0105-024 (RPL)' }V* LICENSED CONTRACTOR DECLARATION
I hereby affiAX under;penalty of perjury that I am licensed under provisions of
Chapter 9.(commencing with Section 7000) of Division 3 of the Business and
Profdg�'ionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
4;-S' 493 f3 O53
r
Date ` �= - Signature of Contractor
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).
( ) 1, 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.
( ) 1 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:
Cartier pp LLW AN tNr xlpS AWF Policy No. eayN 4 3 3Ate '
(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: y_ �_T 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. r -
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 inspection purposes.
Signature (Owner/Agent) r :_�..�,•� ,r^ _fid �f•, Date',N.
_ _ °
r BUILDING PERMIT PERMIT# '
DATE VALUATION LOT OIW )24 TRACT
f
JOB SITE
APN
ADDRESS
90 TANGIZWOOD
OWNER = _ =
CONTRACTOR/DESIGNER/EN (NEER --_ `—
R.Ah,: CAPPO
PtlR%i�.C'.:.1 i)OL„1 JE) t.o%d`�',Ei:UCIMIN ..
$$,X39.0'1'AWGL:�i"� )OD
P.O. BOX, ISM
LA.QY.ills TA. CA 92233
PALM 171° M' C.A 92261
s
(760)568,4963 C3x:U 725
USE OF PERMIT
POOL.ANIVOR. s`3i3A
P001 ,'1r'A.Ai,A13.MMAi.''MER 5KAU,. HE tet PLACE AT PRIT PLASTEft
€HO1'U`'!' ON. POOL HtYliotAWNT XHC- a 51J NOT INCt.iYI -Fu
POOL ANDA SPA 20,090,011 La
�",ao Or CM1Jd�S.6�Ke.VIcnia-4
4�*VlG�4�r42y+
•���ryry ���������ggssftg •�,n (X�'•egYB�lYri1�k.YbW9.Y.A1bA2'
Y'.i'.d�fMArY T L 3? KUWA aL4.II
PLAN CHBC K RE 101-0001439-316 39-316 $1,34,53
t"xl'r TRUCTION FPE 101-000-428-000 $7V330
MECHANICAL FEE .- POOL 101.000-421 •MO $24.00
C.f,,EC`P}t:f.ClA1.Fr_V1... pool, 101-0001.420-000 045.00
PLAIkld00407H.9 , :BOOL 1014=419.000 $ 7.00
i�CIB'1<•"' i AI. f:C.►k1'S`i"ItUA`"'TION 1 ND 2' LAW CXEC1�.
63�'. ►S
1:,M p1 —PATD k'?MS
MOO
".€`Ll'ft'L1-r-RW1. FRES DUE NOW
$43755
RECEIPT
DATE,/ F
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Foitms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O. {
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Steel
Electric Bond
_
125�0�
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Undergro r+ G
piderground Pibg. Test
G in
b. ^
�•�$ �D/
Final
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
8/3/�/
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)
l
'Ail viYa;�
BUr A E
NS `1R
BY
DAT
A RE -1 30 o
WILL BE k `�
PLANS N
THE SI OR f CHE UL 'D
INSPEC ��►ST;�,�� ��a�n� �. �� , ��
CEPTIONS!
i IT
T_5
Q,
0
ti
� nQA
d �1'
SENT BY: PGA WEST RESIDENTIAL ASSOC, I; 760 771 5125; APR -27-0i 8:54AM; PAGE�2%2
PGA wisT
USIlpIaII UL-
d6S$QCIIdTI0P1, INC.. r
Apnl 25; 2001 ;
Ms. Rae Capps - • '
55.390 Tanglewood
La'Quinta, CA 92253 '
°
Dear: Ms. Copps,
The plans to construct a pool and spa at your 55-390 Tanglewo6 home have been approved by Mr.
Don Adolph, Aichitw ual Corninitt4'Chairman. Please note that all'grass replacement is to be sod
and. any electrical wiring exposed • during construction must be reported to the PGA West
Homcovmers Association Res, L Also, if access to the pool'is required through the golf course, the'
contractor needs to secure K.5,L: approval.
We appreciate your coopeiatlon in submitting rthis request for approval. If 1 may be of further •
assistance, please -contact me at the HOA office, (760) 771`-1234' Extension 15.
Sincere . ,^., •' , � � +,�
Kelly cGalliard „
Operations Manager .
` KWsno
cc: Awhitectural Comrnluee
P.O. Box 1060, La OulnW. CaWornla 92253, Telephone 780-771-1234 FAX 760-771.5125 '