0401-354 (683) SEISMIC REPORT (2)79691 Arnold Palmer
LICENSED CONTRACTOR DECLARATION i
U) I hereby affirm under penalty of perjury that I am licensed under provision of
BUILDING PERMIT PERMIT
401-3-54
H Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT TRACT
WProfessionals Code,and my License is in full force and effect. J, '<`,j 1, . •
License# Lic.Class Exp.DateJOB SITE
y
O W '731152 E M i 013!31 '( ADDRESS r-•69... 5 AIMOLD { i6sLD PMM, _TPN
Z r,— ,Date / Signature of Contractor — ' r' OWNER CONTRACTOR/DESIGNER/ENGINEER
_0
~ o OWNER-BUILDER DECLARA ION 1 Gf AlT;ST.R.E ;^L`.A ' '.A1..ASSOC IA 170-N
_J U -,P.O:B0X.10e10 2533 SOt7IR C OAST..I lM.-T ,'A.Y S1'1~ 250
W LUaW I hereby affirm under penalty of perjury that I am exempt from the Contr toes LAQT.3W T.A OA 91253 C1RDBY'0,IE {A 9200-7
U) License Law for the following reason: _
Z ( ) I, as owner of the property,or my employees with wages as their sole 7fsti? 3 "1010 GBS 582.3
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed GENER G
contractors to construct the project (Sec. 7044, Business & Professioals
Code). I "t?YILLINT.HRY SE15.M1C'.F24TIt VII
co () I am exempt under Section B&P.C.for this reason
LO
O N Date Signature of Owner
L) Z WORKER'S COMPENSATION DECLARATION
p
Q 1 hereby affirm under penalty of perjury one of the following declaratiolns: VALUATION a,t>ti4,40 i,S
r F2 O ( ) 1 have and will maintain a certificate of consent to self-insure for workers'
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J.Q performance of the work for which this permit is issued.
m Q U ( ) I have and will maintain workers'compensation insurance,as required by
O L Q Section 3700-of the Labor Code, for the performance of the work for which this
rn I— permit is issued. My workers' compensation insurance carrier & policy no. are:
d' Z Carrier STATE'f 1314D . Policy No. 04601 UlNITIV0941.1 EMUTU.A 3;FID COST OF 0.01.4 'INUC TION 6,00D.w
cr.° O 71' :t L`. .t"1 SUMMARY
Q (This section need not be completed if the permit valuation is for$100.00 or less). CONSTRUCTION YER 1011,000.418.000 S?).(M
J ( ) I certify that in the performance of the work for which this permit is issuIed, STRC,1 40 MOTIMI FEE a RESID (07-.0400-u 1_0100 $.60
1 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 Se tion 370Q/of the Labor
Code, I shall fo!!fthwith comply with'`th fise provis'ons. —I
Date: .t V _L_d' ' + ` -- ! ' l. i\
6 ,; F i
s Warning: Failure to secure Workers' Compensation coverage is unlawful end
shall subject an employer to criminal penalties and civil fines up to$100,00'0,in E ^w^•"' ?l i i
addition to the cost of compensation,damages as provided for in Section 3706 JAN 2
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety C!"7W ` 'A
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 perso I at SUM_-TOTAL CONSPIKUC`11011A D PI...AW CIMM 1.60
whose request and for whose benefit work is performed under or pursuant to 00
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 TOTAL PERMIT Ii—IM,S DUE NOW $8.1.+t i
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 IIIIIIIIIIIIIIIIIIIIIIIII 05
• 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 i IE
.the above-mentioned property for inspeption pur'os S. —-
RECEIPT DATEBY - DATE FINALED INSPECTOR
rn,., o.inno.r - f d t r.,-. n o 7 /7rt'1 `✓2 - ° c'
INSPECTION RECORD
OPERATION j 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 _ Q 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
-
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
COMMENTS:
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)
os Page of
,E DAVE STEAVENS
Inspection Services
0,
PROJECT P66 W OLA SS I G S PROJECT # oda, -1 'ts'-
ADDRESS '7Q-(vq l 6,%Wl CLIENT +�(s6 - 10e-,T— Hz a-
AR�1oc DATE 13 hM A t-f cav o �-I-
BLDG. PERMIT # 01+0 (- 3 T-q ARCHITECT C�oL-R A A 2 cW
ENGINEER�k.�) Std Ov r CONTRACTORflc r c_, BLD S
INSPECTION TYPE
INSPECTION REPORT
-bea fa, S- Vs- ;3 #AJ f L y IJ A I&-/ J&,
AA 3 -- v CJ,/ A til� ���/ ����,� J` - �v ti►ti.,�-T�=.
