0108-117 (POOL)79723 Arnold Palmer
` I rLICENSED CONTRACTOR DECLARATION PERMIT#
` I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT
> Chapter 9(commencing with Section 7000) of Division 3 of the Business and DATE VALUATION LOT 01willr TRACT
'cv W Professionals Code,and my License is In full force and effect.
O License# Lic.Class Exp.Date $29A"00
=) M
d e JOB SITE APN
LU r*_ ,? ' C53 . r ADDRESS 79-72.3 ARNOLD PATAM
cZ r- D tem ''` Signature of Contractor OWNER CONTRACTOR/DESIGNER/ENGINEER
O
c_J U ( OWNER-BUILDER DECLARATION,, TOCl .t?'4 X BUB SPRNGS
W W r— I hereby affirm under penalty of perjury that I am exempt from SS
om the Contractor's 79-723,ARNOLD PALMeX 71509 SAW GORCYl N10
License Law for the following reason: L AQj W1A CA 9y'2.i32i+WUkt eF CA 922e0
Z ( ) 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 (760)'.441"333t 4 # S4f
safe(SBC.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 Ff0LAND/OR SPA
Code).
c'') () I am exempt under Section , B&P.C.for this.reason_ Pf1OLr"36',A. ALhRMS4SARRDK tiS;tl.ALL BE 1'N PA.AC9 AT FRZ—PL1k''4'TJfR
O N Date Signature of Owner g?dPReCT:ION, f'OOS,M 1)1 P M V T INCi,O;itJRF WQ'T MCI,U@7ED,
rn
CL Q WORKER'S COMPENSATION DECLARATION
It z I hereby affirm under penalty of perjury one of the following declarations:
Lo H O O 1 have and will maintain a certificate of consent to self-insure for workers' PCr01 ANDIOR;1PA jsjRq gq,n(J'L;y
X W u compensation, as provided for by Section 3700 of the Labor Code, for the
m _ Q performance of the work for which this permit is issued.
QU (,, I have and will maintain workers'compensation insurance,as required by
p tJ Q Section 3700 of the Labor Code, for the performance of the work for which this
liLO
Z permit is issued. My workers' compensation insurance carrier & policy no. are:
Cattier Policy No.
ao Z) AC:Cr' :'t''1,A,HCE.FNM W1908461.3 ES"kMA'!KID COST f;9F C:4?NSTFa5Mt"N 29"M
r O (This section need not be completed if the permit valuation is for$100.00 or less). ' ' "
J ( ) I certify that in the performance of the work for wh'ch this permit is issued, PLAN C . ECK FE W)"00€9A39.31 S X184,95
1 shall not employ any person in any manner so as to become subject to the C0*NSTR.Y3CT,0N ME r 101-1000-418-000 $29436
workers' compensation laws of California, and agree that if I should become MUMMIC,Ag,M--PW1.4 sh't-WO-421-000 S24,00
subject.to the workers'compensation provisions of Section 3700 of the LaborR.LE(.3,71411 Ali,FEE.,,POOL $t7$_ ,,o2fl.;lOf) $45.ou,
Code l shall forthwith comply with those provisions. ) 'LT,1M'FJJN0 ME,--POOL '101-WO-419-000
Dat: Applicant .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 D
addition to the cost of compensation,damages as provided for in Section 3706 d
of the Labor Code,interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety AUG
for a permit subject to the conditions and restrictions set forth on his AUG 3 ?oo
application.
1.Each person upon whose behalf this application is made&each person at Cm'OF
whose request and for whose benefit work is performed under or pursuant to SUB-TOTAL Cst' ,
any permit issued as a result of this applicaton agrees to, &shall, indemnify x pT' k? -k A;iOlS l1,Ci!3
& hold harmless the City of La Quinta, its officers, agents and employees. a
2.Any permit issued as a result of this application becomes null and void if TYLAL PERTb111 FEED
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.
1 certify that I have read this application and state that the above information is r I IIIIIIIIIIIIIIIIIIIIIIII 1
• 60
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 IE
the above-mentioned property for inspection purposes. --
RECEIPT DATE BY i DAT F AL ] INSPECTOR
t lgnature (Owner/Agent) f Date
INSPECTION RECOIRD
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. I
Framing Compressor i
Insulation Vents ;
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Lines `
Party Walt Firewall I
Exterior Lath I
Drywall-Int.Lath I
I
I
Final I
Final POOLS - SPAS
BLOCKWALL APPROVALS steel
Set Backs Electric Bond -
Footings Main Drain I
Bond Beam Approval to Cover
Equipment Location
Underground Electric b—`
Underground Plbg.Test / 7
Final Gas Piping 1 /
PLUMBING APPROVALS Gas Test i
Electric Final I
Waste Lines Heater Final
Water Piping Plumbing Final '
Plumbing Top Out Equipment Enclosure
Shower Pans O.K.for Finish Plaster
Sewer Lateral Pool Cover I _
Sewer Connection Encapsulation
Gas Piping
Gas Test �f
Appliances
Final
COMMENTS:
I
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) '
Rug 05 01 03:05p Exotica Intl Design Group (949)49'7-3081 p. l
61
IE
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
July 25,2001
Thomas Crank
79-723 Arnold Palmer
La Quinta, CA 92253
Dear Mr. and Mrs. Crank:
Mr. Don Adolph,Architectural Corrurrittee Chairman,has approved the installation of a new pool
wid landscaping at your 79-723 Arnold Palmer residence. We do require that all contractors supply
us with the following:
1. Names of all contractors
2. Contractors license number
3. Proof of insurance
Upon completion please submit the enclosed Notice of Completion to this office.
We reserve the right to make a final inspection of this change to make sure that it matches the
original request. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
We appreciafc; your cooperation in submitting thus request for approval. If I may be of further
assistance,please contact me at the 140A office, (760)771-1234,extension 15.
Sincerely,
Kelly MCG liard
Operations Manager
cc: Architectural Committee
Enclosure(1)
P.O.Box 1060, La Quinta, California 92253,Telephone 760-771-1234 FAX 760-771-5125