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9802-039 (DEMO)79832 Arnold Palmer LICENSED CONTRACTOR DECLARATION ,, ' I hereby affirm under penalty of perjury that 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// -/YS g ture of Contractor J 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`,the project (Sec. 7044, Business & Professionals Cod ( Ilam exempt under Section B&P.C. for this reason pa e 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. ( ) 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: CarrierPolicy No. (This sectli n need not be completed if the permit valuation is for $100.00 or less). ( 7 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 Co J6', I shallrfidhh ith comply with those provisions. Applicant 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 toy " 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_ for inspection Ignature (Owner/Agent),w---- ~-'--W fDate -. / f PERMIT# CONTROL# . BUILDING PERMIT x;iz.sl DATE 2/131918 VALUATION LOT TRACT S 8 7 JOB SITE ADD ESS 79-832 AKIVi.lLD t'lif.t ER APN ifiy•+j1 i-U7U OWNER CONTRACTOR / DESIGNER / ENGINEER ltOS1 i ' JACKtiON 70-832 ARNOLD PALMER LA QIANTA CA 92253 'USE OF PERMIT DR Ni +°1' <3ttAliAl '1't:E SUN:il;i tlls'MI' 1S4 t Nt:'.ii t3F' 11tt}1J:11NCsl,}i.12A11'1', .4tw altittf.•8 i',V l.0 )'yY 'k.J.i COINS 3,37,N ri153' PER t4'r)i.P. E, SZtiliNIA 11Y 423-000 1 lfgbtOl.171< N FIM 101-ON0423-000 ft 8044=3'GiTA C, AND i`'T.AN1 }# ji:6 V1,1111; r T47Ttidi, TIklttttfi' F I,F:'4 DUE NOW 54K.I111 j IIIIIIIIVIIIIIIIIIIIIIII 37 ! IE ,RECEIPT DATE r BY, DATE)ftINALED g INSPECTOR 30 4 „ 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 SMC o Final Final �o _ BLOCKWAI A ROVALS 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 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 jemp. Use of Power 'Final 111tility Notice (Perm) r- OWNER/BUILDER INFORMATION Dear Property Owner: An application for a building permit has been submitted in your name listing yourself as the builder of the property improvements specified. For your protection you should be aware that as "Owner/ Builder" you are the responsible party of record on such a permit. Building permits are not required to be signed by property owners unless they are personally performing their own work. If your work is being performed by someone other than yourself, you may protect yourself from possible liability if that person applies for the proper permit in his or her name. Contractors are required by law to be licensed and bonded by the State of California and to have a business license from the City or County. They are also required by law to put their license number on all permits for which they apply. If you plan to do your own work, with the exception of various trades that you plan to subcontract, you should be aware of the following information for your benefit and protection: If you employ or otherwise engage any persons other than your immediate family, and the work (including materials and other costs) is $200.00 or more for the entire project, and such persons are not licensed as contractors or subcontractors, then you may be an employer. If you are an employer, you must register with the State and Federal Government as an employer and you are subject to several obligations including State and Federal income tax withholding, federal social security taxes, worker's compensation insurance, disability insurance costs and unemployment compensation contributions. There may be financial risks for you if you do not carry out these obligations, and these risks are especially serious with respect to worker's compensation insurance. For more specific information about your obligations under Federal Law, contact the Internal Revenue Service (and, if you wish, the U.S. Small Business Adminstration). For more specific information about your obligations under State Law, contact the Department of Benefit Payments and the Division of Industrial Accidents. If the structure is intended for sale, property owners who are not licensed contractors are allowed to perform their work personally or through their own employees, without a licensed contractor or subcontractor, only under limited conditions. A frequent practice of unlicensed persons professing to be contractors is to secure an "Owner/ Builder" building permit, erroneously implying that the property owner is providing his or her own labor and material personally. Building permits are not required to be signed by property owners unless they are performing their own work personally. Information about licensed contractors may be obtained by contacting the Contractors' State License Board in your community or at 1020 N. Street, Sacramento, California 95814. Please complete and return the enclosed owner -builder verification form so that we can confirm that you are aware of these matters. The building permit will not be issued until the verification is returned. Very truly yours, CITY OF LA QUINTA DEPT. OF BUILDING AND SAFETY 78-495 Calle Tampico La Quinta, CA 92253 .(.760)�01 FAX 1 OWNER'S�I'NATURE / PROPERTY ADDRESS PERMIT NUMBER(s) �r- IIIII III IIIII IIII 14R � �� 11111 III11111 IIII PROJECT IE SHEET NO. STRU,CTU�RAI JOB NO. ITEM 'DATE , o INGINEERM-G, ENGINEER RlE\j I s lA L z \../� + ca, 0%) A -+I-* t- 5sf> I . aSaa 8 7-y fir-/.�cAtleFi.o34) 9S Q r- S.z3 k•o3(1'Ll t.o o¢ / /, 40 A /04P ( Z.3-0 .5 S.S� Zlo7z Z� s'"7 4 W,4,r, L- 8.1;s moi: APR 0 3 1998 a0 QRS ��4i ARCHITECTURAL APPROVAL APPLICATION ALL CONSTRUCTICN DEBRIS CREATED BY THIS MODIFICATION IIIIIIIIIIIIIIIIIIIIIII :MUST BE REMOVED FROM THE CC.`e LEX DAILY 39 IE PU WER R= n M Lssocua 0m. INt Date 19L%G- /, /9q2. Homeowner Applicant Name(3) ZO ,;F -A -T .L o,✓ _l �9C'+� n r� Address / 7.P a — /-b'y r"� fia'E" , /✓ r _ Ae"41- (Primary Resioencei Telepnons % %/ — / %t2 �? d C,Z- -- (PGA West? (Long Distance! PGA West Add Modif==ationlsl Requested a -O Lot F,2 / Work Schedule Commencement Date Completion Date Contractor(3) /s/«!�!✓ ��t'o l' % %/ TO T:M ARCHITECTURAL COMMITTrE: You are hereby advised that the above work is proposed and approval is requested. Attached is a arawing of the work to be done and types of materials to be used as indicated on the drawings. We unaerstand that building permits for home improvements are required by the City of La Quinta and that the cost of the permits and responsibility of obtaining permits and sumsequent inspection will be borne by the applicant. We acknowledge that all approved changes in the original design will be at our expense; that any and all damage to building structure; or other damage resulting from the constrzction of the proposed improvement shall be at our (owner's) expense. Additionally, any maintenance of the permitted improvements shall be at the applicant's expense and the applicant agrees to holo the PGA West Residential Association harmless for the cost of maintenance of same. Homeowner agrees to indemnify, defend and hold harmless PGA West Reslcential Association, its officers, agents and employees from any liability arising from executian of this app ication. Signatures of 9L all owners v y y ARCHITECTURAL CONTROL COMMITTEE Approvea i Conditionally Approved Disapproved Reason ?ar Conditional Approval or Disapproval Date Signature Arcnitecturai Control Committee Ctairman In aadi=ion :o this approval, you must obtain City approval for the requested modification as well as any other necessary building permits. You are required to summit evidence of the Association approval to obtain the building permit. For this purpose, all blueprints ana ?:ans will be embossed with t..^.e Association's seal, the signature of the Property Manager, and the date of the approval. Compietea Work Signed off by Date