9805-010 (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 !f ' Lic. Class Exp. Date
99377 C53 C27;'" j c�/3tJfSif3
tDate'� f r Signature of Contractor'^ r%4 .r� `_ f 0-/1 �r
J. -
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 Policy No.
F..X7arvWTION ON FILE
(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
workerscompensation laws of California, and agree that if I should become
subject to the workers' compensation provisions of Section 3700 of the Labor
C.od`e, I shall ;forthwith comply with those provisions. d t
ate: lltt'=`ml 3. Applicant -
Warning: ''Failure
pplicant Warning:'Failure to secure Workers' Compensation coverage is uni/ful 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 fdr inspection purposes.
VSlgnature (Owner/Agent) """" 1 . f;f I J' Date '� 7 ,1
s. Vl
BUILDINGPERMIT PERMIT Jt °ONTR°`"
DATE VALUATION LOT TRACT �i Q
r Q
JOB SITE P t `
APN
ADDRESS
57-7971Ni EPL -LAC -HEN
OWNER
CONTRACTOR / DESIGNER / ENGINEER
7 DONALD SHOCKEY
NATURAL. EFFECTS
57-797 IMMKLACi-1EN
73-96A)1-i1GHWAY I11. SLA 1'E g
LA QUINTA. CA 92253
PALM DESERT CA 92260
r? p�s�Lt 67?6 CELf# 5220
USE OF PERMIT
F
4t i.
j?rjODSPA.OM Y, ALA1R SAIAitl2fERS ARE TO BF i.1PERAT IONAi- P -WOR ll
TO VIR-CAP. PRE.-PLAS7ER INSPEC717TON
`14AY
11 1990-
POOL AMIM SPA 17,000.00 LS
r'ITYOFLA
C> UINTA
u
ESTIMATED COS f OF WNS"I'lRUC 1100
'J.7s13�t3�fftt
PERMIT FEE SUMMARY
PL kN CRECtKYES 10.1-000439-318 $1.17,00
,COI 31RUCTION FEE 101-000-418-000 $180.00
INIECHAMCAL F1- -- POOL, 101.-000-421000 V4.00
E1,ECTfi1CAL, FEE -- POOL 101.000-420-000 345.00
Pfji3MStNO FEE POOL. 10.1-000-419-000 $27.w
r
'SUB -TOT -AL CCATSIE.UCTION A1ND PLt%N CHECK,
$393.00
LESS P.F�L?�PA11) FEES
$00
TOTAL PERMIT FEES UiTE NOW
S393.00.
RECEIPT
DATE
By `
DATE FINALED
INSPECTOR
F
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 Wail 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
Gas Piping
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
COMMENTS: o
�( ko Alp M m t N 3-b4 llEd' W C( &X f zS V i
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. UFe of Power
1
4
Final
Utility Notice (Perm)
April 27, 1998
Mr. James D. Shockey
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(619) 776-5100 FAX(619)776-5111
RE: Architectural Change Request for 57-797 Interlachen
Dear Mr. Shockey:
The Architectural Committee has approved your request for permission to install
a Pool and Spa at the above referenced address at PGA WEST with the following
condition:
1. - Lantanna on Golf Course side of Pool addition is specified to be planted
3 feet on center. The committee feels that this is to great a distance
between plants and requests that you plant them 18" on center
instead.
This approval is good for a period of six months. If construction is not begun by
September 28, 1998 you will need to submit a new application.
Please contact me at (760) 776-5100 to schedule an inspection of your
improvements so that we may refund your performance deposit.
Sincerely,
For the Arcbitp t ral Committee
John J. Monahan
Association Manager
CC: Board of Directors
1