0003-218 (AR)LICENSED CONTRACTOR DECLARATION
I. hereby affirm under penalty of perjury that I am licensed under provisions of
Uhapter 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
Date Signature of Contractor f—J..
i, :
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.
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 E„ Policy No.
�rrsr. �,hrr-9j
(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' compensation provisions of Section 3700 of the Labor
Code, I shall forthwith comply with those provisions.
-Date: Applicant 4��-� - • IN A 92
"'"Warning: Fal re 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. 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
lthe above-mentioned property for inspection purposes.
y
e�
Signature (Owner/Agent) +• - Date 2 ,
-
PERMIT #
1W-6 BUILDING PERMIT
DATE VALUATIONEJIi `�. )«) LOT TRACT
JOB SITE N-655 1INO R i fi-i;W001)
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
RL J k "P,
VA QI QFNA-A (.,A. 42253
tcliY,Yr-,j KS, t -'A 42788
USE OF PERMIT
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11! .70
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S3SO4.43
RECEIPT
DATE
BY p� j
� /
DATE FINALED
INSPECTOR
'i a
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel 17
Combustion Air
Roof Deck.
Exhaust Fans
O.K. to Wrap /j
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
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
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
n
. . s ..
. ' ..
p -
February 16, 2000
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Mr. & Mrs. Cliff Morton
X79 -650 -Northwood .
La Quinta,_ CA 92253
Reference: Architectural Change — Addition of Family Room
Dear Mr. & Mrs. Morton:
Your resubmitted plans for the addition of a family room to your property at 79-650 Northwood were
reviewed and approved by the Condominium Architectural Committee.
The Landscape Committee approved the addition of shrubs in the landscape planter and color in the planter
beds in conjunction with the approval of the room addition by the Condominium Architectural Committee.
Please contact Raphael Villareal, supervisor for Valley Gardening Service, at 760/399-1844 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
condition when the project is completed.
Approvals given by the Architectural Committee are good for only sig months from the date on the
approval letter. After that time a new application must be submitted.
In the meantime, if you have any questions, please feel free to contact Carol Fuller, Association Manager,
..at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Condominium Architectural Committee
Carol Fuller.
Association Manager
/clf
cc: Board of Directors
Unit File
_ a
INSPECTIONS
JCMInspections
Garand39725 GaLane Suite F
Palm Desert, CA 92211
Phone: 760-345-5554 - Fax: 760-772-3895
INSPECTIONS
EPDXY INSPECTION REPORT
DateA —d3—o
Project Name:
�O ✓1
Project No:
25�d! n — �l �� c.1t yvl c� sick a �t c¢�
_ _ .. _ ..
Project Address: \
t iV0
City:
v.7pp u G C.2
Title 24 AWSUBC
File # ❑ D 1.1
App# [__J D 1.4
❑ Other
Other:
Client: Sub -Contractor:
Q W vie -or-
General Contractor:
Architect: Structural Engineer: - n` Pr'r,
Epoxy Type:
Epoxy Shelf Life:
Hole Cleaning Method(s): i'�,
® Anchor Bolts Rebar n l
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Qa ,� �Ot t
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Weather:
SulnnL ) 144
Unresol3 d Items:
� None
E] see Below
Description of Work Inspected:
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Work complies with written approval from Structural Engineer and ICBO Evaluation Report # S
I hereby certify that I have inspected all of the above work, unless otherwise noted, and to the best of my ability I have found this work to comply with the approved
plans, specifications _applicable building laws. Final report issued at project completion.
Inspector: Jac C. Millin ICBO Certifi tioct,No: 0842216-49
Con ct a Representative:
—WAY
Copy 1 JCM InspeetZnns Copy 2 Project Superintendent Copy 3 Go4erning Agency Page _� of