0202-148 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed undev�provi$ions 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
C 53
Signature of Contractof -41, _ j ll
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason: • .1
( ) 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:
Policy No.
Cartier S�'.81`1'.1S 1UND IS;16431•f11
(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 -land agree+that if I should become
Subject to the workers' compensation provSslons of Section 3700 of the Labor
Code,�I s all forthwith comply with those prjovisions.
/Date:;.. �Gdry Appllcant�
Warning: Failure to secure Workers' Compensation coverage is untawful and
shall subject an employer to criminal penalties and civil fines up to $100000, in,
addition to the cost of compensation, damages as provided for in Section 37Q6•i!
of the Labor Code, interest and attorney's fees. u
IMPORTANT Application is hereby made to the Director of Building and Safet
for a .permit . subject to the conditions and restrictions set forth on hi
application.
1. Each.person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to; & shall, indemnify.
& hold harmless the City of La Quinta, its officers, agents and employees
2. Any permit issued as a result of this application becomes null and. void if-
work is not commenced within 180 days from date of issuance of such"'
permit,or cessation of work for 180 days will subject permit to cancelfation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon .
the above-mentioned property for inspectiorypurpose$w,
,/Signature (Owner/Agen )!1 Y Date"
...tom^'•``%- �� �.., 6.,✓'
PERMIT #
BUILDJNG_PERMIT'
DATE , , VALUATION LOT- TRACT
02 -NI
JOB SITE
ADDRESS 54 _ WINGED FOOT
APN
w
OWNER
CONTRACTOR / DESIGNER / EN (NEER
IMM. R,AmalY
hikefuRPOOLS
54-435 VI.xK0T� JJ FOOT
73-5S5 3OF3WAY 1.1.3 '
JA Q3J3'.wm , ' '92253
PAI.,Ti+1 T5EHE R T' CA 92160
USE OF PERMIT
POOL AMD/GR HPA
POOL AND Sy'}n?,e+igONLY. llq;.,r?/a�ktyA/itWBA47:QtiZ3Ii.L�.RS4 PPJO
pS{HAd.py.�+�piYE
.G7V11qPl3"9
6{dSUVgRaf
MCI,UDEIi ni PERMIT.
FJt3 edl'�1�31w EP�l�D 113
:15 i1'`!3 d:6i"T C1? C'633dS"1i'RSC'Id?,b,C3l�
PLAN Cl•13f'K T : 101,=00"39.311 $548.2
CONS T RUCTl 4 FEE 101-0,10.4,18-0.00 $223.00
M, WHANICAL IME -- 1' )OL 101-000421-000. $24.00
ZLEC."F.RICIAL09Z<- €001. , ;� 9.01-000-A20a000 .143.00
1?LiJ11B1?d f 1 --PGO P a; 101.000-4194100
tv"I A'laa2
0 rr
FB X ... f UC 'T0X fiaW �T,�r'�.W r'1°l�OK,
IA a /.11S
TOTAL PERWC YKEFS DUE NOW
r
/
RECEIPT
DATE
Z
BX " ,•
",'
DATE ED
INSPECT
5
2 ��
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
L
:Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
_
Equipment Location
Underground Electric
Underground Plbg. Test
�q -®
l
I
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
Gas Piping
cncapsulation
-4
Q� _l!� ►�
';as Test
Appliances
Final
f
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Uiierground Conduit
Rough Wiring
Low Voltage Wiring
Futures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
FROM MONARCH FAX NO. 7607765112 Mar. 06 2002 11:48AM Pl
Rn PCJA WEST 11 RJESIDENTIiAI ASSOC:LM-10N. IXC.
rr.
P.O. BOX 1282. LA QL'IVTA. CA 92253
(.760) 776-5100 FAIR (760) 776-51.11
n
March 6, 2002
Mr. & Mrs. Ramsey
54-435 Winged Foot
La Quinta, CA 92253
Reference: 54-425 Winged Foot
Architectural Change Request — Addition of Pool & spa
Dear Mr. & Mrs, Ramsey:
The revised plans were received on February 28"'. The plans were reviewed and Iapproved as
resubmitted. t�
Review by the Cgmmittee is only for general conformance with the architectc,rafi 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.
It is understood from your:application that there are no landscape, irrigation or.iighting changes
associated with this project.
Approvals given by the Architectural Committee are good for only six months from the.date
on the approval letter. After that time a new application must be submitted.
Upon completion of your project, please complete and return The Notice of Completion of
Architectural Change.
If you have any additional questions or concerns, please do not hesitate to contEct Carol Fuller,
Association Manager, at 760J776-5100, Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc Board of Directors'
Unit File
• . -Q
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