0306-104 (RPL)LICENSED CONTRACTOR DECLARATIONT PERMIT# , T
I hereby affirm under penalty of perjury that I am licensed under provisions of BUILDING PERMIT 03t%-104
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and DATE - -
VALUATION iitt LOT TRACT c
C; W Professionals Code, and my License is in full force and effect. y
O ch License # Lic. Class Exp. Date
r CY LO 656t122� CS,i IIIC rCp � C1l 3 ; 1pa JOB SITE �P.t'?i ITAC1'� APN
W j „ ADDRESS` x^�•
Z r -Date �r- ff ��, ;1l OWNER CONTRACTOR / DESIGNER / EN (NEER
o Z , Signature of Contractor ,
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r` I.- C) OWNER -BUILDER DECLARATION �. �., ry t /
BO-1W1`.'1m, eT xj K . 0AVEI�';TIS.154
FW- WW a.I hereby affirm under penalty of perjury that I am exempt from the Contractor's LA 1 a3 1�%A. A 92253 �� cAC—q11, .a t° IMM
U) License Law for the following reason:
Z ( ) I, as owner of the property, or my employees with wages as their sole `pt'.•f�r"`��^��3%7 C fil.:f� �>f~`'
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed�%>L.23hlOR.
contractors to construct the project (Sec. 7044, Business & Professionals
Code). -•---....... _.._._.
) .,'L 6l.E.�ia C".P� i'X •l,ffs,'j;stl,�l l.,.S fiv�6•lY,iy�. :7' ..Y-. J r.LL6 -L.• -. 4'd::-1at;.� i•l i 1
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() I am exempt under Section , B&P.C. for this reason „'1',fhhla Df�it3J Al 'ti?t?Zwsi ,llfi}.RI4✓�.• r'�3d41.Ma L 3e•f C?l a:wi? f�:i' 'I3.: -i+ ,�A; 1 i R
O N Date Signature of Owner 1 1>iSPElC;'fI(2.
rn
d Q WORKER'S COMPENSATION DECLARATION y
C)r Q I hereby affirm"
penalty of perjury one of the following declarations: 4 ')°,'},�,° •),),, by?>� ,)�'
O O 1 have and will maintain a certificate of consent to self -insure for workers' ;" J�'[.,� z P VOR U'RA dO,glris. a3
X W LL compensation, as provided for by Section 3700 of the Labor Code, for the
O J Q performance of the work for which this permit is issued.
m Q () ( ) I;have and will maintain workers' compensation insurance, as required by
O U Q Se'ctio`n 3700 of the Labor Code, for the performance of the work for which this
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier `: �`.� F �:C)T�A.E�?�'ki�#;':f E Policy No.1b
ao'�E"?4I'
Q (This section need not be completed if the permit valuation is for $100.00 or less). I -AA CICKR"' e 101-000-439-3
J () I certify that in the performance of the work for which this permit is issued, GC: Nb-1'EtUrr1CAv f10% 101 -00041 O -W J•
I shall not employ any person in any manner so as to become subject to the MECHANICAL MR 'ItC,01, 101.0..00.421. 0'sl t3I4.00
workers' compensation laws of California, and agree that if I should become ELrA,TR14,AI, PV,'�-- POOL►01-.00014.20-001, I'J.?3tl
subject to the workers' compensation provisions of Section 3700 of the Labor 1�I>f.�l((9 ngp ,:t%oCsZ� ' 1rl•CjQIj, j �YQ, d�,{1Ct
Code, I shall forthwith comply with those 1151
/ t
Date: a .�.4i r' Applicant ^3',n/
Warning: Failure to secure Workers' Compensatio'Pi 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 • 's:r t�I. �:."C#.'i �u's'RLFC'('lC�k4 A"I' F"A""AR a 2. 0
whose request and for whose benefit work is performed under or pursuant tonC
Lt°;r ti"' ;:•a7F;tJ 7 `T~ $10100
any permit issued as a result of this applicaton agrees to, & shall, indemn& hold harmless the City of La Quinta, its officers, agents and employee .D,.Ey, ,e!Yn; „0,.2. Any permit issued as a result of this application becomes null and void�b,1�A.K,Izi )_� .. alb a: i work is not commenced within 180 days from date of issuance of supermit, or cessation of work for 180 days will subject permit to cancellatio I certify that I have read this application and state that the above information icorrect. I agree to comply with all City, and State laws relating to the buildin construction, and hereby authorize.;representatives of this City to enter upo ,
the above-mentioned property forlinspection purposes.
s 4 RECEIPT DATE BY D TE F NALED INSPECTOR
Signature (Owner/Agent) j' J ,r <� /�r` ,� Date �.' �' O 3
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
OX 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
Steel
-POOLS - SPAS
Set Backs
Electric Bond
Footings -7
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
LY
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
Fbctuures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
June 16, 2003
Mr. & Mrs. Larry McNabb
3012 Live Oak Ct.
Danville, CA 94506
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 80-364 Hermitage, La Quinta, CA
Architectural Change Request — Pool, Spa, Barbecue and Patio Decking
Dear Mr. & Mrs. McNabb:
Thank you for resubmitting your architectural drawings for the installation of a pool, spa, barbecue and patio
decking.
The Architectural Committee reviewed your revised plans excluding the wrought iron fence and approved your
application.
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 Architectural Rules for all
required submittals.
Approvals given by the Architectural Committee are good for only six months from the date on the approval letter.
If construction has not commenced within six months after the project approval date, a new application must be
submitted.
Upon completion of your project, please complete and return The Notice of Completion of Architectural Change.
The committee recommends that you review the enclosed specifications for the PGA West concrete mix for
consideration prior to the installation of your patio decking.
Please have your contractor warranty the shrubs for six months.
If you have any questions, please do not hesitate to contact Carol Fuller, Association Manager, at 760/776-5100,
Ext. 20, or Cathy Clark, Assistant Manager, Ext. 18.
Sincerely,
PGA WEST H RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller, CCAM
Association Manager
cc: Board of Directors
Unit File