0011-308 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of givision 3 of the Business and
Professionals Code, and my License is in full foe and effect.
License # Lic, Clas7 , Exp. Date
,/ 71_T_b
�3i1; (110B
Date Signature of Contractor.
OWNER -BUILDER
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 carver & policy no. are:
Cartier Policy No.
W:1UANOVA Y001 00 WC i. �,112fi�
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of a work for which this permit is issued,
I shall not employ any person in any anner so as to become subject to the
workers' compensation laws of Calif ia, and agree that if I should become
subject to the workers' compensatio revisions of Sejtion 3700 of the Labor
Code; shall forth i comply with t e p visions.
Dater "' Applicant
Warn g: Failure to secure Worker Compensation coverage is unlawful and
shall subject an employer to crimin 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 it
whose request and for whose benefit work is performed under or pursuant4to
any permit issued as, a result of this applicaton agrees to, & shall; indemnify
& hold harmless the City of La Quints, 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 witn/811 City, and State laws relating to the building
construction, and hereby ayf# 6rize representatives of this City to enter upon
1hS above-mentioned prop for inspec%n purposes.
Signature (Owner/Age It "' Date_.
BUILDING PERMIT PERMIT#
DATE VALUATION LOT ow J •,3W TRACT
JOB SITE
APN
ADDRESS
1551—W-5 MERRY 111W IS
OWNER
CONTRACTOR/ DESIGNER / EN (NEER
IWM f''.R?E}T.,
A & M Cti'/RT R-'0 C:'tY0)4
55-525 E_1101rfat HL �,si
: 8 -WO C LUE CADIZ,
LA QUJH f'A, CA 9223_3
1 A QTINTIIA CA 92253
(7&))564,4,83Z >" rtTa1 2n
USE OF PERMIT
qq '' Y
MLLL710�1,L AWROi S 0
PML C/t~.tA14A AN V12 .AFPR(rdED PIL ANSJ ON I
VAlXA7'1C3N X%0,0.00 LQ
'd.:ST!AUTM) C01141' OFF Le.NSa:ITdic-]1014'
2. IS 0ffd.;kk)
PL104 CHECK FFY, 101-000-439-318 $163.0
CO -W S3`i'l.UCTIf, N W0 1.01-000-et18_000 $2_-51.00
tYEC)rTAANICAL Iy g 101-M9,421-000 530160
X1:t1X,'TR'.IC',>A,.L, MIK 103-00: 410 -OCC) V0.00
N.rllf[II( RKT y'Ys'T{ 101.000-4'19n000
s i
1
TI�''1'.Cttl(-1' 0W AN -5 10ST Cr�0',1171K
$505.80
L
fjjII tt 1 ,J
LA
RECEIPT
DA)T
Y
DATE FINALED
INSPECTOR
1; r7 ?1 1 p
MSP C TIOM CRGC ORS
OPfERATM
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
SULUNG APPROVALS
MCMAMCAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings �J
Ducts
Slab Grade ��! D1
Return Air
Steel
Roof Decj,�(y C�� j O( r
O.K. to W11*��, �jj
Framing 3 7''
Combustion Air
Exhaust Fans
F,A.U.
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controts
Party Wall Insulation
Condensate Lines - —
Party Wall Firewall _
Exterior Loth
Drywall - Int. Latin
FonaV yp p nip/`�/j%/(np aln�lF
C
Steel
Electric-Bond—
lectricBondFootings
Footings
Win Drain
30nd Beam_
Approval to Cover
—
Equipment Location
Underground Electric
Underground Plbg. Tast
_
l�inaG
7?l INJL-S� 37LNG ?P[aI if!Ai1S
Waste Lines_
Gas Piping—
----- —
– -
Ga
ElectricFinal
_ _ --
Heater Find
'Vater Piping
Plumbing Final
_ _
Plumbing Top OLA
_ _
_
Equipment Enclosure
Showar Pans
_
O -K. for Finish Plaster —
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
_
Gas Test
Appliances
Final
FinaD
Utility Notice (Gas)
ELECTMCAL 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
Rimm
Utility Notice (Perm)
r..
nr
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
December 29, 2000
James and Sharon Paul
55-525 Cherry Hills
La Quinta, CA 92253
Dear Mr. and. Mrs. Paul:
Pending receipt of an architectural deposit in the amount of $5,062.00, the Architectural Committee
authorizes commencement of construction of the pool at Lot 19 and cabana. at your 55-525 Cherry
Hills residence.
Please be advised you may not commence construction of your custom home at Lot 19 prior to
submitting an.additional $5,000.00, which would serve to satisfy the $10,000.00 refundable deposit.
If I may be of further assistance, please contact me at the. HOA office, (760) 771-1234, 'Ext. 15.
Sincerely,
> ,'
C
Kel y cGalliard
Operations Manager
KM/dpo
cc: Architectural Committee
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125