0212-146 (RER)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
774382 13 C33 10C
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).
( ) 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'rAj'1,,VtMI) Policy No. 4687A
(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: t w 4 Applican—t-
Warning: Failure to secure :Worke s' Comp.e s;ZtiC 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, indemnifyl%-;
& 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•inspectidn purposes."
P.N. .�
Signature (Owner/Agent)-.-•�--�"� Date
BUILDING PERMIT PERMIT#
0212446
DATE tpq p`�-'}�/Fq9/�� VALUATION ���� .�(��//yy �y�},9�, LOT TRACT
�r4iid7/L6JW W`B,rJWOYdWJ
JOB SITEy, ,,�c�
ADDRESS B.TJ)Q,, a �t n �VALLP8.�y
APN
OWNER
CONTRACTOR/DESIGNER/EN (NEER
PGA'' 'f T.�SMRIMAL HOA
FPOCa3: C0143'Z:tLLrM(YN, MC'.
42.600 CAROXA COxTtRT
7062 C'ONV YY C:OMW .
PAM DMERT CA 92.21.1
SAN WIG0 CA 92111
USE OF PERMIT
UR UR 1..'tINDRAdf„ 3 DVX_t;
�1-3`7REN
Crj?TWO
VALVA110N 4,500.00 #ss
$aSMATIM COST OF COMMCIC'.' 014
MOW .ar".1 SUAWUMY
:,`t?MTRU'CTdCiNPIEZ 101-000-08-000
CONM .1'MiC+ T AM PSTN i 3 XX.
$30.00
Pte,.. F0, LW. S FIRE -PAW EW.
$0,00
�'t
i � �i "`��+b
1�*A.E.G.'dl'I e1T.AYSSY+,'L'sBetRS lJM.,Y°s L��HB'
,4 �FYZr
t'1r9'kia'tV49
�r�
4d 1
EEA.P"
RECEIPT
DATE
BY--
Zw,
DATE FINALED
INSPECTOR
11 4 f.�?
.
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
POOLS - SPAS
BLOCKWALL APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pars
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)
Send to: EPOCH CONSTRUCTION
Address:
Attention: HARRY
Regarding: PGA WEST 2 - MEDALIST DECK REPAIRS
From: Tim Golba
Date: 1 /28/03
Copies To: File
Comments:
Harry,
Please let this memorandum confirm that our office has inspected all
14 buildings of deck repairs for the current MEDALIST phase of repairs
for PGA West 2 Residential Association. This includes all of the upper
level entry and rear balcony deck repairs for the buildings along
Winged Foot, Southern Hills and Laurel Valley. We find the repairs to be
in conformance with the manufacturers specification and are
approved by our office.
Please let me know if we can offer any further clarification for you or
the City of La Quinta in this matter.
Sincerely,
Tim Golba, Principal
GOLBA ARCHITECTURE
Ll
G O L B A A R C H I T E C T U R E
656 NINTH AVENUE SAN DIEGO CA' 92101 VOICE: 619.231.9905 FAX: 619.231.4.288