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0110-262 (SOTB)N_ C/) W O M f`W� oZr� O O HCIO J LU a - fn Z M N ON U (3) CL Q Z `rQO X W L= co U U M H t Z_ co 5 r C) Q J 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 Of, 61M8 C-53 Wo 04311'01 Date 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. CQ, 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 (STATE CGeMP:f NSA- 11 Policy No. 046goof dR (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' compensationprovisions of Section 3700 of. the Labor Code, I shall forthwith comply with those provisions. Date: L Applicant +�A'- "�� ;r 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 conditicns 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 pursuanfto 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)��,•F�'-'✓ Date. /J PERMIT # BUILDING PERMIT 0110-2&2 DATE ,�, VALUATION ► b LOT YRACT JOB SITE ADDRESS :.A5-AI.�Ar :Bjiiz Bum ' APN - OWNER CONTRACTOR / DESIGNER / EN (NEER ..AdRS. k'uwal 01MLY (WIi+'C RXIA F+001.9 & SPAS t1i"P 3Wa C01 55-M.,81g'US1wWT.M %47^25 JON! 11A , SUNT. 0. 1-0,QXJTN A �. 922,13 PAIM �.±EN t CA. ��2d3fJ (760)340-9000 €`plul 00355 USE OF PERMIT 4`�1•!I3101A BTRUNNQ ` lC:IV H Ffl%»F.;4ri...f'LC9 QNi,;Y RUM CHECK FER 101-000-439-313 CONIS1'RUC`t 1014 ?F8, 101 1R-000 �fii.S3+9 �� LY OCT 2 5 2001 CITY OF I_A OUINTA FINANCS 0=_PY STT8-,f`O'1;AL CONITTIIi UC3109AND MAN CHECUe. 1.=+ D 1'F,R-PAID PEEMS $0,00 1 91 NO W 3,�'�i RECEIPT *TEr' + BY DTE I LED 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 1 Set Backs P Footings �/� I Bond Beam / /� Q� G/�/ � Electric Bond Main Drain Approval to Cover _ h �! ` 6X/ Equipment Location Underground Electric Final /�/�Q/p 6J� Underground Plbg. Test 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 I xterior Receptacles . F.I. ,Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: 55.8sg *—AE PGAVr. FAIRWAYS ASSOCIATION " July 11, 2000 Mr. and Mrs. Edwin O'Kelly RE: Architectural Change Request --Dear Mr. f--Mrs_.0'Kei6X: - - -=. _..._..__._........_.._... The Architectural Committee of the PGA WEST Fairways Association has reviewed the plans submitted for a kiva and trellis at your new PGA WEST home. Based on its review the committee has approved the plans as submitted with the following condition: 1. The colors to match existing surroundings. Please contact me at (760) 564-3858 if you shouid have any questions. Sincerely, For the Architectural Committee `- Ql n J. Mon Association Manager P.O. BOX 13710 - PALM DESERT, CALIFORNIA 92255 - Tel. (760) 776-5100 • Fax (760) 776-5111 emaili pgawest@monazchgrp.com . ol