illt.t't{"�+'�t�t�tii� 1C)1-E�1C'f-�t13�-f1C1f3 S`„St1p
TtX40, N1C1'1701N FU3 - RE"3.1J 101 X00 2 91.-fZtlt) VIM
4
A Vii;
SD__, WfI11"Alf, CONti {VIC'° TON ATI(? PT.AN' Y :CR
*;41.75
1C�
�.i ls's 11plu4"'A.1E7 i'L1B
QR � 91991
TOTAL PERRIIT Fi+;Os i)tJE NOW
RE IPT
DATE
BY
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
OX 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 2r
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
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:
rk. it- 22 r1J - ',� 7 I' E 2 : 2 5, FF 141
April 29, 1997
'71
il 9 776 5111
PGA WEST It RESIDENTIAL, ASSOCIATION, ON -P
P.0, BOX 1'182, LA QUJ.NTA,
CA 92253
(6,19) 776-5100 FAX (619) 776=51,11
V
Robert K. Scott
12 Burning Tree Road IN
Newport Beach, CA 92660
RE: PGA WEST If Residential Associmlon
Architectural Variance - Skylight. 56 545 Riviera
Dear Mr. Scott:
Thank you for your submittal of plans on the above -referenced residence regarding a
Skylight. Please be advised that the Architectural Committee of,PGA WEST 11 Residential
Association, in conjunction with the Board of Directors, has approved your plans with the
following condition:
• I 9eca6se oi thi thtens"ity of summer sun in that directi6'n/
Guidelines encourage you to consider a smoked, tinted, or frosted glass, skyligh,t'.
Thank you for your 5,0bmitt"af, and'should-you have any questions, please contact me or
- I
my assistant, 16hn M6nahan; at 7 76-5 100.
�fy
Sincerely, N
PGA WEST 11 RESIDENTIAL ASSOCIATION
For the Architectural ltom'niittee
3ohn H., Handel, Association ManageK
Don Troy, Chairman
Monahan, Assistant Manager
N.
V"