0001-031 (BLDG)LICENSED CONTRACTOR DECLARATION
hergoy;affirm under penalty of perjury that I am licensed under provisions of
'�;hapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force at d effect.
License # Lic. Class ! Exp. Date
523bw% 13a r �i2i��i2iJi
Date ` Signature of Contractor 7�
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:
Gamer Policy No.
.a:.d♦ :iMLa� d
(This section need not be completed if the permit valuation is for $100.00 or less).
No 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 �. visions of Sectio 3700 o the Labor
Code, I shall fort with compI with thos rovisions. �I
Date: 11 Appliant �� f �'!
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
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 withiri 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 epresegtatives of ,this City to enter upon
the above-mentioned property for in�r ectio 7purposes4:7
7� /Signature (Owner/Agent) / Z �Date 19 d
BUILDING PERMIT PERMIT#
0Ci€91rt13E.
DATE t . , VALUATION eLOT TRACT
\ V
JOB SITE
�1�1'1.r
ADDRESS 54-435 N ED FOO
APN
_
OWNER
CONTRACTOR/DESIGNER/ENGINEER
34-435 V+'DIGxED FO(Yr
82723 DR. CA,�. O BLVD.
LA {2iJIWEA CA 92253
1NDIO CA 92201
MA 1461
USE OF PERMIT
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WALL
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PE, 1 .ii".N.R SLiMAILARY
PLAN CGfiECK FEE i{)J-iK?f1 4;�► 31t4 �44U !+a
U1. rrrrICAL F 5 "I,
`ili(Oi4 , 1vl01 iC�P1Rh i0.1- -WO-241 -OW .,+J
tit}'r3_t'(7d',Al, {;'C)�+jC'1'j2i,fC."`F'�tiN �aN_i'� T'i.�•n? f'FfF'('F�
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LESS PARE, RtUD f'� iS
TO 00
1.'MAL PERM-13'FEES DUE NOW
5120.:20
RECEIPT
DATE
BY t
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs!
Underground Ducts
Forms & Footings
Ducts
Slab Grad!-
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
FramingCompressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
6 4
Final
Final
BLOCKWALL APPROVALS
POOLS - SPAS
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 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)
FROM : 1,1014ARCH-ACCOUNTING
i r 54,
FGA, WIEST,.
r
December 17, 1999
Mr. Roger L Ramsey
P O Sox 10297
Zephyr Cove, NV 98448
PHONE NO. 760 776 5112 Dec'. :22 '1999.05: 68PM P1.
PGA u'EST II IZESIDENTIAL, ASSOCIAI10N, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760)776-511.1
Refere..nce: '54-435 Winged Foot
Architectural Change Request .Sl'ding Glass Door
Dear Mr. Ramsey:
.The Planned Unit Development' Architectural Committee at its December. 14,1° 99 meeting has
L. .
reviewed your plans to install a sliding glawdeor on the outside wall of your den and wishes to
advise that your plans have been approved as submitted.'
Please contact Miguel Valenzuela, supervisor for Valley Gardening Service, at 760/399-1844 and
Carol Fuller, the Association Manager, prior to any irrigation modifications associated with this
change. Upon completion of changes, please contact Carol Fuller. Damage tD the landscaping,
i.e., shrubs, trees; flowers and turf is the responsibility of the contractor. The landscaping must
be brought back to its original condition When the project is completed.
Review by the Committee is only for general conformance with the architectural guidelines. It is
the responsibility of the owner to fully understand and conform to the architectural guidelines
criteria whether or not all deficiencies are noted during review. It is also the owner's full
responsibility to field verify all existing conditions. The Committee's decision with regard to
project design will be final, Please refer to the PUD Architectural Guidelines and Application for
Change for all required submittals.
Approvals given by the Architectural Committee are good. for only six mon-.hs from the date
on the approval letter.' After that time a new application must. be submitted. .
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
Association Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the PUD Architectural Committee
Carol Fuller. '.
Association Manager
cc: Board of Directors
Unit File
. ` . .
,., CITY
JOB ADDRE�S 43!!;, W1kCA -FOOT PERMIT NUMBER OWNER 906612- RM56vi* BuILDER-5
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This form �hafl be
n Card at all times in a con picuous place. Only persons
^
onthis job. Any changestoAmomtmust uoappnzveuuvthe Building Division prior -to commencement mwm,x,'nulu==Comply will ^result ^'^�^-,"-g-- `workvoidance
�_,of building permit. For each applicable trade, all information'requested below must be completed applicant. "On File" is not an acceptable rasp
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Classification
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