0310-125 (RPL)LICENSED CONTRECLARATION
I hereby affirm under penalty of perju y alai 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
Date '' '' Signature of Contractor—
OWNER-BUILDER
ontractor
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.
(4..) 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`!: '''9 �:�"+;4 LTNSIX111 Policy No. 046-5168-200
(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: % tr'�:. Applicant—
Warning:
pplicant 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 foHnspection purposes.
Signature (Owner/Agent) !"�a--.,'' J rM Date���
r,
PERMIT #
= .BUIL PERMIT�
DATE VALUATION e�i�i�� .G;�f,>,} LOT TRACT
JOB SITE80-144 W�'.rd'RA APN
ADDRESS .
OWNER CONTRACTOR / DESIGNER / EN INEER
80.14,8 PMR& 86-1 MANUIR :54
l.A.t�c�+1XTA A. 12.1�,Si3 (aOAC19991 �.. (!N 927.`i
USE OF PERMIT
PCY3LAWWOR EWA
f.t.v�d`.��~i7 L'.t'DI�. /.'..b i;.!"r� �vil.tl6,ir ]Ci.G '. [l fi✓�•1wWli ['.1'1 1�iZM1»•I'�t•�ti !��9L, ii9 iil'!'.Li' ��..t,f�7.
>I;;21. ipmrar u�C;U'7;?t1R.t,1~ m INCI,tJnwD
POOL. AN*.DP-R SPA
12100P..0 klh
011' CONFfRUCROIT
P 14110 HZ4•1;. .1'&,B 101 0 ii«`f S9 -3i8 M. t'1157
GOWN'`. UCT1014 ixX 201
PLi.1M r INO FEE -'(10L 1 01 t (11419.000 x�1,ih'9
RECEIPT DATE ', f•. I BY
INSPECTION RECORD
OPERATION
I DATE
I INSPECTOR
OPERATION
I DATE
I 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
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:
4 .
N4
PGA WESTn
October 17, 2003
Mr. Mark Hanson
5.650 Yonge Street, # 1707
Toronto, Ontario, M2M 4G3
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 80-144 Riviera, La Quinta, CA 92253
Application for Architectural Change — Pool, spa, fire pit, water feature,
barbecue and additional landscaping
Dear Mr. Hanson:
The Architectural Committee and Landscape Committee reviewed your revised plans to add a
pool, spa, fire pit, water feature, barbecue and additional landscaping and hereby approves your
application. -
If natural gas is to be used in your fire pit, the installation must be permitted by The City of La
Quinta and inspected.
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.
Approvals given by the Architectural Committee are good for only six months from the date on
the approval letter. If construction has not commenced within six months after the project
approval date, a new application must be submitted.
It is the Association's understanding that you accept full responsibility for the Phoenix Robelenii
and should they die, you will replace them. Your contractor must warranty all trees for one year
and all shrubs for six months.
Added shrub and turf irrigation should be on separate controls due to over -seeding in the fall.
Added lighting must conform to that which already exists and must be connected to homeowner
electrical.
Please contact Javier Contreras, supervisor for Valley Gardening & Landscape at 760/776-6667
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.
Mr. Mark Hanson
October 17, 2003
Page Two
Upon completion of your project, please complete and return The Notice of Completion of
Architectural Change.
If you have any questions, please do not hesitate to contact Carol Fuller, Association Manager, at
760/776-5100, Ext. 20, or Cathy Clark, Assistant Manager, Ext. 18.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
1 For the Landscape Committee
t�
Carol Fuller, CCAM
Association Manager
/clf
cc: Board of Directors
Unit File