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
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INSPECTION RECOR,
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
—"3
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 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