0212-138 (MISC)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. Dafe
D774592 M01
ate "l •'lam ? ` ' Signature of Contractor
OWN ER -BU ILDER,DEC A ATION ` r•'�
1 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 Oe60611y, am exciuslvely Duntiactlny will; licenced
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
S ction 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 ,STATS I','rUND Policy No. 46"L OA
(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!r ; •,„ ,�
Date: Applicant
. Warning: Failure to secure Workers -6o p nsation 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 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 fo nspecction purposes. ,
Si nature (Owner/Agent)�'� Date `y�`r1a
BUILDING PERMIT PERMIT #
0212-138
DATEq VALUATION �1 f�0g� (�(� LOT TRACT
JOB SITEAPN
9�
ADDRESS Jid 010.5 h1q{,Y1X FOOT 5 5 LL i 5
_.
OWNER
CONTRACTOR/ DESIGNER/ EN INEER
PGA 'k V "a 1`+S'i . HOA
H LOCH CC2MTMUMON, INC
42»600 CARO1.MR ":C3i. R
7062 CONVOY OY CGURr
PAt+LM'711SPAT CA, 92211
SAM=0 CA 92311
USE OF PERMIT
G-VA&TK, BUI.IDIw2 a
131MG, 5 S5 -391,r- , .9 x, 55-405:,0,'PAIR tIP;AdL?I;',� LS &DECK
COATINQ
'd'AT.tIATI(14 4,n avo 14
ids" rim' l Con of co.,t�w>Ztzua:tam
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COM9`RS:IC>'" 1014 M 101 -000-4.18-000 00 tbd
rsog AwD PLM fuv..�x
� $30.00'
26 Z02
LA
r�
RECEIPT
DATE
1, ��
BY-
DATE FINALED
INSPECTOR
LY
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 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)
4
Send to:
EPOCH CONSTRUCTION
Address:
Attention:
HARRY
Regarding:
PGA WEST 2 - MEDALIST DECK REPAIRS
From::
Date:
Tim Golba
Copies To:
1/28/03
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 Ind the repairs to be
in conformance with the manufacturer's 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
t
G O L 8 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:.619,231.4288