0302-161 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
iChapter 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
656128 C5:$ W1*1 el.8 10,41110'
yl2n r
Date s. Signature of Contractor
OWNER -BUILDER DECLARATION`S
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.
W_ I have and will maintain workers' compensation insurance, as required by
9ecfion 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 ;I` ATE COM1''YRIMS 1'1' Policy No. 046-61$84"ri
(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 wit,�'� se pr visions.
Date;. Applicant F d
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
the above-mentioned property er. inspection purposes.
Signature (Owner/Agent)_ �� k Dat - � -0
G�
,, �
BUILDING PERMIT PERMIT#346
DATE VALUATION LOT TRACT
JOB SITE
ADDRESS (164 R"MR APN ..
OWNER CONTRACTOR,/DESIGNER/EN (NEER
.g
MR. ANT3lC3:Et1VMt, SAN1E°ORD CALFlJRi.J.IAP ,01.0 & ORM (MP:e1d,€ N CO
80.064. R VERA 86.100 AV:�.k� UE 5.4
1,a%imt�i `P . .92233 C:OAr'`g:t IU -4. C A. 92236
0760)398.9222; 4.M-01 170355
USE OF PERMIT
POOL AkJ:C• OR. PA
POIDUSP+A. 5 L F. 3' W=K W;f►'L4 CITY STAND.0
AIARM&ARFURB 11,HA!,L BE VH P1,AC4 A'1' Pilo -PLASTER INSPIXTION,
5 *Ff, WALL
P001, r't.NDIOR SPA
5.0011F
1042,I1,10 AS
Z
1=3 :PPRE- PAC3 F920
TOTAL PTqZ'W.r FRES OW NOW
RECEIPT I DATE I BY
a
rll
$6131,93
$CVM:)
e�.�CS%rF.v�'}�.'l.u�."TI�A,a f;'�3�
1t:•d1-r�(7®»d41.2�-�tLQ
�ifU'.�4#li
MI+:%1•i.AINICALFM- •.1'PC 01,
101 000-421-000
MF 'MCAL P2Z - POOH..
101-000.420-000
�«S S.Fiti
PU MS1140 Fu,R -> P0011
101-000-4 19-001D�l"l.OD
Z
1=3 :PPRE- PAC3 F920
TOTAL PTqZ'W.r FRES OW NOW
RECEIPT I DATE I BY
a
rll
$6131,93
$CVM:)
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 POOLS - SPAS
BLOCKWALL APPROVALS Steel _
Set Backs Electric Bond
Footings Main Drain
Bond Beam or Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final Gas Piping
PLUMBING APPROVALS Gas Test
t; 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 i
Final 3
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
=0
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM : MONRRCH
February 13, 2003
Jim and Wendee Sanford
900 Doral Court
Placentia, CA 90870
Reference:
Dear Mr. & Mrs. Sanford:
PHONE NO. : 760 776 5111 Feb. 14 2003 03:26PM P1
PGA WESTII RESIDENTIAL. ASSOCIATION, INC.
P.U. BOX 12£12, LA QUINTA, CA 92253
(760) 776-5100) FAX (760) 776-5111
80-064 Riviera, La Quinta, CA 92253
Architecoual Change Request — Pool, spa, patio deck extension, BBQ
The Architectural Committee reviewed your drawing again and wish to advise that although there is a 5'
setback requirement on the side property, the committee has granted an exception and approves your plan
as submitted. For any future architectural application requirements, please refer to the Architectural Rules
and Application -for Change dated 7/1/00.
Review by the Committee is only for general conformance with the architectural guidelines. It is the
responsibility of the owner to fully understand and conform to the architectural guidelines criteria whether
or not all deficiencies are noted during review. it is also the owner's full responsibility to field verify all
existing conditions.. The Committee's decision with regard to project design will be final. Please refer to
the Architectural Rules for all required submittals.
Please contact Javier Contreras, supervisor for Valley Gardening Service at 7601776-6667.and Carol Fuller,
the Association Manager, prior to any irrigation modifications associated with this change. Damage to the
landscaping, i.e., shrubs, trees, flowers and turf is the responsibility of the contractor. The landscaping
must be brought back to its original condition when the project is completed. It is the understanding of the
committee that no additional landscaping will be done as part of this application_
Approvals given by the Architectural Committee are good for only six months from the date on the
approval letter. If construction has not been commenced within six months after.the project approval date,
a new application must be submitted.
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller, Association
Manager, at 760/776-5100, Ext 20.
Sincerely,
PGAVEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller, CCAM
Association Manager
cc: Board of Directors
Unit File
511
SELECTIONS
-rT-Tr-%DT*7 A "'rTnT-.
T STONE
2
U IN D I T JL JOU.LN I -U
TILE
FIELD
SALES
BOULDERS
VA li:�'
DECK COLOR
JANDY
PEBB./PLAS
SIGNATURE
DRAINAGE NOTE:
planters and pots, by
Drainage and irrigation for plan
others, unless otherwise noted.