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9711-120 (AR)LICENSED CONTRACTOR DECLARATION Thereby 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 684857 B 3/31/98 Date Signature of Contractor OWNER -BUILDER DECLARATION 1 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&RC. 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. ( ) 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: STATE FUND Policy No. 22997-981M. ` (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 l should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions. Date: 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. 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 the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date — F1 Lc PERMIT # CONTROL # BUILDING PERMIT 9711-120 DATE VALUATION 528,M.2 % LOT TRACT 6338 l 2 to�j JOB SITE ADDRESS 56-040 RIVIERA APN 761-461403 OWNER CONTRACTOR / DESIGNER / ENGINEER JOHN V & KATHLEEN J OKEEFE BOB EDWARDS CONSTRUCTION 56040 RIVIERA 79-920 FIESTA DRIVE LA QUINTA CA 92253 LA QUINTA CA 92253 (760)775-7933 CAL# 3212 USE OF PERMIT ADDN GUEST HOUSE AND GOLF CART GARAGE ADDITION. CUSTOM CONSTRUC Tivi4 323.00 SF GARAGEtCARPORT 173.00 SF ESTIMATED COST OF CONSTRUCTION 28,552.50 PERMIT FEE SUMMARY PLAN CHECK FEE 101-000439-318 $180.70 CONSTRUCTION FEE 101-000-418-000 5278.00 MECHANICAL FEC 101-000-421-000 $35.00 ELECTRICAL FEE 101-000-420-000 $29.77 PLUMBING FEE 101-000419-000 539.00 STRONG MOTION FEE - RES1D 101-000-241-M 52.86 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $565.33 LESS PRE -PAID FEES $0.00 TOTAL PERMIT FEES DUE NOW $565.33 RECEIPT DATE BY DATE FINALED INSPECTOR P.O. BOX 1504 TEL 760-777-7012 78-495 CALLE TAMPICO INSPECTION REQUESTS Twit 4LA QUINTA, CALIFORNIA 92253 760-777-7153 _ 3 00 °- w 0 o w° ' n m g -_ �� °_- p n (D ID (OD 0 19'W `2 sa 3Qw d QU° 7'x.3 m nom.^_. ID �0 vQ7�.� ��°p m C O C `G �T. 7 O N w A7 w M r° C 7 m0 CD CD m - N m 7 O (D - 6 m n- (n (D - (n 6 3 N m(D < _ _r. (D (D O '-I Al C 0- (Q N N O (D 0 (n 3 A7 N ,C 3 (D 7 '" (D .� [. to m (D 3 pl S 7 m D 6 0 (D' .. 3 0 °- a _. . J w 7 w< m ° w" w a, r c«? ° m w 3.� Z 5�-n 'v �° m Z c m om m m m 0 m �o w m 3 m �, m N -i n m w° o °a 00 m o w o? c s 3 0 A 0 3 {* C�0 3 7 7 O w U) O (p pl (En O N D O O O C (D 1 m -- Q_ O O_ ` 'O O 7_ CD o o-< m o m e c o m m r 0 o m w 3 N m IDD w c Qa m 3 m �' o ( m c O c ° m W m s C ° m CD m w m CCDm °N' CL 0 ° o w o o y �N o.� 30 < r -o 0 3 m W ° o OCD :3 o m m 0O cn �D m .O-. 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Framing Compressor insulation Vents Fireplace P.L. Grills Fireplace T.O. Fans & Controls _ Party Wall Insulation Condensate Lines Party Wall Firewall Exterior Lath Drywall - Int. Lath r inai Final BLOCKWALL AP ROVALS POOLS - SPAS steel Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric underground ring. Test Gas Piping Final PLUMBING APPROVALS Gas Test Electric Final Waste Lines Heater Final Water Piping Plumbing Final Plumbing Top Out Equipment Enclosure Shower Pans OX, for Finish Piaster Sewer Lateral Pool Cover Sewer Connection 0,_ 22 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.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Penn) Desert Sands Unified School District Notice: 82-879 Highway 111 Document Cannot Be Duplicated Indio, CA 92201 619-775-3500 CERTIFICATE OF COMPLIANCE Date 12/1/97APN #'61-461-003 No. 16320. Jurisdiction La Quinta owner Name John V. & Kathleen J. Okeefe Permit # No. 56-040 Street Riviera. Lag # ' City La Quinta zip 92253 Study Area . Tract # Lot # Square Footage 323 ~ Type of Development Residential Addition No. of Units 1 Comments At the present time, the Desert Sands'Unified School District does not collect fees .on garages/carports, covered patios/walkways, residential additions under 500 square feet, detached accessory structures or repla-gement mobilehomes. It has been determined the above-named owner is exempt from paying school fees at this time due to the following reason: - EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.84 X 323 or $ 594.32 the property listed above and that building permits and/or Certificates of Occupancy for this square footage in this proposed project may nov% 6e issued Fees Paid By cc/First Bank/Bob Edwards Construction Telephone 775-7933 Name on the check By Dr. Doris Wilson Superintendent Fee collected /exempted by Olivia Aguirre Payment Received $594.32 /571 Check No.. 038860 Signature NOTICE: Pursuan t Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified above will begin tclFrun from the date on which the.building or installation permit for this project is sssued or on which they are paid to the District(s).or to another public entity authorized to collect them on the District('s)(s') behalf, whichever is earlier. Collector: Attach a copy of county or city plan check application form to district.copy for all waivers Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting I PGA WEST II RESIDENTIAL ASSOCIATION, INC. r P.O. BOX 1282, LA QUINTA, CA 92253 (619) 776-5100 FAX(619)776-5111 PGA ES 1. December 10, 1997 Mr. & Mrs. John O'Keefe 56-040 Riviera LA Quinta, CA 92253 RE: Architectural Variance Request for above referenced address. Dear Mr. & Mrs. O`Keefe: The Architectural Committee of the PGA WEST II Residential Association is please to report that it has approved the Golf Cart addition at your PGA WEST home. The committee however, requests that your contractor Bob Edwards provide a copy of the "Sunburst" River Rock for color verification prior to . installation of said rock. Please note that this approval is good for a period of six months, if work is not begun within that time, a new application will be required. Please contact me at (760) 776-5100 if you have any questions or concerns. Sincerely For The Board of Directors John J. Monahan Assistant Association manager CC: John Handel, Association Manager Architectural Committee Hoard of Directors '.N