13309 (RPL)44
P.O. BOX 1504
Building 54-460 Riviera 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner William Wray
Mailing
Address Same
City Tel.
. La Quinta, CAJZip 92253 1 771-0505
Contractor
Lund Construction*
A dd ps
, g15 Villeta Drive
City Zip 12253 Tel. 345-0717
La Quinta, CAI
State Lic.
& Classif. QvW 475655 CL i'ct Y # 2979
Arch., Engr.,
Designer
Address Tel.
City Zip State
- I Lic. #
LICENSED CONTRACTOR'S DECLARATION
I hereby.qffirm that I am licensed under provisions of Chapter 9 (commencingwith Se?�,Gon
,of Division 3,oLthe Business anb Professions Code, and my license is in'f - ull force;and
�e oftoe t - /,;� - A/Y
0' 7 - q -
DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county wh.1ch requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issua,,ice 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 !000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom. and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civilpenally ofnol more than five hundred dollars (S500).
0 1, as owner of the property, or my employees with wages as their sole compensa*,ion, 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 of 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 one year of completion, the owner -builder will have thq burden
of proving that he did not build or improve for the purpose of sale.)
0 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 Licqnse 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.)
0 1 am exempt under Sec.—B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
klehereby affirm that I have a certificate of consent to self -insure, or a certificate of
Wor r's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company —
0 Copy is filed with the city. 0 Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in'the performance of thp work for which this permit is issued I shall not
employ iny persofi in pny mdrhai so as to�become subjecl to the Workers' Co�npensation
Laws�of'Califoenifii�,?*,
,�Dat / /
;�- �1_1_ net 1_/
0 ",1
E TO APPL fler making this Certificate f Exemption you should become
subje�l to the Workers' Compensation provisions of theoLabor 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 car tify that I 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 Addres
City, State, Zip
BUILDING: TYPE CONST
P. Number
No.
OCC� GRP.
13309
Legal Description
P . roject Description Rock/gunit6 waterfall/fountain
Sq. Ft. No. No. Dw.
Size Stories Units
New 0 Add 0 Alter El Repair 0 Demolition 0
Estimated Valuation $6,500.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
15.00
Mech.
Electrical
15.00
Plumbing
S. M. 1.
Grading
Driveway Enc.
Infrastructure
TOTAL
30 . ou
REMARKS
ZONE: BY.
Minimum Setback Distances:
Front Setback from Center I in
Rear Setback from Rear Prop. Line
Side Street Setback from Cerlite
Side Setback from Property, SO
FINAL DATE
Issued by:—
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. @ $
UNITS
SLAB GRADE
2ND FL. SO. FT. @
BONDING
YARD SPKLR SYSTEM
POR. SO. FT. @
MOBILEHOME SVC.
BAR SINK
GAR. SO. FT.-@
POWER OUTLET
ROOF DRAINS
CAR P. SQ. FT. @
GAS(ROUGH)
DRAINAGE PIPING
WALL SQ. FT. @
OTHER APPJEOUIP.
DRINKING FOUNTAIN.
SQ. FT. @
TEMP. POLE
URINAL .
ESTIMATED CONSTRUCTION VALUATION
GROUT
WATER PIPING
NOTE: Not to be used as property lax valuation
FINAL INSP.
FLOOR DRAIN
MECHANICAL FEES
WATER SYSTEM
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASH ER(AUTO)(DIS H)
APPLIANCE DRYEA
FINAL INSP.
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERM11 SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. @ c
BATH TUB
SO. FT. @ c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. Fr. RESID @ 11/4 c
SEWAGE DISPOSAL
GAR. FIREWALL
SO.FT.GAR @ 3/4c
HOUSE SEWER
LATHING
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DEL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT.FEE
SMIFEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
GROUND zlll�
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
I
GARDEN WALL FINAL
ARCHITECTURAL/LANDSCAPE VARIANCE APPLICATION
PGA WEST RESIDENTIAL ASSOCIATION, INC.
Pl1ease complete and include this request form, along with four (4)
sets of your proposed home improvement plans to:
PGA WEST RESIDENTIAL ASSOCIATION, INC.
P.O. Box 1060
La Quinta, CA 92253
or, 55-940 PGA Boulevard
La-Quinta, CA 92253
Attn: Property Manager
NAME: 1�')/ <. e- /+'-VIA/ F_ 17A VH U.),YA DATE:
ADDRESS: S—a /12 � L, --'l e< 4 j4- &I Y
c_,(t ,k; /-74, rA I I-J6A—
PHONE: -7 -7 0_q UNIT: g�l e- e- K
PROPOSED- STARTING DATE:
CO Z_
C
Homeowner'S Signature
The following appropriate information should accompany your
completed application:
1./ Four (4) s'ets of complete plans to include:
a. Improvements and/demolitions
b. Plot plan
c. All dimensions proposed
d. Relationship to neighboring units
e. Material and color -scheme
f. Planned modifications of all external systems (land-
scape, sprinklers, gas lines, el'ectrical, etc.)
2.K Agreement. and Covemant Running with the Land completed
and notorized. Two (2).original.
3_v'� Conditions of Approval and Disclaimer form (signed)
4 -All A Facing and Adjac'ent Neighbor form. (if applicable)
5./ Construction Regulations form (signed)
ELECTRICAL Approved ].Disapproved
Signature Date
LANDSCAPE Approved Disapproved
S natu
i gMN Date
ARCHITr C Trr proved Disapproved
Signa.ure Date
ARCH/Rev 5/93 -1-