9806-163 (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 Exp. Date
11556M X53 �' ` 10/3if 1+
ate "Signature of Contractor
1
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
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 I have and will maintain workers' compensation insurance, as required by
Scfction 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.
3"Vi 'rE FUND
(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
su tett to the workers' compensation provisions;of Section 3700 of the Labor
ode, I shall forthwith comply with those<provisios,.
Date: r'u-'+ Applicant N r �;'��
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on. his T
r
application. ,
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuantito
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
,construction, and hereby authorize representatives of this City to enter upon r
/thebove-mentioned property for inspection purposes.
ature :(Owner/Agent )'_'T� } }-- _ Date
BUILDINGPERMIT PERMITq CONTROL#
ggJJ ;63
DATE j¢�b/t VALUATION y��'���➢ LOT TRACT
7978
vbi /
JOB SITE
ADDRESS 54.307 SOUTHERN HILLS
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
USI, 1.,Ii ',D 1.1
C'Al..l.t'OR.1,11.A. K)044* :P-A,S
56-140 PGA 91.V1).
4-725 Icim Dkfvk, #:fig
LA. QLi1Mtri. CA 92253
PALM aRSEWr CA, 92260
(760P40-9000 �P,l.,;t, z55
'
USE OF PERMIT
POOL
POOUSPA, t Bf3Q, ALAW.V13AjtTcTPR3 MALL BEHN A'T Pim:-'PLAsTOZ
St•;gNfri;�t'je;�v.
POOL ANDIO4R (Vit 141W.00 Lu
OF, CONISTMUCTION
yEr1 1141T .Y411 diJ.l�$t 1'
PLAN c..' 1b.' :l;'. Ftit# 1.01.•t�31f-43�?.3.it3 �;tr�g„lta
r7Ot0YrR4..r,1Y!()WVVE lot _000-1-41840) �yFi.r.�xi
ib2 WHAMCAL VEX -• POOL 1{).1--000-421-000 00
in. 101..ViCAL FM -.. POOL 101 •.00111-42411•.000 X45.(0)
.
(',t.trMOWNu :f4%, y Pte,. 1011 -OW -09-M) ) S27.(*
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t+��1�4s'�'IZ�t"�fo'3.:i0
.1,1».SS �' �-Rr' M FE13S
x{3.00
JUN 2 21998
PERNOT FEES DtIr.NdiW
&%3.30
g Off,
BY
DATE FINALED
INSPECTOR
,RECEIPT
Xt
'�
s
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms 8 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 F.inat
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 -
q u. i q r^,
Gas Piping
Gas Test
Appliances
Final
_
Z (.
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Vottage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
June 9, 1998
Nicholas ,& Patricia Temple
54-307 Southern Hills
La Quinta, CA 92253
Dear Mr: and Mrs. Temple:
Your request for an architectural variance has been approved by Mr. Don Adolph, Architectural
Committee Chairman. %Specifically, you have the approval to proceed with the installation of a pool,
spa, and barbecue at your 54 -307 - Southern 'Hills residence. Upon completion please submit the
enclosed Notice of Completion form to our office.
The signed PGA West Residential Association,'Inc. Notice of Architectural Approval form must be
submitted to the City of la Quinta prior to their issuance ofpermits.
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
change. _
We appreciate your cooperation in submitting this request for approval. Should you have any further
questions regarding this matter, .please feel free to -contact me at the HOA office, (760) 771-1234.
Sincerely,
Ke alliard'
Operations Manager
cc: Architectural Committee,
enclosure (2)
P.O. Box 1060, La Ouinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
N Wept J'un-17=98 09:48an fr69 7607715125*760 771 33.81 Page' 1
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
PGA WEST RESIDENTIAL'ASSOCIATION, INC.
Notice of Architectural Approval
This shall serve as written notification to the City of La Quinta that Mr. and Mrs. emle of 54-3nT
Southern Hills has gained written approval from the PGA -West Residential Association, Inc:
Architectural Committee and From a Management Employee -of 'the Homeowner Association.
Specifically, Mr. and Mrs: Temple has the approval to proceed with the installation of' pool, spa
and barbecue: This signed approval must precede the• issuance of "permits from the City of La
-Quinta:
rchitectucal C mittee
Date
00"0.?
t /
*HOMan ent . S
Date
. Ut
PosI:R J L,
Rna NOt^RJ7677I 6 1 Z;I --,
To
-41
. . Pironcr .
PO. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125
b :'.,,.;jam r jsi•'ti ,z t*tj. $}?^fir .' �� 1