9604-051 (MISC)79705 Arnold Palmer
LICENSED CONTRACTOR DECLARATION PERMIT# CONTROL#
U) I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT yty;►¢.{;4f 3105
H Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT TRACT
C\1 w Professionals Code,and my License is in full force and effect. 4146196 .iKl
o .License# Lic.Class Exp.Date
LID t,.> JOB SITE APN
LIJ C> 1 1 .` ; ADDRESS 79-705 iXIIN«Li D ir,tii,t117ER 76;V411-040.y
CE I r M l,r ,,ttt a• r f
Z Dates r `' Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER
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OWNER-BUILDER DECLARATION ' ^' nkr0 t
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W W 1 hereby affirm under penalty of perjury that I am exempt from the Contractor's 7:#70;r1.10t0L0 PALMER 70.920 HitMA Ea.RIV111'
~ o_ License Law for the following reason: I.A tlPINI•t;A.CA WSd I'A QUIN)"A CA «2253
Z_ ( ) I, as owner of the property, or my employees with wages as their sole fo.91775-7 33 011114 3:LJ
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
contractors to construct the project (Sec. 7044, Business & Professionals MISCM),.i.,lllJfiOU
Code).
O I am exempt under Section , B&P.C.for this reason :aO"tIC AL 1N18PWflQN
O N Date Signature of Owner
rn
CL Q WORKER'S COMPENSATION DECLARATION
> cc I hereby affirm under penalty of perjury one'of the following declarations:
Lin P O ( ) 1 have and will maintain a certificate of consent to self-insure for workers'
' •X W U_ 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.
C0 Q CJ ( ) I have and will maintain workers'compensation insurance,as required by
OC) Q Section 3700 of-the Labor Code, for the performance of the work for which this
D.: LO
Z permit iscjsswed:tVlyNiworkers' compensation insurance carrier;&Policy no. are: g').'Ij+, Ag'j D :'COS' OF CONg'' RILI(." 1GIN
Carrier Policy No. i,Ib;l!tit IT I C. S111)MR'LARV .
6 Z)
r d SP CIAI,INSWC110N
J (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 tothe;workers'compensation provisions of Section 3700 of the Labor
Code,+I shall,forthwith comply with those provisions. )
Date: 1 r, Applicant `a
1
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 nTI3-*IXWAG CONS"L R. tJ%'MN AND PLAN CFA C:K $100.00
whose request and for whose benefit work is performed under or pursuant to LUSS PRE-PAID VMS 10.40
any permit issued as a result of this applicaton agrees to,&shall, indemnity
& hold harmless the City of La Quinta, its officers, agents and employees. 6'O'g.1L 'L! l7f1'l.tl'FEES DIffR NOW
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 — IIIIIIIIIIIIIIIIIIIII 23
• correct. I agree to comply with all City, and State laws relating to the building t-• IIII
construction, and hereby authorize representatives of this City to enter upon - IE
F the above-mentioned property for inspection purposes: –
t RECEIPT DATE BY D TEFINAL INSPECTOR
S.>ww tt + d•8
Siypature (Owner/Agent)-' % I~ Date t• r`
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION. DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings Ducts I
Slab Grade Return Air I
Steel Combustion Air I
Roof Deck Exhaust Fans I
OX to Wrap F.A.U. I
Framing. Compressor I
Insulation Vents I
Fireplace P.L. Grills I.
Fireplace T.O. Fans&Controls i
Party Wall Insulation Condensate Lines
Party Wali Firewall I
Exterior Lath I -
Drywall-Int.Lath I
• I
I
Final i
Final j -POOLS - SPAS
BLOCK WALL A PROVALS steel -
Set Backs Electric Bond
Footings Main Drain
Bond Beam Approval to Cover
Equipment Location
Underground Electric
-:,Underground PI .Test
Final „ Gas Piping
PLUMBING ,APPROVALSGas Test
Electric Final
Waste Lines Heater Final 1 f.
Water Piping Plumbing Final I
Plumbing Top Out Equipment Enclosure
Shower Pans 0.K.for Finish Plaster'
Sewer Lateral Pool Cover I
Sewer Connection Encapsulation I
Gas Piping
Gas Test I
Appliances
Final I _
COMMENTS:
Final
Utility Notice(Gas)
9
ELECTRICAL APPROVALS
Temp.Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
- Sub Panels
c Exterior Receptacles
G.F.I.
Smoke Detectors
Temp.Use of Power,
.`i
Final
' Utility Notice(Perm)
}
�,a,(2'"�"�c I IIIIIII VIII III VIII IIII 24
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-78-495 CALLE TAMPICO — LA QUINTA, .CALIFORNIA 92253 (619) 777-7000
M
OF FAX (619) 777-7.101
April 17, 1996 .
Subject: 79-705 Arnold Palmer
To Whom it may concern:
Please accept this letter for the findings of the City of La Quinta Building and Safety
Department's special inspection at the above address, Tuesday, April 16, 1996.
The construction performed without permit will be accepted by the City under the following
conditions:
1, Homeowner's Association approval.
2. Return golf cart garage to original condition.
3. Verification of framing members for entry area.
4. Verification_of approved electrical materials in entry area.
5. Verification that shear wall in garage was not affected by window. .
Items 3, 4, and 5 above will be made available by Bob Edwards, General Contractor, during the
process of returning the golf cart garage to it's original intended use. We would request that Mr.
Edwards provide the City with a time frame for completion of the above items, and provide
access to the site for verification of these items prior to the completion of the cart garage revision.
Please feel free to contact me should there be any questions.-
Sincerely,
uestions.Sincerely,
Mark Harold
Building and Safety.Manager
MAILING ADDRESS - P.O. BOX 1504 - LA QUINTA, CALIFORNIA 92253 �d