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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"