4511 (RER)LICENSED CONTRACTOR DECLARATION
U) 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
NUJ Professionals Code, and my License is in full force and effect.
Z) ch ' License # Lic. Class Exp. Date
� Zr /Date Signature of Contractor
�Or
U OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
~ CLCn License Law for the following reason:
Z_ ( ) 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).
co () I am exempt under Section B&P.C. for this reason
L
N Date Signature of Owner
N
O
FL Q WORKER'S COMPENSATION DECLARATION
o Z 1 hereby affirm under penalty of perjury one of the following declarations:
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cr
FZ O () 1 have and will maintain a certificate of consent to self -insure for workers'
X W ! - compensation, as provided for by Section 3700 of the Labor Code, for the
mJ Q performance of the work for which this permit is issued.
Q U () I have and will maintain workers' compensation insurance, as required by
O U Q Section 3700 of the Labor Code, for the performance of the work for which this
L rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
It z Comerryq ttMD Policy No.
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(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
3 subject to the workers' compensation provisions of Section 3700 of the Labor
ode, s,�r I �irthwith comply with those provisions.
ate: ��%ta & Applicant
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, indemnity
& 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 rippection purposes. its
Signature (Owner/Agent) Date
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PERMIT # CONTROL #
UILDING PERMIT 4511
DATE VA ION LOT LOT TRACT
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JOB 91TE
ADDRESS Y�-�! `��
OWNsERR
CONTRACTOR /tDESIGNER /
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IJP ~i'Li •� ,tt 1#i FZ
�ENGINEER 111 i
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LA JTA. ('A 411S_A
(.010)775-7433
USE OF PERMIT
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RECEIPT
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 y
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 I
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
COMMENTS:
Lit— -A, )4
t—
-
Final
Utility
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbhures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
, 'Ti 71'. l h r % �► ,.e, I �i ( ► 771Sil 1,
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``� 1,• PGA WEST I'I RESIDCNTIALASSOCYATION, INC
AL'- P.O. BOX 1282, LA QUINTA, CA 9225;3
(619) 776-S 100 FAX (619) 776-5111
�GASTTN '
_
December 18, 1996
Peter & Carol Tuohy
Post Office Box 1244 t 7f
Chehalis" WA 98532
RE: PGA WEST II Residential Association,, '
Architectural. Variance Request / 79 700 Northwood'
Dear Mr. & Mrs. Tuohy: '
I 9111 pleased to report that th.e Architectural ,Committee of.PGA WEST Il Residential__
Association has approved the S1:.yJ.i.gh.t plans as Subnlitteil for the above. referenced 4
residence, with the' following conditions: • T ,
1) Maintenance and repair of the skylight is the respmisibi ity of the ,Wnieowner.
2) Interior damage caused by the skylight lea}`.ing is the respon.s.b►lity of the - '
homeowner,
Thank you for your submittal, and Should you have any questions plea e do 'tiot hesitate to
call me at (619) 776-51.00,
Sincerely,
— _ /yam.,' � 4 ,+ .. , - ♦
.John H. Handel , r . ,•
r Association Manager
cc: Architectural Committee Chairman.
, ` J
Board of Directors
Bob Edwards C:onstructio,,.
r...,K::.<�•.�y.T,,. .;,,; � . � r . ` }/ 7.}.T'. � .. 'w ...; l ,J ` — ry►. .,;, . .(• r !,/ 1 ,.i7, -w..f!^h 'y we..,.f . 3 •.° , Y .L..