AR (0011-276)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I. am licensed under provisions of
Chapter 9 (com menci ng 'with Section 7000) of Division -3 of the Business and
Professionals Code, and my License is in full'forceland effect• %
License # Lia Class Exp/Date
352894
XD'ate, V ,Z `' Signature of Contractor
OWNER -BUILDER DECLARATION `
I hereby affirm under. penalty. of perjury that) am exempt from the Contractor's
License Law for the foilowing 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 contacting with 'licensed
contractors to construct the project (Seca 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 oneof the -following declarations`.
(
JJ'have 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 'ySp�@g�1 Policy No.
(This section need not be com leted if the permit valuation is for $100.00 or less):
O I certify that in.the pe fo mance,of t e•wok•for
f -which this permit.is"Issued;
I shall not employ any person in any m nner.so as to become subject, to the
workers' compensation laws\of Californi /, and agree that if I should become
subject. to the workers' compensation provisions of Section 3700 of, the Labor
Code, r[shall forthwith comply with those, rovisl S.. ,✓"rte - .f
f�J r f"dL.lfrr..::� - '.aft'.".....
Date: 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 to
any pgrmit,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 commencedwithin 180 ,days from date of issuance of such
permit, or cessation d o k`•for180 ys-will subject permit to cancellation:
,,
I certify that [have read this'applic
correct. I agree to comply with all
construction, and hereby aut oriz
the above-mentioned prope 'for
I Signature (Owner/Agent)
and state'that th •above information is
and Statef 1pw/r lacing to the building
resentativesrof thl�ACity to enter upon
ti i, pur�oses.
Date /A
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0011-470 TRACT `
SITE
ADDRESS
.79-M15JOB
34l��{:�i�C�R
' !6141TR^•014
OWNER
CONTRACTOR%DESIGNER / ENGINEER
ROB I'1'JOR''L'
LA QUZITA. CA 92233
11r'1.C,7tr11r1ii TERT OA 92261
60)"r Pm -1 44 0%# . '361
USE OF PERMIT
REMEM14 %, AMMON
ADD EXTP'.k%f?'itt lafi°!'YX A3sF5Y.sFN. Pit -,a 1997
Clt3IAMM,(iDW6410`i'Rf TI'VE CODR, §304'll YOR AVOR9. DE(' UN •fix'! O(1T
HVIL.W.1140 PERMIT..
VALUATION I„9
' =T8*:1vY TKID C.,0,1�'."li OF C.QdVl'VMp.?'I A.A�r�dV .•:
_ 2.0,0WAR) .
rilaur FEE SUMMAT&I
PLAN C!•lF OCK YU L 01 a%*439-31 8
CONSTRUCTION TION F919 107-000-410-000 $117,00
i.d7,CTRICA L FEE 107-000-420-000 130.00
i✓LuteliBUNO FEE 1.01-000.419-000
MONG Mo7 bvl FF i±::. AR0, 1D . 101-000-241-000 $1,00
ORADINO FRE 1!2't-C,00-=S'1.mp $15.00
INVESTIOA f0H. R31 101.000.142.3-000.. • 0147,00
Si ID-'b"CYS`A►L', C)L*i 'R1X_4 100 fiKh' PL AX O
16.0.1
Sam9 .iy :.M,3�Afd"a 4�Ef.3�
t3,f3ij
NOV 2 9' 2000
NTY uF LAQ- 041 .
RECEIPT
DATE[/ 3
,,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
b D
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
$ p
Drywall - Int. Lath
Final
Final
BLOCKWALL PPROVALS
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:
FROM MONARCH FAX i O. ! Sep. 19 2000 J 1: 46A P1
PGA WFS If RhSll))-.N'1'IAI. ASSOCIATION, INC:.
l o. HoX 1282. I.A-QUlNI'11,{'A y'')2S3
(160.) 776-51W FAX (764)) 7.76-5111
Septe rnbcr 18, 2000 r
-Mr, & Mrs. Roburt Feury - {
5 East Union Avenue
'cast Ruthertbrd, N 07073
:4�efereece: 79.985 Merion
Addition of Outside HathrWm
Dear Mr. 4'r Mrs. F6+ry:
The ArehitectuW Conunitteo at 10 September 12, 2000 meeting WOL-wed the AdjacentlFacina
:Neighbors, Commeat Form received from Dick Brye at 80.015 Motion, UPm rn*iew of Mr, r
Frye's comments, the committee wishes to infdrm you and it has unanimously agreed that you'
may begin construction of your projW.
R®view by the C un►ttee is only for S=ral conformance with the Architectural Rules. It is tl-&
rcepvnsibility of the ovnwr to fully uncWrmud and conform to the Architectural Rules criteria.
whether or not all defieicnoies are noted during roview. It iia also the cmner's full responsibility
to field verify all misting conditions. 'rho Committee's decision with regard to project design
will be find. Plaaw� referto�th6'Architectural Rules and Application for Architcatural Change for
all required submittals-
Approvals givai by. the Architectural Co=iittee are good for only six months from the date an
the approval 10tw. After d at time a new application vrW be submitted.
If you have any questions, please fed free to cm tact Carol Fuliar, Association Manager, at
760/776-5100 rNt. Z0. "
sincerely, ,
PGA WEST U RESIDgWnAL ASSOCIATION
For the Architectural Cammittec
Carol Fuller
.Usociatian Manager
,;,;. Doard of Dirsatort
Don Rickerd y -
Unit rile
+ , r