0010-193 (RPL)LICENSED CONTRACTOR DECLARATION '
I hereby affirm under penalty of perjury that I am licensed under provlslonsof,a
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and!.�'�'
Profe'ss'ional Code, and my License is in full force and effect.
License # x Lic. Class Exp. Date
Signature of Contract�\'J;
�.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.
(V)'11 I have and will maintain workers' compensation insurance, as required by
S6Non 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.
STATPMID Ba�641��-fir
(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"tfio a provisions.
Date f_/? r•+ Applicant— t•w
C e �
Warning: Failure to secure Workers' Co p nsation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT, Application is hereby made to the Director of Building and Safety
for a. permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for insp ction.purposes.
Signature (Owner/Agent)` -r" '� e -7Z -..;"—"I + j .t N Date f ��
� .F ..."..r^-• 6 .n✓ j" 'K:rer' ar .n «' d 1.,,7"s_ ' .
I, f
PERMIT#
BUILDINGPERMIT
,
«:
fDA'TE • ;,' VALUATION LOT TRACT
JOB SITE V
APN
ADDRESS
57- Y`5 SPANU'H M:4, AS
OWNER
CONTRACTOR / DESIGNER / EN (NEER
BOB MET11
Al, C" POOL COMMUi"'° 09
57-445 '7,.'�a1'W1H-113.x;5
739601-1101-IW,AY 1 I 1 • .
3:A Q'11'ad'#`.R. CA 92253
4 ALM.:17EaiM. CA 9W -15
(-MrAO-25811 MLO 1104
USE OF PERMIT
NX)LANDIap, SPA,
POOL & SP.A. 0N1;Y'-A1,Kf,'MV8ARRJ. 1C3 S)RA.LL € F FN PLACE T PREN
1yA.1,A Mit WMTKYA P001, EQi3tPMil' 13 NOT IN CLi N15,
.111 THIS P'& WMT
:100L ANDIOR SPA ���9��Af➢
�Y st?: O'0a1"1" OF r'C:g XSFf'��UC),110N
+S��S�3YtiE)
y$ F�1��q,�/g�yj q; q, •� �y` F�p.7a ,�
iy'ffi.lSL.43,�`L`+y,IIK°f Y.M &J.1'Va.lY.9.11�0.�.7L
1'1M C.H1?011 PEI ' 1 ill -OW-45931 8
CCMSTIdUCTItDN FEE 101-000-418-000
MECHANICAL W. -- POOL 101-M-421-000 00 $24.0
XL•EC'i'RItw:`•A,J..PRE F001 liii-C�(if9-�20-000 �I&.Ut3
1`1,t, MBi14a'3 Fa POOL. 101-000.419.000 3210D
WM-TarX, Ctl�+f'�:�`1' M.M.''ON AND PL N, e_WMK
$891.30
LEW PRE -PAID ELMO
$0.00
'TOTAL PUAVY .Or KEEN DUE ROW
,% `i
91.E
RECEIPT
DATE FINALED
INSPECTOR
/DATEBy'
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
`t BUILDING APPROVALS
- MECHANICAL APPROVALS
SM 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
POOLS - SPAS
BLOCKWALL APPROVALS
Set Backs
Footings
Steel
Electric Bond
Main Drain
/
Bond Beam
Approval to Cover
Equipment Location
Final
PLUMBING APPROVALS
Underground Electric
Underground Pibg. Test
Gas Piping
Gas Test
Electric Final
%j�4w
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 FAIRWAYS ASSOCIATION
October 10, 2-000
Robert Steele
4728 Stonehollow Way
Dallas, TX 75287
Re: Architectural application
Deer -Mr. Ste
The Architectural/Landscape Committee of the PGA WEST Fairways Association
reviewed the plans for the Pool & Spa, Fire pit, Barbecue. and landscape
improvements at your PGA, WEST home. Based on your follow-up, the
committee is pleased to inform you that it,has approved the plans. as amended.
This approva.1 Is good for a period of six months. If oonstruction is not begun by
April 10, 2000 you'will need to submit,a new application.
Please have your'contractor contact me at (760) 776-5100 ext. 24 when work is
complete so that .we may arrange an inspection, and the refund of your
performance deposit.
,
Sincerely,
Grace Davis
Assistant Association Manager i
CC Board of Directors
John Monahan, Association Manager
P.O. BOX 13710 • PALM DESERT, CALIFORNIA 92255 Tel. (760) 776-5100 • Fax (760) 776.511.1
email:awes i
pg t@mouanh�rp.com
i