9907-187 (RPL)y.' LICENSE& CONTRACTOR DECLARATION
1 hereby affirm under penalty of perjury that I am licensed under provisions of
ter 9 (commencing with Section 7000) of DivA;ior.LA, of the Business and
ro esslonals Code, and my License is in full force and affect. -
License # Lic. Class Exp. Date
050, 128 c;53 rF 1 (1.
Vdate 71 Signature of Contractor
OWNER -BUILDER DECLARATION
I 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. myemployees 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 wor0or which this permit is issued.
():4) 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''conipensation insurance 'carrier & policy no. are:
Carrier i Policy No.'
37,
(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 asto become subject to the
workers✓compensation laws of California, and agree that if I should b�eome
subjpit to the workers' compensation, provisions of Section 3700'ofSthe Labor
Code, I shall forthwith comply with those provisions.
✓Date: 7f'2"7 9 Applicant
Warning:' Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines,up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject. to the conditions and restrictions set forth 'on his
application. c
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton'agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 160 fiys from date of issuance of such
permit, or cessation ,of;work for�'180 days will subject permit-to.caacetlatiQD.-_--
I certify that I hava,read this4p"plieat'ion and<state that the above information rs�-
correct.. I agree'to comply with all City,'a&Sfate.laws renting to the bull}Jir)9
construction, and hereby authorize representatives of this City to enter upon"
th above-mentioned property for inspection purpo ee
ignature (Owner/Agent)��"`� Date��
BUILDING PERMIT PERMIT# !
1)907. 187 `
DATE VALUATION LOT �� i TRACT
07/2711" S17,9t -ft I
JOB SITE
ADDRESS i11- j MtRNIITAQ. E
APN
22.jlw
OWNER \
CONTRACTOR / DESIGNER / ENGINEER
11,C 4 21
L.
CALIFORNIA Pt. O MS •� SPAS
80-142 HE RMCCAGE
74423 X)NI DRIVE, -#A
t A. Q'i.lINTA. C- A. 9225
RA IM D17, SER II' CA. 92260
`(f:^
(760)340-9000 CB N. 355
USE OF PERMIT
• s
Pool'. !3;o OR';,V.:t§i niti6iar��1'si>ifaW S HALL Ni IN PLM -Xi KY
TI'M E Or. .I RXII-;PL ASTER 13qWkii.TICIN. 1.NVE'',ST!GA1'1CiN 1-` E ASSESSED
OR. WORK BVI 300. WKAJT.K111,Z1N0 VE(k&.UT
• a,
ti
POOL A'+ DIOR STA. z 7,900.00 LS
°'.1:��f�''E.3tR3't"1:€',� x' o$.3j;.�3i'7,tu19.>t4i
PLAN (.6lf.,Ckl1W,
\
CON' 13T 3.f TC .11ON Ft K .4)(N) -A q td -000 f 14o. W
6.09.1)(1(6421-000 !Sfx>.9t3
PLU:Ml3f@\iOFEE : I?C?tAi 101 -000-4194M
1NVF..!K ICrPeTMNFITt P89M
�. I,IATA� � _Al: �..�1WT11� UC110N ANY) f ,r .t i t C. It
s. ��e� s��
LESS ''P.RJET-ATO FEES
=,M)
TWxA MIT FEES DUE'NO4rr1'
RECEIPT
DATE
BY/ ti''
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
Partv Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
- rywall - Int. Lath
Final
Final I
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
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:
JUL-20-99 TUE 07:05
i
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINI"A, CA 92253
PGAWEST. _• (760)•776-5104• FAX (764) 776-1111
gA
J
July 13, 1999 2 . l�09- ' �! A) �J J
7 t
pl �A k ����
�'�
Mr, &Mrs. Bob Beebe
Reference: 80-412 Hermitage
Architectural Change Request to
Add Spa, Swimming Pool, 138Q & Putting Green
Dear Mr. & Mrs. Beene:
The Planned Unit Development Architectural Committee at its June 8,1999 meeting has reviewed
your plans to add a spa, swimming pool, BBQ and putting green.
Your Application for Architectural Change has been approved by the PGA WEST II RESIDENTIAL
ASSOCIATION Board of Directors at its Acne 30,199 Board of Directors meeting with the
condition that the homeowner will be responsible for maintenance of the putting green.
If there are Irrigation modifications associated with this change, please coordinate these changes
prior to commencement with your landscape maintenance contractor and Valley Gardening. The
supervisor, Miguel Valenzuela, can be reached at 760/399-1844, or contact the Association
Manager, Carol Fuller.
Approvals given by the Board are good for only six months from the date on the approval
letter. After that time a new application must be submitted.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller,
Association Manager, at 760/776-5100, Ext -.20.
Sincerely,
PGA WEST I1 RESIDENTIAL ASSOCIATION
For the Board of Directors
Carol Fuller
Association Manager
CC., Board of Directors
Unit File
Beebe — Swrd ApproVal
V,