0105-306 (RPL)wLICENSED CONTRACTOR DECLARATION
,1,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 Jt Lic. Class . —Exp.`Daf
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57 127 ✓ A C53 TUG
Date Signature of Contractorf
i,
OWNER -BUILDER DECLARATION'S
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 isnot intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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 Policy No.
(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 riot employ any person in any manner„so.^as to become subject to the
Workers' compensation laws of Californid,'and agree t�haeif I should become
subject to the workers' compensation provisions Of S,ection 3700 of the Labor
Code, I shall forthwith comply with those".provisions}
r �
Date: 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, 'indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes nulliand 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 authoriize•'represe t t'Irvef of this City to enter upon;
the above-mentioned property�for inspection purposes.
Signature (Owner/Agent), r ; Q'= ' c ”' Date2
�BUILDING PERMIT PERMT#
DATE VALUATION I LOT TRACT
JOB SITE ARfJ
ADDRESS
�o- 4 t TAINCr.7Ca9):WO00 - -
OWNER
CONTRACTOR / DESIGNER / EN INFER
UkRR�Y VJAP
7
STEVEWDSOW CO3TMU�"ZCr4INC.
55"40TRyOr.4,f
733y:1UVTr gS 1\.e36idp
L.A.Q-0,bYrA_ CA .92233
PALMD15ZU.T CA 922,60
(760)3,46-4032 CRI'a#. IW
USE OF PERMIT
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POOL ANDIO1a' 21"A . 2�,003?.t►710 .
FISIl. W C(Xvr 01r CONSIRi1'MON
2e1110MA i)
PORMIM SUMMARY
PLM MCK FEE 101-000-435+418
CS:+NSTRIUCTI N FEE 102-000.419-000 �ts1.t70
U211CIMNIC-1411FER- Pool" 101i -000-42,i-000 $2.4.00
W.'V RIC AL PIZ -- POOL 101-000-420-000+ 73.00
1AUM1 INO1 ^^ x'001.1 101+000.419.001 $717100
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2001 IMS PRIA'All) IT
o.r�0
MAY 3 0
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1%A r ' N DVE N'O'D
CITI( QUiWA
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fliaAl�C[ DIM
RECEIPT
DATE,
BY
DATE FINALED
INSPECTOR
t ' S
INSPECTION RECORD
,OPERATION.
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Bac;.a
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=;
Steel
Electric Bond
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Final
PLUMBING APPROVALS
Underground Electric
Underground Plbg. Test
Gas Piping
Gas Test
_
G/J
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:
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)
y o
TY
PGA WEST
RESIDENTIAL ASSOCIATION; INC.
May 22, 2001
Larry Dunlap
55-408 Tanglewood
La Quinta, CA 92253
Dear Mr. Dunlap:
Mr. Don Adolph, Architectural Committee Chairman, has approved the plans to install a pool and
spa at your 55-408 Tanglewood residence. Please note: the plans reflect a 40" high screen wall,
please ensure that the equipment is completely hidden from view. Upon completion of this work,
please submit the enclosed Notice of Completion.
We appreciate your cooperation in submitting this request for approval. If I may be of further
assistance, please contact me at the HOA office, (760) 771-1234, Extension 15.
Sincerely,
C •
Kell eGalliard
Operations Manager
KM/sno
cc:; Architectural Committee
enclosure (1)
f
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX,760-771-5125