0208-155 (RPL)yLICENSED CONTRACTOR DECLARATION
I hereh affirmNnder penalty of perjury that I am licensed under provisions of
Chapt 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 lExp. date
6156128 C1153 RTC,
Date Signature of Contractor -Joe
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contracter'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 S'TATI COMPENS.A TI Policy No. 04 1610 -►fie
(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' compensagiahlprovisions of Section 3700 of the Labor
Code, 10, al, fgfrthwith comply with tho e proviisions�
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 r
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 (or`inspection purposes �.
Signature (Owner/Agent) tni� Date
%t
B�IILDING PERMIT PERM IT
.
DATE .,VALUATION LOT TRACT
JOB SITE
ADDRESS '4 �^-.9Ff rANG1 . ,AWA
APN Y
OWNER
CONTRACTOR / DESIGNER / EN (NEER
M& TORI 20B. COPE
C:r :WC?,"f NIA'.POOU & SPAS CM1) Sj� M t"U•
54.976 i.A1 G1;P-W001*.1
86-100 .A4"I�-NUE 54
LA C X111T2'A CA 92253
C0.4f.111TFIl A. Cly. 922.36
C160)398.9222 MIX 00355
USE OF PERMIT
POOL ANWOR VA
PCJtal:,1SPAt,,, 3 Ll. 4` OA..f']. ,4 WALL, CITY S'['ANI,Ck.F1RD,
AI,Ai.1M.MARRM841 WALL BE IN PL AVV,, AT Ph1.&P1LMMA INSPECTION,
4 FT. WALL 5100 11F
EMMATIM CO, S[0� 11'yCp 02SUMCONYy
1€fiM
PTU6 FgVmkRir y:
(.t Q
V?AN 011=Pr r✓ i'r�i�JV�4J�u1 d'F!, ��b.��iy.
CONSTRUCTION I" ii9t��tit1�49P1-13£14 $Ia;9.Ots
M'tv{'ki.l ICAL Ir ?F. - POOL 141-000.421-000 $24.00
9+'t?,CTMI CM.LME- POOL. 1011-000-420-000 $45.00
P2.3MINOFR, '-POOL 101.4419.000 �27:OQ
ty
•;�ill�-�l:d`1'.f�,Ii..O'�%AI`�';['1e%11'�13:C1�3' e�1V'i� 1�T�.l�DG��
�44;1').�i�
sLF,30. HZIE.-PAMDFM
hcu TOTAL rRyaw:MMS Du now
' 0
$447.85
AUG 2 0 2002
CITYOFLAQUINTA .;
RE
BY
D .E INALE / NSPECTOellR
90
ik
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
i
Final
Underground Plbg. Test_
Gas Piping
7 -✓
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
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
`Utility Notice (Perm)
Final
COMMENTS:
/�
r
14 11 Fill1 1
August .7, 2002
Michelle Cope G
., 54-976 Tanglewood`f
La Quinta, CA 92253,
Dear Ms. Cope:
L
•
1
Mr. Don Adolph, Architectural Committee Chairman, lias approved your request to add a new pool,
spa and decking at your 54-976 Tanglewood residence contingent upon you the following:
• To date we have not received landscape plans. Prior to your deposit being refunded
landscape plans must be approved by Bill Bobbitt, Landscape Manager and landscaping
must be installed.
Upon completion please submit the enclosed Notice of Completion form 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 the aesthetics of your proposed plan and should not '
be taken as any certification as to the construction worthiness or structural integrity of the proposed
'T- change. Prior to commencing any work on PGA West property your contractor must provide proof
of insurance.
We appreciate your cooperation in submitting this request for approval. If I may be of further
` assistance, please contact me at the HOA office at (760) 771-1234, Extension 15.
Sincerely,
Kelly McGalliard
Operations Manager
KM/sno
cc: Architectural Committee -
Enc (1)
P.O. Box 1060, La Quinia, California 92253, Telephone 760-771-1234 FAX 760-771-5125
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