�A • ` - �'f'A- !S•7a 004-L.L. �/j� ��-� d4te,wj(. ��!!a^,7L.�rine-
L-a- 45AS S-3 ' 1Z1ot r'-Tc2 •�+1D �L`1 /VA r� KJ 1,
:Z RL O c..I.l AJN tai:Y A)w
c
0'gy�% 7�
1 #.� k'T—
CERTIFICATION OF COMPLIANCE:To the best of our knowledge, all of the reported work, unless otherwise noted,
e substantially complies with approved plans, specifications and applicable sections of the building codes.This report covers
the locations of the work inspected only and does not constitute engineering opinion or project control.
CERT.NO. 6 e S� 3 4*-S�� INSPECTOR NAME �A tJ S1 A%V e�-V 5
�{ / '` C` (Print early
DATE 17 IY�/� 7 (��!`T INSPECTORSIGNATURE
IIIIIII VIII III VIII IIII 07
IE 4
P.O. BOX 1504 t , mN o. 11403
Building79-691 Arnold Palmer 7&105 CALLE ESTADO
AddresLA QUINTA,CALIFORNIA 92253
Owner
Edward Gall � [[[
Mailing BUILDING: TYPE CONST. OCC.GRP.
Address 111 GayinestonmDr,
A.P.Number
City Zip Tel.
AuguL'ta t1E 94732 1207/622-3219 Legal Description
Contractor Project Description
California Pools
Address Spa Es EquipmentWall
41910 Boardwalk W 18 if of 6' block wall
CityZip Tela
Palma Desert 92260 340-9000
State Lic. City
&Classif. C53 1$5102 Lic.# 355 Sq.Ft. No. No. Dw.
Arch., Engr., Size Stories Units
Designer New ❑ Add ❑ Alter❑ Repair ❑ Demolition ❑
Address Tel.
City Zip State
Lic.#
LICENSED CONTRACTOR'S DECLARATION
I'hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
7000)of Division 3 of the Business andProfessions Code,and my license is in full force and
*�-:--�-"�-�-�..� "�• - • �
SIGNATURE -' DATE
OWNER-BUILDER DECLARATION Estimated Valuation
I hereby affirm that I am exempt from the Contractors License Law for the following 9000.00
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT AMOUNT
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that.he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. Dep. A
subjects the applicant to a civil penalty of not more than five hundred dollars($500). Plan Chk. Bal. y. 2
❑1,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,Bulsness and 108.00
Professions Code: The Contractor's License Law does not apply to an owner of property who Const.
builds or improves thereon and who does such work himself or through his own employees, Mech. 2 4 V A
0
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner-builder will have the burden Electrical 45.00
of proving that he did not build or Improve for the purpose of sale.)
❑ I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing 27.00
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law n
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.I. 90
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
Grading
❑I am exempt under Sec. B.&P.C.for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure,or a certificate of
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Policy.N o. Company
O'Gopy is filed with the city. ❑Certified copy is hereby furnished.
TOTAL 275.10
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
his section need not be completed d the `' i 1 �. +•t' r r L'
(T p permit is /or one hundred dollars (5100) valuation Ti rT. t� - '��-i-• t
or less.) - -. - - -
I certify that In the performance of the work for which this permit is issued,I shall not
employ any parson in any manner so as to become subject to the Workers'Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT. If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit Is issued.(Sec.3097,Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out,signed and validated,and is subject to
expiration it work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date Permit
I agreeto comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for Inspection purposes. Validated by:
Signature of applicant Date
Mailing Address Validation:
City, State, ZIp
CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES
IST FL. SO.FT.® $ UNITS
2ND FL. SO.FT.
YARD SPKLR SYSTEM
POR. SO.FT.® MOBILEHOME SVC. BAR SINK
GAR. SO,FT.® POWER OUTLET ROOF DRAINS
CAR P. SO.FT.® DRAINAGE PIPING
WALL S0.FT.
DRINKING FOUNTAIN.
SO FT ® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER y
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL ' FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM B.T.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR HP POLE,TEM/PERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER. B.T.U. SO.FT.®q BATH TUB
SO.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SO.FT.RESID®1%c SEWAGE DISPOSAL
SO.FT.GAR®3LC HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH_FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK GROUND PLUMBING UNDERGROUND A.C.UNIT COLL.AREA
SLAB GRADE ROUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK
FORMS SEWER OR SEPTIC TANK ROUGH WIRING. DUCT WORK ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APPJEOUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. INAL INSP�`1� cu.yd.
