0106-314 (RPL)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. Date
6561218 c5.1 Date ` Signature of Contractor t- 4,
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 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 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.
e ( ).ave and will maintain workers' compensation insurance, as required by
Sttion 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:
CarrierT Policy No.
9TA(770M. FEWISATI 040006108
(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 withtthose provisions. ,//��
Date: r." Applicant 2 /''/'
Warning: Failure to secure Workers' Compensation coverage is unla
shall'subject an employer to criminal penalties and civil fines up to $100, i
addition to the cost of compensation; damages as provided for in Sectio
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and fety
for a permit subject to the conditions and restrictions set forth n his
application.
1. Each person upon whose behalf this application is made & each pe on at
whose request and for whose benefit work is performed under or purs ant to
any permit issued as a result of this applicaton agrees to, &. shall, ind
& 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' -for inspection purposes.
/3
Signature (Owner/Agent) ? �"- •- Date
tt
BUILDING- PERMIT
DATE VALUATION ' " `' LOT ��,�_ TRACT
JOB SITE
APN
ADDRESS
9g g ro Cep t�c7 s��w t� A
OWNER
CONTRACTOR / DESIGNER / EN (NEER
MNI PARYf l l
CJW1,y0R9iA,.P001Z & 3AM (SVP MANT C,'0
€32.165 =XMIrN S WAY
74725 7ONT'DRPV4 MMS, 0A
x.:.j 010,.6, CA 92133
PAl':MD13S..J�'s Cil. 9226.1
(760)340-9,000 MU i55
USE OF PERMIT
VC*11,+ AXY.tVOR STA.
P00V3.P.AA3..UQ..Z .5331995. A€..ARMIk3ARRIEPS -SKA L 33 IN PLACE
AT •~iiia) -W11_, 4; a.11;i.2;rNSPECTION. OL,14Kfi_jxn T &ICLOSi1,RE140TJ
V0011 Aardop. SPA
b
1LS'JC1MHIED COS 01r a:'i?:M: RI-Tt:"rMN
25.00.00
C014ra'I PLUC'k dM FEE 101-000-418-000 $232,00
3J1F..tv<T3ANIC.€iL FRE - POOL 101d•000.421-000 $24.00
E='TRIC.A1., MON -� Pt"}. )L 1101-010"20-000 $4 x.00
PLUMBNO1'I -.POOL 'iii? -0001419-000
W
JUN 2 1 ]20010
CITY Of LA QUINTA
FINANCE DEPT yT€3R_`.111.L4�9.i:�'JTr7C;�I2:��v'G1i�s
1.�3t2
00
.
r yp{wIr ggYY��CIENOW
TMIs
RECEIPT
DATE,/ / BY
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 8 Controls
Party Wall Insulation Condensate Lines
Party Wail 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 Gas Piping Iz
�!
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 Cove _ ----- _
Sbwer Connection Enca,,sulation�/�f�5
iFas Piping
G- as Test
Appliances
Final
COMMENTS:
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Jnderground 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)
FROM : PGA MASTER
June 22, 2001
FAX NO. 7605642329 Jun. 22 2001 12:19PM P2
I
PGAM
t �
.
FAIRWAYS ASSOCIATION
Mr. And Mrs. Mark Parnell
81-165 Legends Way
La Quinta, CA 92253
Re: Architectural Request
Dear Mr. Parnell:
At a meeting of the Architectural/Landscape Committee, which was held on June 19,
2001, your plans for the installation of a pool, barbecue and covered patio.were approved,
conditional upon the following:
1. Grading levels shall comply with the Association's CC&Rs and Architectural
Guidelines;
2. California Health and Safety Code requirements regarding pools are complied
with:
Should you have any questions regarding the above, please do not hesitate to contact me.
The Committee and Y appreciate your submission of plans and -compliance with the PGA
WEST Fairways Association Architectural requirements.
Very truly yours,
�-74�
Bobbie Gaffney
Association Manager
P.O. BOX 13710 - PALM DESERT, CALIFORNIA 92255 - TeL (760) 776.5100 - Fax (760) 776-5111.
email: pgawestCojmonarcbgrp.com
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