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9910-208 (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 P ofessionals Code, and my License is in full force and effect. Lice -_•^e.# Lic. Class Exp. Date" r53 MIMI 4 ©ate Signature of Contractor - OWNER -BUILD(= DECL RATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) 1, 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 carrier & policy no. are: Carrier +�AA 77++11�� FUND Policy No. h[c �3TXI131'U��D (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; -.,P. I shall not employ any person in any manner sous to become subject. -to -the workers>'compensation laws of California, and agree that if I Should become subjedt to the workers' compensation provisions of S_ection."60 of the Labor C9de, I scall forthwith comply with those�provisior � �- �ate: ✓ i� Applicant 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 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 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. l,a'gree to comply with all City, and State laws relating to,thelbullding const uciion, and hereby authorize representatives of thi�C)tylo enter upon the ove-mentioned property for inspection purposes-- 5 -Signature (Owner/Agent) -- Date XZN PERMIT # BUILDING PERMIT�,�„ DATE 1,1101 JIT)YALUATION . S17,200.00 . LOT TRACT JOB SITE ADDRESS 57-419 CO AE APN M _ r OWNER 57419 COLONLU, USE OF PERMIT t't_"1..f1 N 010K }>11A CONTRACTOR / DESIGNER / ENGINEER 74.725 aR-jN! D3U.� EZ, IA CA Ci2253 PA•1.1V1 i1E8831T C lk 922W (760040-91M t £3i.# 354 1TOOL. AND SPA C>NLY . ALARA4 41ARRWAS SIIA M, D.2 INPLACE ,AT 1VkE5 Pf,A,1Tf11 Z INSPUi; ]-':!ON.. EQUININ-11.04 f VAULT SkUUJ, BE 1''3?lilvf.#.`1.7EX) Vff,,Lf.'. POOL A IND1 >1Z SPA Co- ST OF C OPOORIUCIRVII I JA .,AN CHEX'X C•EW, 101-000-439-118- $422,1415 (;4'1"NISY'¢51f� . S'f{31ti 1~i 1011-W6419.11N) II89 00 fi417C'ILr>£•o'f:CAT. FT3C -P001, 101-000.42t-000 EJXC'1'1UCAL, (-E'E -• P00i. 10i-000.4204)0 4b -tNi f'!,t?:'�13fidC} �'� --Ir�•�c�. 1lY;-E3t60-�t!':t-ti{�� �i;;.�u i SUR"('t'�!'F1 {, C (li�i�"i �t lf':1`fC3#� 411Vi.� t�1, hAf t✓�:t�'C;� ��tU'Y.� 5 LESS PRE -NIM HES $0,00 TOTAL PERMIT YLPS DUE T.(OW, I $417.4.5 RECEIPT I DATE I BY ` I DATE FINALED I INSPECTOR INSPECTION RECORD —� OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Foo(ings Slab Grade Ducts 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 POOLS - SPAS BLOCKWALL APPROVALS 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 _ 00 Gas Piping Gas Test Appliances Final COMMENTS: 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) or -29-99 F RI 1 21 r T>IONARCH ki FAX SIO. 619 776 611.1 P, i PGA WEST 11 RIESIDENTIAL ASSOCIATION, INC, P.O. BOX 1282, LA QUIN'FA, C� 92253 (760) 716-5100 FAX (760) 7 6-5 fi I 4:) ' October 29, 1999 Mr. & Mrs, Peterson 340 Beach Rd. Selvedere, CA 94920 Reference; 57-419 Colonial, La Quinta Architectural Change Request - Swimming Pool & Spa Dear Mr, & Mrs. Peterson; The Planned Unit Development Architectural Committee at Its October 12, 1999 meeting reviewed your plans and a site inspection was subsequently conducted as indicated in our October 19, 1999 letter. We wish to advise you that your plans have been approved as submitted. Please contact Miguel Valenzuela, supervisor for Valley Gardening Service, at 760/399-1644 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 eonditlon when the project is completed. Approvals given by the Architectural Committee are good for only six Months from the date on the approval letter. After that time a new application must be submitted. It you have any additional questions or concerns, please do not hesitate to contact Carol Fuller, Association Manager, at 760n76-5100, Ext, 20. Sincerely, PGA WEST 11 RESIDENTIAL ASSOCIATION For the PUD Architectural Committee Carol Fuller Association Manager cc, Board of Directors Miguel Valenzuela/VGS Unit File