RPL (0307-381)57211 Medinah
0307-381
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Charier 9 (commencing with Section 7000) of Division 3 of the Business and
_Professionals Code, and my License is in full force and effect.
License # 1 + Lic.. Clays s Exp. Datte,r d D
C Cvs 11
1 16V
Date A. Signature of Contractor '+' zze
di G
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).
O 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.
( ), 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 19*1A T Y COM'T1Y d1"T1 Policy No.
(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 tho§ provf Ion s.
Date: (r .µ 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 fo'i Jr+lnspection purposes.
12
Signature (Owner/Agent) f .:. . '.,_>91
.» .+ °'- Date •.^
PERMIT ,3
BUILDING: PERMIT y 4
DATE VALUATION.Ay n ji 4I4 f t1 LOT TRACT
JOB ADDRESS uf,{ •.D,r
APN
OWNER
CONTRACTOR DESIGNER ENGINEER
AMY OR u_ MYW`JO
cA L•vw.U.", ufJrmS'& gi M, Q~s
?,AQUft,1 A CA. 92253
C!, +ryaC+'y-1111 , .))-A C:.'.A "4rr tti.. X5/.9 •.
NN f
USE OF PERMIT
P}i)iJ. g v&°Ny t<.G' .%1' .i rtl•Dti•.: JS3, f, tiCIG. rl, tY.t.,t,Wyt; , sat_J_F.
FT. NKALL
&teJt;S1L,.1 ?71:±!'C5I'? e1y1l. t ,Sfi' ,30 1.
CONS`.i'itUCT.0074W.- )C17•%JiA-tii 7' 1:t7'
3s,+11; "lt . ir 'a`4,i„ ' '. -. PO ' I. `ICT! •()C tPn E:I.'l. •i C►;I €.CzG
EL10-f-R1C:xtd, "11. , PL'X1 I E)9_000-4' 0-000.9 ? 4rs.rlia
PX.DMZ•I?,< G FEY ,,.. ,POOL, a C1 t C f3Cl T C9Cai {ff
FITi1 •-•CleCAS ” CI -CCK.
Dn
AUG .0 8 1003. r; r,S: t. uc N01
CITY OF LA QUINTA
FINANCE DEPT,,
RECEIPT
DATE
BY
DATE FIN ED
INSPECTOR
/i !
61
f r
flp,
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.
Fireplace T.O.
Party Wall Insulation
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final I I
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 y
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
OX for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
I Fnrancidatinn
COMMENTS:
Final
ELECTRICAL APPROVALS
Temp. Power Pole
Underqround Conduit
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility
RECREATION CORPOWcrYION
® OF 1. A4 r) ►► 9iq
JUN 2 4 RECD
June 17, 2003 BillLritlV a +,
City of La Quinta
78-495 Calle Tampico
La Quinta, California 92253
Attention: Building & Safety
Re: 57211 Medinah, La Quinta ---yPGA WEST (the "Property")
Property Owner: CHERNOV
Deaf' Sir/Madam:
KSL Desert Resorts, Inc., ("KSL") is the owner of the golf course property _immediately
adjacent to the rear property line of the Property. Under the terms of Specific Plan 83-002,
Amendment 3, dated August 6, 1996, as approved by the City of La Quinta, Section 3. 1.1 provides
for a rear yard setback of 10 feet under the Specific Plan Residential designation (the "Pool
Setback"), with the notation that swimming pools/spas are allowed to be constructed up to the rear
yard property line subject to the approval of the golf course owner.
u _4:C t.. -,-. f ._... r,a,. ,r _: V. d ; •I Se .°.•( 51
Property Ownerand the' pool contractor contacted' KSL-regtarding'KSL's approval of the
encroachment of the pool/spa within the Pool Setback area. This, letter shall serve as your notice that
KSL approves of the construction of a pool/spa improvement on the Property within the Pool
Setback, as depicted on Exhibit "A" attached hereto, subject to the following'conditions:
1. Construction of a solid, continuous buffer wall running along the length of that
portion of the pool/spa which encroaches within an area five feet in width measured
from the rear property line;
2. The top of the wall height of the buffer wall shall be a minimum of 18'inches from
the finished grade and shall not exceed a height of 36 inches; and
3. Property Owner and/or homeowner association remains responsible to maintain any
landscaping between the pooiispa improvements and the rear property line.
If you have any questions, please contact Barbara Larsh, Managerof Real Estate Contracts, at
(760) 564-8023.
Sincerely,
Barbara Larsh p
r n. .1 ° ;. I 3 :, • . u • ...: ' a..1 p (i.i ..': A 9 yJ(.la
Manager.of Real Estate Contracts
'tr,F;1, F'tri+ fi ;:.r, ...; ,;:.• P.••.: ... .°moo '_. .. .-. .. ,
Cc: PGA WEST II Residential Association (via facsimile 760.776 5111) `~ -
America's Leader In Distinctive Lifestyle and Recreation' -
P,6 5 g0 gA yArya Bg a as 0 La Quinta, CA 92253-4600 • (760) 564-8000 • Fax (760) 564-8003