BLDG (0005-238)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 E p. Date
C^` V!/31/2(
/Date � ' Signature of Contract v
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).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals.,.
Code). 4
() 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 *FR1yR OC 4T COMP INS Policy No. T'V-1111 S9SW7305
(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 t the workers' compensatiuri-p, ,,rrsl ns of Section 3700 of the Labor
Code,a�fo with comply with th Islons.;�
Zate: Applicant
r
Warning: Failure to secure Workers' Compensati n coverage is unlawful and
shall subject an employer to criminal penalties a4d 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 1_a 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.
•1 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 oK 'City to enter uporf
the/above-mentioned property for i spe � n pu p s�
4f� `� S �
Signature (Owner/Agent) Date�
BUILDING PERMIT PERMIT#
-
DATE LOT ', OWS-238
TRACT
g..�
0C $5
JOB SITE =APN
ADDRESS 79 -mw,
;
a
OWNER CONTRACTOR/DESIGNER/ENGINEER
ROBERT FLURY CAUM POOL COWS RUCfTON, INC.
9.985 i .xO..X 78-7 10.L;A I'll AAA
Dk-. LA QUI' CA
LA Qt1TAiTA. Chi 92233 PA UA Up-ICf.li ,
CA
92261
(740)360••66.02
C T_A ' 1944 a
. USE OF PERMIT
t.C:IVA PtREPLACtfrA]ND 819Q
VAIAIATION { 3.f(lt1.fl91.8 .
ZJ
ES)T JV1ATFD COST OF, CONSYR C'1700
s
�� .. 31000.00 `
'yam },]}y �'��+�'7� y �py7•q /�•����}�jy�
••{ diali.S1��.L1 JO J El A7l/Stl.,�NillR A
n>•$
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PLAN G} EC -1K FEE 101-000439o31 8
CONSTRUCTION FEE 101-000.418-000
STRONG MOTION FEE • RESID 10.1n000m241n000 $.sq
KIB-TOTAL CG>I~i 'i'I2il'C1�1C92+T 1?g..AAr C -r3 c
w
E3i .fiD
1.T013 .PRE -PAM TTW..
.$0.00
1'01Y_A'[j P—MMT JX� DUE NOW
MECEIPT
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
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 APPROVALS
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 APPROVA S
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:
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253-
(760) 776-5100 FAX (760) 776-5111
CITY OF L Q.�79NT
PGA
�` "' BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTION.
March 28, 2000
bel i , at A&M.XAO ?Tl n r, Ury DATE �— BY..
15 Union Avenue _
Rutherford, N.J. 07070-1273
.Reference: 79-985 Merion
Architectural and Landscaping Changes =
..
-__t T3,Ta^ 11..aA....�L':«nwlnro T �nricr��in0
Dear Mr. & Mrs. Feury:
The Landscape Committee and the Condominium Architectural Committee reviewed the resubmittal of t
your drawings to install a pool, spa, BBQ, outdoor fireplace and landscaping and wish to advise that your
plans, as revised on March 15, 2000, have been approved.
Please contact Raphael Villareal, stipervisor for Valley Gardening Servicc, at 760%399-1844 and Carol
Fuller; the Association Manager, prior to any irrigation modifications associated with this change. Upon
completion of changes, please contact Carol Fuller. Damage to the landscaping, i.e., shrubs, trees, flowers
and turf is the responsibility of the contractor. The landscaping must be brought back to its original
condition when the project is completed.
Approvals given by the Architectural Committee are good for only six mouths from the date on the ;
approval letter. After that time a new application must be submitted.
In the meantime, if you have any questions, please feel free to contact Carol Fuller, Association Manager,
at 7601776-5100, Ext. 20.
Sincerely,.
PCA WEST lI RESIDENTIAL ASSOCIATION
For the Condominium Architectural Committee
Carol Fuller
Association Manager.
/cif
cc, Board of Directors
Unit File .
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