9704-102 (GRES)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
c"57 B 3r, -;t199
Date f Signature of Contractor
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).
( ) 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 Policy No.
'FA 'M fi,(NU 221'1''-'rw 2
(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 those provisions`
ate: # Applicant . , t" \.
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 for inspection purposes.
Signature (Owner/Agent) 4'N'- Date`
BUILDINGPERMIT PERMIT# CONTROL#
5029
DATE 41x2197 VALUATION 53.410.40 LOT TRACT
JOB SITE ADDRESS 5"7614ICRION
APN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
i'( RAS IFISt1ER
131013 EDWARDIS CON! 1IRUC1'!041
56-870 MEKION
79-920 iTlEWA OKI VE
LA{ji_OTIA CA 92251
LAQ1.lINTA CA 9:253
(700)775.7933 (11111€ 3212
USE OF PERMIT
A100 Ok YLIF, CM j. UARAut.,
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f .
1,051'r31A'11 ED WST O C.'01NIS1'RifCCION
1'i�:ttllbiiT S' f~:1�: �iii(VIi�1,�It3'
PLAN (A1ECK FPY 101-(M-431)-319 $40.95
f " +N; TRI r("Ptr ►ly ! I t if11-(?1�t?-Elttt-t?fif) lei.( !
U.IX11tt(:AL V10's 1.0140-420.000 f�
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& 1 ?? Qz
LEMS 1'1: &PAID FEES
$Uo .
APR 2 g
1997
tc►T,�1, IPFaftllZt r FF, K% 1;),IF NOW
5122.Si9
C17)01OF7141
�R_rA
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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 / 7
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
BLOCKWALL APPROV LS
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
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)
COMMENTS:
".,-7R-29-97 TUE 2:25 PM MONARCH GRGU� � U" �h`tt i��. 619 776 5,1 i 4i r 2
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC,
r - 1:
P,O. BOX 1252, LA QUINTA,CA 92253
619) 776-510FAX {619) 7cj 76-51111P� VMSTN
April 29, 1997
Vera Fischer
c/o Will Fischer Dist. Co.
3539 W. Farm Road 142
Springfield, MO 65807
RE: PGA WEST II Residential Association
Architectural Variance - Cart Garage / 56 876 Merion
Dear Ms_ Fitcher:
Thank you for your submittal of plans for the. above -referenced residence regarding installation of a
cart garage, Please be advised that the Architectural Committee of PGA WEST 11 Residential
Association, in conjunction with the So„rd of Directors, have approved your plaits as submitted with
the following conditions:
1) You need to submit irrigation plant,
2) Plan to be modifled as agreed, so that grade door faces house,
3) General contractor to Interface with Miguel Valenzuela of Valley Gardening Services (399-
1844) with regard to any changes in association irrigation as a result of the Installation of the
cart garage.
Please feel free to contact me or my assistant, John Monahan, at 776-5100 with any questions you
may have. We look forward to this addition to the association,
Sincerely,
PGA WEST it RESIDENTIAL ASSOCIATION
For the Architectural Committee
John H. Handel, Association Manager
cc: Don Troy, Chairman
Bob Edwards, General Contractor
john Monahan, assistant Manager
Unit File