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LICENSED CONTRACTOR DECLARATION
:Thereby 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 forceand .ffect.
License # Lic. Class Exp. Date
C.' 1. tMV c
D to -- [� Signature of Contractor +�.�
4 `
OWNER -BUILDER DECLATTIO
I hereby affirm under penalty of perjury that I am a empt 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 8. 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:
Cartier Policy No.
91TAT y F-VIND 0444<321D1
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of thew or which this permit is issued,
I shall not employ any person in any An6r so to become subject to the
workers' compensation laws of California, and agree that if I should become
subject tl
o, he workers' compeLasa io pr visions of Section 3700 of the Labor
Code,�i sh Y' ,orthwith comply with th se r visions.
Awe: �.'+ � ' Applicant—
Warning:
pplicant Warning: Failure to secure Workers' pmpensation coverage is unlawful and
shall subject an employer to criminal pe allies 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 vill subject permit to cancellation.
I certify that I have read this applicatip.95d state that the above information is
correct. I agree to comply with t l dity, and State laws relating to the building
construction, and hereby,�a o ize representatives of this City to Enter upon
th above-mentioned propel _pection purposes.
Signature (Owner/Agent) �y . DateL"
BUILDING PERMIT PERMIT#
DATE VALUATION LOT�}S,�j } `f,'� TRACT
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MORTON FROMIOXIE
F:`3Adlr' YTOCU OCU C° 0NSMIXTION
80-2501M, 20 'Y'AGE
5.4 3 W AVEE 1QDARAM=
LAQ,U"DA CA 92253
wl,T.1,, CA 92253
(7450r -5655 CUSLO. 29,9
USE OF PERMIT
*hIARyell. Ai.dIRMUMAR,l IERS SH -41A, 19Ir YN Pf,.AVY, AT PAR-PLASTRZ
INftPEC"UON,. Pool., .C; 3S°kfl Il' G:P#CI.0 �iDjlDt:.'f+lo2' 131c:D:otDO D7,
POOLANDIOR SPA 45,000,00 U
i„ii`g�y'�ru., C����1��BURY
rYYs4�yyd±>'q�,
p
701 0004 @A(3 gyp
C014STRUCTION FrIZ 101-000-41R-0410 $382.00
MWHAJ1!l"CCAJ,V99—POOL 101-000-421.41100 V4.,00
Zk ,ECTRYCAL.. F10t. K.• POOL, '1401-000-420-000 $45X9
PUTMO},rM SSE ^ Tool, 01.000--M9r000 ��'.W
a-�
' :c'QaU.> 4 isZAIa.sa
LESS PRE -PAID PREU
AUG -2 2001 yr
$0.00
GI;ITA
CITY Or LA
riNAMC�E_l'� __.----
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
z_
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
_
COMMENTS:
� � i4�+�ts �� 7
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Law Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Jul ,13 01 .05:22p
FROM MONARCH
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RL
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a�N
July T 3, 2001
FAX NO. : 7607765112
Jul. 13 2001 02:00PM P1
p.2
PGA WEST I1 RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Mr. Morton Firestone
c/o NIDM Associates
777 S. Figueroa. St., FL 9
Los Angeles, CA 90017-5800
Reference; 80-250 Hermitage, La Quinta, CA 92253
Architectural and Landscape Request for Awning, Barbecue, Patio Decking Extension.
Pool, Spa, Painting
Dear Mr. Firestone:
The Architectural Co eviewed yow plans for the addition of an awning, barbecue, patio decking
extension, poo , spa and painting at its hely 10, 2001 meeting.
Ttie Ait)lutccturaI Comminee approv6d your application upon the receipt of your ,revised wfH ir►g.
Review by the Com nittee'is only.for generaleommn- anee w Q1� hC architectural guidelines. It is the
responsihility 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. Pleast refer to
the Architectural Rules for u)) required, submittals.
Pleasc contact Raphael Villarryal, supervisor for Valley Gardeating Service at 760/399-1844 and Carol
7 Fuller, the Asrociation Manager. prior to any irrigation modifications associated wide this change. Upon
completion of changes, please contact Carol Fuller. Damage to 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.
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 submined.
Upon completion of your project. please complete and return The Notice of Completion of Architectural
CIhange...
in"the racantime. if you have any, additional questions.or concerns: please do not hesitate to contact Carol
Fuller, Association Maatagcr, at 760/776-5100; Ext. 20.
Sincerely,
PGA WEST II RESTDENTTAL ASSOCIATION
F��orddthe Architectural Cornmittee
Carol puller
Association Manager
ec: Board of Directors
Unit File
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