0202-147 (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
Professionals Code, and my License is in full force and effect.
License # Lic. Class U0. Uate
056I M C.53 Eric C -K,07 $.
Date SiW�lgnature of Contractor 4M9,5�. ,
10
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 STAT-, C()MPi .3,AT1 Policy No. iY46•i�3 41i�62sS9
(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, Whall forthwith comply with those leraisions.`�,
Dater -d �A-2Applicant_,jF;,� _ 6 '
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.
a
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
the above-mentioned property f r inspection purposes
Signature (Owner/Agent) '•- Dated
f
BUILDING PERMIT PERMIT#
DATE VALUATION LOT WI4Y.7+-147 TRACT
47 _ 21846-3
JOB SITE APN
ADDRESS .54-45PfTAN GIJrVV001) 7`75s- )?_W4
OWNER
CONTRACTOR / DESIGNER / ENGINEER
I&M, VOGL
CA%1FC RMIA PC) OLS & WAS (Mr, MAN C01
54-5N :.:iI&GUENV
74725 JC)NaDIZ.t- 31, '3T'. 0-A,
LAQ1J. QW. -LA CA x7,253
P,A2.M,M, EXT CA 92260
(75C1)340-9000 CrBIA4 00353
USE OF PEERMIIT.�yg+�
7y �y
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P0 AM) " Rk 0 B ,nR&PI1' & 13 LIP 5' 3LOC X W.A;Li, C17Y
STANDARD, ALARMWBA,fi3PURS SHALL K 1'9 PLACE PRIOR TO
FOOL M17101 SPA 2450&00 U1
5 rr, WALL 13-00 LF
E fi•:�'.ED COU Up t,'OANG,1.R.:Ttr ON
=781,45
FXRWr,bVE BAR.%
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101- $M.04
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Z=723CAL FE;P -1?CaOL 101-000-420-€:00 �tS.tjB
PLl1M01140 FIX .POOL '901-000-419-000
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41
X.E33 PRM -PAW nil=
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$0,00
FEB 20 2002 '.. � .M?M �,~ S DUX "Wo
0PY0FiLAQUIRM
FIMAKFU PT'
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
:P.;
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
steel
POOLS - SPAS
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 C
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas).z
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)
10 M ON
T ;� .. .moi•..-�F r.. .
ra •
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
February 15, 2002
I;tarold and Paula Vogl
54-598 Tanglewood
La Quinta, CA 92253
Tear Mr. and Mrs. Vogl:
Mr' Don Adolph, Architectural Committee Chain man• has.approved your request to.,install a new
pool and spa, decking, firepit, barbecue and new landscaping at your 54-598 Tanglewood re pidenee.."
Upon completion please submit the enclosed Notice of Ca' mplction forrn to this office.
-We reserve the right to make a final inspection of this change to make. sure that it matches the
original request: An approval is based only on ir.e aesthetics of your proposed plan and should not
be taken as any certification. as to the construction worthiness or structural integrity cif the proposed .
cliar�gc.
We appreciate your cooperation in submitting (his request for approval. If 1 may be of further '
assistunce, please contact the at the H OA office, (760) 771-1234 extension 15"
S<;ere
alliar
Operations Manager
cc: Architectural Cunimittee
Enclosure
P0. Box 1050, La Quinta, Callf=4 92253, Telephone 760.771.1234 FAX 760-771-5125
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