11129 (RPL)r W
4`
P.O. BOX 1504 N o . 1,112 9.
Building 78-105 CALLS ESTADO
Address 55-483 .Qakhill LA QUINTA, CALIFORNIA 92253
Owner
S 1adek
Mailing BUILDING: TYPE CONST. OCC. GRP.
Address sayn
A.P. Number
CityF.a Quinta Zip 9223 Tel. 771--035&
Legal Description
Con`raactor gorn la ' Pf?JIS �u acjaaS Project Description Pools& Spa
Address .
4191 Boiidwal k ;HA2
City Zip Tel.:
Pala Desert 92260 340-9000
State Lic. City
& Classif.. C53 185102 Lic. # 355 Sq. Ft. No. No. Dw.
Arch., Engr.;
Size Stories • Units
Designer New ❑ Add ❑ Alter ❑ -Repair ❑ Demolition -0
Address Tel.
City Zip State
Lic. #
LICENSED CONTRACTOR'S DECLARATION
-J hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7,<000) of Division:3.of.the:Businesriind-Professions Code,. and my license is in full force and
'�-=::,.;.;-:'.-
�iS1GNATURE - DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt.from the Contractors License law for the following
reason; (Sec. 7031.5,Business and Professions Code: Any city or county which requires. a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement'that he is licensed pursuant 'to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 0/ the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any. violation or Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not -apply to, an owner o/ property .who
builds or Improves thereon and who does such work himself or through his own employees,
provided that' such improvements are not intended�or offered for. sale. If, however, the building
or improvement is sold within-oneyear of completion, the owner -builder will have the burden .
of proving that he did not build or improve for the purpose of sale.)' .
❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property'who builds or Improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) - -
O 1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date owner Infrastructure
WORKERS' COMPENSATION DECLARATION
I hereby affirm that I have a certificate of consent to self -insure, or a certificate of '
Worker's Compensation Insurance,.or a.certified.copy. thereof..(Sec. 3800, Labor Code.)
Policy No. Company '
d'Copy is filed with the city. ❑ Certified copy is hereby furnished.
TOTAL
Estimated Valuation 11,000
1.
PERMIT
Plan Chk. Del;
Plan Chk. Bal.
Mech.
Electrical
Plumbing
S.M.I.
Grading
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed N the permit is for one hundred dollars (S100) 'valuation
' 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 Callfornia.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
'subjectto the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that 1 have read this application and state that the above information is correct.
I -agree-to comply'with all city and county ordinances'and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City, State, Zip
REMARKS
304.00
AMOUNT
£1.90
126.00
24.00
45.00
27.00
1:.10
Lir[ 7-4&6-_9 lj,z , eb2 t, 4
ZONE: BY:
Minimurn Setback Distances:
Front Setback from.Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date Permit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES`
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT. ®'
WALL SO. FT.
SO FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
-
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN.
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM. FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GAS (ROUGH) METER LOOP
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SO. FT. ® c
BATH TUB
,FINAL INSP.��G Lll
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1% c
SEWAGE DISPOSAL
REMARKS:
SO.FT.GAR ® V4c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PLCK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR'
SETBACK
ROUND PLUMBIN i UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB. BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL) TEMP. POLE
GROUT
WATER HEATER SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
,FINAL INSP.��G Lll
FRAMING
FINAL INSP.
ROOFING
� � I n � - � �
� �/� �
REMARKS:
VENTILATION
FIRE ZONE ROOFING:
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION.
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
. :.. i.,,. .. ;.:. .; .r..... :,.,, ....: ..y ;; 1n 4:t _ ..tai`.• -H -i ..l'� _ .
Pi.:
ARCBIT$CTQRAL APPROVAL APPLICATION
ALL CONSTROCTION'DEBR°IS CREATED BY, THIS MODIFICATION
MOST., BE.:REMOVED ,FROM: THE _COMPLEX DAILY
POA MEQ AE90EMM Ati0CUM. INt
Homeowner
Address
Telephone
PW West Address �.�,Sn3 LJ-I1Liael;L-L.. Tract�•g5 Lot 3�
Modification.(s) Requested Gori SZ'R-y LT eco t_ f0►'iJ c)-
��r. � \C O L `x.='iw� \'uC''o G'1.♦ iL'T:�.�G�° : A�L7 A�`Is .lam\ 'QOT1' /7 AfC.Y f� .
Work Schedule Commencement Date " i 2`, Completion Date
Contractor (a P= _1__1_Arm"O''
TO THE ARCHITECTIIRAL..COMITTEE::
You are hereby advised'°that the,,above work -is .proposeo..and approval is'requested. Attached
is a drawing of :the' work to be `don!a and iypes.-of mate"rials, to. be used. as indicated on the
drawings. We understand that: building, permits for�home improvements are required by the
City of La Cuinta and that the cost of.:.the,.;permita and• responsibility of.obtaining permits
and subsequent' inspection will be borne by, the applicant.
We acknowledge that all approved changes .in, :oii'ginal,design will be at our expense;
that any and all damagei,,to building. strvcture,,'.o'r` other damage resulting from the
construction.. of the proposed., improvement. shall; be` at ':our (owner,'s) expense. .Additionally,
any maintenance of.tha.permitted improvements,3hall; be at.,the applicant's expense and, the
applicant agrees. . to ,.hold:the"PGA'We .at. Reaidentia'1 As'aociatioir harmless for the cost of
t.maintenance of same.- Homeowner agrees; to inddmnify, defend and hold harmless PGA West
Residential Association, its officers, a ta;.and employees from any liability arising from .
execution of ths.appllcation.
Signatures of
ail owners
/ ARCHITECTURAL CONTROL COMMITTEE
Approvea ✓/ Conditionally:Approved: Oisapprovea
Reason for Conditional Approval or Disapproval. J8 A5 EZ S -T!
.. t_" _X I -./_ 7W_ A5 Pi dam..
Oate� Z/ Signature
Architectural Con iok'Commitree Chairman
In addition to.this approval,, you.must obtain."City approval for, the requested modification
as well as any other necessary building permits. You, are required to submit evidence of
the Association approval to 'obtain the building, permit. For this purpose, all blueprints
and clans. will—be' embossed.. with tae. Association's seal, the signature of the Property
Manager, and -the- date of the approvai.
Completed .Work Signed -off by Date
Y .t:.S a ti xrt+