0107-242 (RPL)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
061«� _ 2,
4 1�1f g3�4Zr
Date - ,,"9 Signature of Contractor41�i .!, +,
� � L "4w
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&RC. 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.
STATS CDAVEMMATI 046006162
(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,
I1shall 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 withhose provisions. r7
Date
: - Applicant id ,/r . ^" r'1.
AA
r . _ . �ter• �� � .�
Warning: Failure to secure Workers' Com pen satio%4coverage is unlawfu� a .
shall subject an employer to criminal penalties and civil fines up to $100,0 t rrrt
addition to the cost of compensation, damages as provided for in Section%1tis
of the Labor Code, interest and attorney's fees. �1
IMPORTANT Application is hereby made to the Director of Building and Spfety
for a permit subject to the conditions and restrictions set forth o - his
application.
1. Each person upon whose behalf this application is made & each persn-at•
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes, null and void if
work is not commenced within 180 days from date of issuance' of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply,with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property forlinspection purposes.
Signature (Owner/Agent)+ ' Date
BUILDING PERMIT PERMIT#
DATE VALUATION$q LOT 0107-21$2 TRACT
�rYV a�9767nriMJ .S
JOB SITE
APN
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
pal-.aMAN
Cu?LIR)RNAd 3'00SSl%w (' p MA14 C01
S4Iy5 YSwLrK
7 47 5 J 01111OR A; S•IT11r 0A
L'A0".JyNA CA 9225.1
PALM.Dr-0—IRT CA, 920460
(j6O)340.9000 MI. 114 355
USE OF PERMIT
P00.1—AND1011, WA
oT.At.�lpaRyAliq��Y�f,�e��'�.kLf��RSRpSFpI:A111de. sp, IN
P OCIL&y>��7:!'%Bb9EQ Ag11ratil
L�tt9�{wSt�glSd1s'
P tl/Sf�L: d4. !' ,i Rle•d-Ant sd'[�8r16 A.1"l i� abra�ii it/SN. 5 G.7X O $ iEKJH ,OLe�1CK
POOL ANW1011 SPA. AU04,'i� us
5 Fr, WALL 5.00 Wo
Y
Z91*04N ' D C`,OXr OF COidFJl'RC'MON
2.5,11 :',.''
RVIRIar BSIX 9101 &'R
PIM C HEXI1t, FEV 101-000-439-318 0-439.318 $1,5'1,95
°k01ZSTIRtJr;TIGH FEE, 101-0001418-00Q 01418-000 $243,00
IARC:HAWCAL 1�'' ,, -- POOL 101.0001.421-000 $24.00
SI A7C'. TICAL FER p-• POOL, 101-000-•420-000 $45.00
--pr
JUL 2 6 2001
CIT( OF LA QUINTA
FINANCE DEPT
[RECEIPT
DATE
By,"
DATE F AL
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
Set Backs
Steel
Electric Bond
POOLS - SPAS
rig
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
/6
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 Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (germ)
COMMENTS:
FAIRWAYS ASSOCIATION
July 18, 2001
Ms. Cheri Behlman'
Re: 55-775 Brae Burn
Dear Ms. Behlman:
At a meeting, which was held on July 17, 2001, The Architectural/Landscape Committee
reviewed your plans for a pool and landscaping at the above address. Your
improvements were approved, conditional upon the following:
1. A deposit, in the amount of $7,500.00, must be received by the Association prior to
the commencement of any work.
2. Additional information is required on irrigation, drainage and lighting.
3. Each tree must have a deep root bubbler at its base.
4. Several of the plants you selected are not on the Association's approved plant palette.
The Association will not accept responsibility for the health of these plants.
5. Although it is not required, the Committee is recommending that you consider
planting a shrub on the corner of your property, as requested by your neighbor.
6. It will be your responsibility to remove and replace, within fourteen (14) days, any
trees which do not survive during the first twelve (12) months.
Should you have any questions regarding the above, please do not hesitate to contact me.
I may be reached at my on-site PGA WEST office (760) 564-3858.
Very ruly yours,
��, 1
Bobbie Gaffney
Association Manager
P.O. BOX 13710 - PALM DESERT, CALIFORNIA 92255 - Tel. (760) 776-5100 - Fax (760) 776-5111
email: pgawest@monarchgrp.com