FRAMING FINAL INSP. $ plus x$ =$
REMARKS:
ROOFING n% S
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION-
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL
IIIIIIIIIIIII IIIIIIII��� 08 44
•
IE
P.O. BOX 1504 No. 002569
Building 78-105 CALLE ESTADO
Address 79-691 ATI)nld V0_11.rpr LA QUINTA,CALIFORNIA 92253
Owner
BUILDING: TYPE CONST. OCC:GRP.
Mailing
Address 705 CXXUltry C1d2 Lr'iM A.P. Number
City �Ztz*
p Tel.
P31. 92260 -%8-2828 Legal Description
Contractor
Project Description ;E�_-�7•l.C� �� � �_
Address 's"Iy►7CiC C
asaw+.►
City - Zip Tel. '
Dam
State Lic. City 3478
&Classif. _ Lic.# Sq. Ft. No. No. Dw.
Size GM 696 Stories Units
Arch., Engr.,
Designer New E)jC Add ❑ Alter ❑ Repair❑` Demolition ❑
Address Tel.
City Zip State
Lic.#
_ LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9(commencing with Section
7000)of Division 3 of the Business and Professions Code,and my license is in full force and
effect.
SIGNATURE- DATE
•% f ` OWNER-BUILDER DECLARATION Estimated ValUatlOn c t�
I :ereby`affirm that I am exempt from the Contractor's License Law for the.following $ 211 4a8.00
reason: (Sec. 7031.5,Business and Professions Code:.Any city or county which requires a �r
permit to construct, alter, Improve, demolish, or repair any structure, prior to its issuance also AMOUNT
requires the applicant for such permit to file a signed statement that he is licensed pursuant to PERMIT. -
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of -
Division 3 of the Business and'Prdfessidns Code, or that.he is exempt'therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit Plan Chk. bep.
subjects the applicant to a civil penalty of not more than five hundred dollars($500). " '
❑1,as owner of the property,or my employees with wages as their sole compensation,will Plan Chk. Bal. r„q*4 QQ
do the work,and the structure is not intended or offered for sale.(Sec. 71)44, Buisness and Const.Professions Code: The Contractor's License Law does not apply to an owner of property who 11 fill
l
builds or Improves thereon and who does such work .himself or through his own employees, Mech
provided that such Improvements are not Intended or offered for sale. If, however, the.building !1
or improvement is sold within one year of completion, the owner-builder will have the burden ElectricalV .
of proving that he did not build or improve for the purpose.of sale.) __
73
❑ I,as owner of the property,am exclusively contracting with licensed contractors to con- Plumbing ��R
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
rA
does not apply to an owner of property who builds or improves thereon, and who contracts for S.M.1.
such projects with a contractor(s)licensed pursuant to the Contractor's License Law.)
0 I am exempt under Sec. B.&P.C.for this reason Grading
Driveway Enc.
Date owner Infrastructure 2.000.00
WORKERS'COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self-insure, or a certificate of
Worker's Compensation Insurance,or a certified copy thereof.(Sec.3800,Labor Code.)
Policy No. Company
❑Copy is filed with the city. O Certified copy is hereby furnished.
TOTAL „6 $
CERTIFICATE OF EXEMPTION FROM REMARKS
WORKERS'COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become ZONE: BY:
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith Minimum Setback Distances:
comply with such provisions or this permit shall be deemed revoked.
Front Setback from Center Line
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback from Center Line
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued.(Sec.3097,Civil Code.) Side Setback from Property Line
Lender's Name
Lender's Address FINAL DATE INSPECTOR
This is a building permit when properly filled out,signed and validated,and Is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct. Issued by: Date 9-10-86 Permit
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this city to enter the above-
mentioned property for inspection purposes. f Validated by:
Signature of applicant '��- Date /I"'• �
Mailing Address ' ""' Validation:
City, State, Zip
A6311 9 . 10_ 3665, 62 U,
HARD COPY
CONSTRUCTION ESTIMATENO. ELECTRICAL FEES NO. PLUMBING FEES
1ST FL. SQ.FT.® $ • UNITS
2ND FL. SQ.FT.
YARD SPKLR SYSTEM
POR. SQ.FT.® MOBILEHOME SVC. BAR SINK
GAR. SQ.FT.® POWER OUTLET ROOF DRAINS
CAR P. SQ.FT.
DRAINAGE PIPING
WALL SQ.FT.
