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0305-094 (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 t1ke Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. date Date Signature of Contractor a f/ .%�.�°'/ �•- 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. ( ) .11h ave 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. +�:i<C".°I�yP�2iitil�Td PolicyNo. fia-•2063 (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'provis{ons. ,r Date: ,� t= 1 Applicant- Warn pplicant r 1. • r�Ys 6 r s rr'+ i ' 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. 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 'nspection purposesw Signature (Owner ,�li . d r r . : Date /Agent) I ., -- PERMIT # BUILDING PIRIT. 0.i DATE 1 VALUATION �N'e��{�,i} LOT TRACT ADDRESS APN OWNERS ti CONTRACTOR / DESIGNER / EN &NEER t&_ pWJ/c)rk ta'.L. sAnm C.P,1XW-_)F.?3.CA61- 001 ` RE M. — MAN CO. . -6) O ` ANGLEM000 86-1 C10 AVEMMY.L 54 �O A 92253 i:OA►°, ., , r3 G' �, 92236 USE OF PERMIT TTPERMIT M f q t SIT.>1IMU,Zi AALAftM:3MA'RHA,90 TO :DE FS PIAC E PRE -PLASTER IN'S FIC71014 FOO, L AM0/0R %VS A 17,9(4.09 IS PLAN CHEM RK -1 101 _0010: 47i -318 R� p Q��,a:� �,011S5.RUC71014 ��+'.t'Y.. 'i4+:.'�ib�ti'w�•'�iCY"6/W'4A7 lRVr. 110 MECR4'NiCAS,PER ..1S:yOi, 101-,0(3110-421-000 '11XICTRIC'A;L?rt211 y PLSOL 401•:+0'00-420-"000 P41WHNM FRE X-100 lQ;140t"19-0a.) U7,00 I©l MAY 1 3 2003 TY OF,LA QUINTA•• FINANCE DEPT.. A�.�.. 9 W C`, 2,04a RECEIPT DATE BY I DATE F ALE 1 INSP OR Arl:l :z r I v 3 g 19,000-00 $4 al.83 V100 INSPECTION RECORD OPERATION I DATE I INSPECTOR BUILDING APPROVALS Set Backs Forms & Footings Slab Grade Steel Roof Deck OX to Wrap Framing Insulation Fireplace P.L. Fireplace T.O. Party Wall Insulation Party Wall Firewall Exterior Lath Drvwall - Int. Lath Final OPERATION I DATE I INSPECTOR MECHANICAL APPROVALS Underground Ducts Ducts Return Air Combustion Air Exhaust Fans F.A.U. Compressor Vents Grills Fans & Controls Condensate Lines Final POOLS - SPAS BLOCKWALL APPROVALS Steel Set Backs Electric Bond Footings >7 Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric Underground Plbg. Test 1.4 Final Gas Piping PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pais O.K for Finish Plaster Sewer Lateral',., Pool Cover Sewer Connection Encapsulation Gas Piping Gas Test Final Utility Notice (Gas) ELECTRICAL APPROVALS Temp. Power Pole Underground Conduit Rough Wiring Low Voltage Wiring Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) Final WL14 2 COMMENTS: lA k I V ��Lj DATE E RA 0 1h'NY B SOLD BY CHECKED '$Y rSCALE, jJ SENT BY: PGA WEST RESIDENTIAL ASSOC, I; 760 771 5125; l • 1N PGA WEST RESIDENTIAL ASSOCIATION, INC. May 9, 2003. Eugene and Mary Sayler 54-616 Tanglewood La Quinta, CA 92253 Dear Mr. and Mrs. Sayler: MAY -12-03 2:36PM; PAGE,2/2 Mr. Richard O'Donnell, Architectural Committee Member, has approved your request to install a new pool, spa and decking at your 54-616 '1'anglewood residence. Upon completion please submit the enclosed Notice of Completion form to tris 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 the aesthetics of your proposed plan and should not be taken as any certification as to the construction worthiness or structural integrity of the pr* sed change. We appreciate your cooperation in submitting this request for approval. if 1 may be of further assistance, please contact me at the HOA office, (760) 771-1234 extension 15. Sincerely, C Ke y McGa,lliard Operations Manager cc: Architectural Committec Rnclosure (1) P.Q. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125