0011-284 (RER)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
Dater Signature of Contiacto�`�'"
OWNER-BUILDER6/p CLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 1, 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).
( V) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals
Code).
O 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:
O 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•. .
(This section need not be completed•if the permit valuation is for $100:00 or less).
( L)�l 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 with those provisions.(i
Date: ApplicantCl
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.
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
'! above-mentioned property'for inspection purposes.
S
Signature (Owner/Agent)//' ' - Date
o/
BUILDING PERMIT PERMT#
DATE VALUATION LOT 0011-284 TRACT
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CONMRe,CCTION FF8 101-000.418-00 3 V163.00
FI EC TRICA , YFR 101 -000 4` o,-0 0 $2t 73
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RECEIPT
DATE F�
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 & Controls
Party Wall Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Hacks
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
COMMENTS:
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.1.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
j:
PGA WEST
RESIDENTIAL ASSOCIATION, INC.
November 22, 2000
Mr..Bob Rositano
55-635 Pebble Beach
La Quinta, CA 92253
Dear Mr. Rositano:
Your request for an architectural variance has been approved by Mr. Don Adolph, Architectural
Committee Chairman. Specifically, you have the approval to proceed with the removal of the
existing fireplace in the master bedroom and installation of a new one on the adjacent wall.
We appreciate your cooperation in submitting this request for approval. ` Should you have any further
questions regarding this matter, please feel free to contact me at the HOA office, (760) 771-1234,
Ext. 15.
a
lliard
Operations Manager
KM/dpo
cc: Architectural Committee
P.O. Box 1060, La Quinta, California 92253, Telephone 760-771-1234 FAX 760-771-5125