0003-290 (RPL)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
U)
F— Chapter 9 (commencing with Section 7000) of Division 3 Of the Business and -
04 U)
Professionals Code; and my License is in full force and effect.
O M License # . Lic. Class, Exp. Date .
C'1 t�911l►i;5°� "`, ir3!3ii20f
r` w
I Z r, -Date �- Signature of Contractor
CD
0'
r_' I" OWNER -BUILDER DECLARATION;
co `
W W n I hereby affirm under penalty of perjury that I am exempt from the Contractor's -
~ U) License Law for the following reason: 4
Z_ ( ) , 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).
( ) 1, as owner of the property, am. exclusively. contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
C'`)(). I am exempt under Section B&P.C. for this reason
N Date Signature of Owner.
ON
rn
Z WORKER'S COMPENSATION DECLARATIONCL
.
O 2 Z I hereby affirm under penalty of perjury one of the following declarations:
T � 0 () 1 have and will maintain a certificate of consent to self -insure for workers'
X W compensation, as provided for by Section 3700 of the Labor Code, for the
O _ Q performance of the work for which this permit is issued.
m Q (� Y. -I have and will maintain workers' compensation insurance, as required by
O USection 3700 of the Labor Code, for the performance of the work for which this
LO
Q
9 permit is issued. My workers' compensation insurance carrier & policy no. are:
Z Carriers, , Policy No.
ao � ..,1 t�R.1NSi:7i2A.NCl3 C(WCOl 1'7934-00
r` O
(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,d�hI�,orth I comply�,u'th those prov Ions.
�%te: • vApplicant
Warning: Failure to secure Workers''CornpensaUon coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 ,days from date of issuance of, such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
• correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize .representatives of this City to enter upon
the above-mentioned'"ropery for inspection purposes)
`"'��ignature (Owner/Agent) ` ��� Date -3 2� OD
BUILDING PERMIT.,. PERMIT#
ilt4{33-r'93
DATE VALUATION}31i1.Qit1 LOT TRACT
JOB SITE 3J -f GeDLIt VWW DRJVE
APN _
ADDRESS _
OWNER
CONTRACTOR/DESIGNER/ENGINEER
N0111. SH 'IN ,
MC.1 -UYU POOLS & SPAS
LA QU1NZA x N 92225-1-
1,A, qiJ_ 1?A tj�,k. 92253
t7 t7)�ut1- � CHL'if 10415
USE OF PERMIT
P001, A1i,`D1011. SPA
�tJs��.. � til✓st E3tvLY' = AL P.Et��'ISiS.1VZ�.1F.�CS S�t�+1.i. !3E }.!v Pl.li�� _� i'
PRE -MA V ER. TNSPEC"C1ONZ
VALUATfUN 1$, 700,00 LS
NS"5T[i3IA'9 ED (30ST € F CONS'DTiR9Jfv`i ION
1i71,?11>�►.¢U
PERMIT FEE SUMMARY
PLAN CHECK F91 101-000439-318
C0Nfb fRUCT'10N FEF 101-000-Q1$-( OO
MEC"Al+ICAf, ME ..- POOL 1011400-421-000 324.1710
ELFCTRICA1:.1~ T •- P001: 101-003.420-000 $45,09
PLJNMING FEE -- POOL 101••003-410-000 $27.110
SUB -TOTAL C30NMIRLICTIGIN -AND PLAIN CHECK
S42170
LI -SS Ms -.PAID f -IRIS
50,00
TOTAL yL R'k,.Qtt1UT FEES S DUE iYONN
$4.22.70
RECEIPT
DATE
BY ":Z_.
�-
DATE FINALED
INSPECTOR
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
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
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
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)
COMMENTS:
FROM : MCINTYRE POOLS AND SPAS
March 14,'2000'
Mr. Lloyd Shin
413 Lauder Lane
Inverness, II. 60067
FAX NO. : 760 360-3435
FAIRWAYS ASSOCIATION
Mar. 28 2000 04:12PM P1
RE: Architectural. Application for 81-035 Golf View Drive, PGA WEST
Dear Mr. Shin:
eTMI e. uraVLandscape Committee of the PGA Wim- Fairways Association
has reviewed the plans for the Pool and Spa improvements at your PGA WEST
home. Based on' your follow-up, the committee is pleased to inform you that. it
has approved the plans as submitted.
This. approval is good for a period of six months. If construction is not.
September 15, 2000 you will need to submit a new application.-'.
begun. by
Please have your contractor- contact me at 564-3858 when work is complete so
that we may arrange an inspection and the refund of your performance deposit.
Sincerely,.
John 1. Monahan _ ..
Association Manager
P.O. BOX 1.3710 • PALM DESERT, CALIFORNIA 92,255 • Tel. (760) 776-5100 - Fax (760) 776.5111
email. pgawest@monarchgrp.com
k)