DRINKING FOUNTAIN
SO.FT.® URINAL
ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING
NOTE:Not to be used as property tax valuation FLOOR DRAIN
MECHANICAL FEES WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASH ER(AUTO)(DISH)
APPLIANCE DRYER GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY
AIR HANDLING UNIT CFM KITCHEN SINK
ABSORPTION SYSTEM. B.T.U. TEMP USE PERMIT SVC WATER CLOSET
COMPRESSOR HP POLE,TEMIPERM LAVATORY
HEATING SYSTEM FORCED GRAVITY AMPERES SERV ENT SHOWER
BOILER B.T.U. SQ.FT.®c BATH TUB
SQ.FT.®c WATER HEATER
MAX.HEATER OUTPUT,B.T.U. SQ.FT.RESID®11/4 c SEWAGE DISPOSAL
SQ.FT.GAR®3/ac HOUSE SEWER
GAS PIPING
PERMIT FEE PERMIT FEE PERMIT FEE
DBL TOTAL FEES MICRO FEE MECH.FEE PL.CK.FEE CONST.FEE ELECT.FEE SMI FEE PLUMB.FEE
STRUCTURE PLUMBING ELECTRICAL HEATING&AIR COND. SOLAR
SETBACK GROUND PLUMBING UNDERGROUND A.C.UNIT COLL.AREA
SLAB GRADE ROUGH PLUMB. BONDING HEATING(ROUGH) STORAGE TANK
FORMS SEWER OR SEPTIC TANK ROUGH WIRING DUCT WORK ROCK STORAGE
FOUND.REINF. GAS(ROUGH) METER LOOP HEATING(FINAL) OTHER APP./EQUIP.
REINF.STEEL GAS(FINAL) TEMP.POLE
GROUT WATER HEATER SERVICE FINAL INSP.
BOND BEAM WATER SYSTEM
GRADING
LUMBER GR. FINAL INSP. cu.yd.
FRAMING FINAL INSP. $ plus x$ =$
ROOFING REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
AR,CHITMCTM:tAL APPFXNAL APPLI=ICc7
M.L C=3TROCT:':S Orman cazAT= BY T-13 MO MCA,'ZC9
:MOST BE RE.`f = FROM T= CC:eL= DAILY IIIIIIIIIIIIIIIIIIIIIIIII 09 �
MA WW YSM28MAL A%SDCJrZ&ML
Date
Homeowner Appl ca t• Jame Is)
Address 1�2 AV GAJ STYE
(Primary �.:iasace�
.aleoaoae - a 6 o g .96
lPGA1 hest) (Lonq O:suate)
PGA West Address f—�- =act Lot 1.3
Mcd13_:4=ical31 Requested CJI ►n77 c %-")
. ... . w A...1_ . Qa4.c� P�.-Ari I r,STALd_ ACO Q�«1 (CA►��6�ZR.a. S•rc�t� t�s��.fZS
FEct P
Work Schedule Ca=mencsment Data Completion Data
Caat_ac_a_is 1 C_A l_% F=o 4P-Pa t A t:oo L_.�-. AaD SMAS a 4-
TV
_V = ARC=-==L1L C--M==:
You are heresy aavised that the above work Is proposea ane approval is requested. At--ached
is a arawsnq of =a worr. to be done and .types of materials to be used as isdicatsa on tts
dzavL:tgs. Ne uaaerszand ttat buildlnq perstits for home improvements ase required by the
Ci_y of La Gulsta and t=at tts cost of tis permits and rssponsihillty of obtalaiaq permits
anal suosequsnt L=pection will be borne by t:s'appil-eat.
He acknowledge t=st all approved ctsages in the osiginal deadga will be at our expeaast
that any and all damage to build—'-q or other damage .rusu.Lt -q f--= the
coast=cyan of tis proposed i3provement shall be at our (owner's) expense. Additiznally,
any masatsnancs of t" permitted improvements shall be at the applicants expsase • and tie
applicant agaves to hold the PGA West Residential Association harmless for its cost of
maintenance of same. Homeowner agrees to ladsmnify, defend and hold harmless M West
Resicant:al Association.' its officers, agents and employees from any 11", -.y arisizq from
execs t:nr. of '3 appilcation.
Sigaat__ss of /l/J
ail :vne rs XXXJ//
/ ARC8I»^.IRAL C9S.40L CC"'T I=
Appr:veo V Conditanal y Approved Disapproved
Reason ::: Caadi- anal Approval or Disapproval
Oats `1I INy signature—vi
Arc:.(=act:t. Cant:oi CammLttae C:ai_-:as
La acait:cn t_ :is 'approval, you nest obtain C::y approval for t=e requested oodi==cation
as wei: as any otter necessary bui::iLaq permits. You are requi-ea to su=UZ eVLdenCe of
tie Assoc=tion approval to obtalA t_e buildlaq permit. For tris purpose. all blleor:nts
and :tanswi'� .e emaossed With tis Assoc_at::n's seal. the signat_ro of t-s ?:rperty
.mwager. and cis data of t-he approva:.
Caapistsa Warx S:znea of= by Data