9607-018 (AR)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
31V 8
Date Signature of Contractor
OWNER -BUILDER DECLARATION
I 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&P.C. for this reason
Date -1 " () _942 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 sis we ., M o kers' compensation insurance carri, r policy no. are:
.,.�.,�AY>3`7�d ��R�4�9�,.
Carrier Policy No.
(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 I should become
subject to the workers' compensation provision's of Section 3700 of the Labor
Code, I shM forthvY h comply withihose plViliions.
Date: / 4e Applicant IrC
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
".he abOu;-mentioned property, for inspecti
o
n purposes.
Signature (Owner/Agent) � D'ate
BUILDINGPERMIT
PERMIT#
'0607-01#
CONTROL#
DATE VALU_TION LOT
1i1.2,€i17 20
TRACT
PLAN r111;:CK CFA
101-4700-43U•31k
$93.0
JOB SITE
ADDRESS
CONS7'UCII.`ION M.
APN
76l'S 6+ 1-014
OWNER
CONTRACTOR/DESIGNER/ENGINEER
M i ii`.NIC31., i+i3f
ROY C,1: DNANE, Claw'
EiO13 EDUFMMS CONSTRUCTION
.5t 445 Iii V1.ER' A
79-920 FMS 1'A. DRIVE
1014)00-420-(W
LA C, UINI-A, CA 92253
LA. QU#P3'i'A.
CA 922,5:
r IZ.FRIO 10I' -ON -241 -WO
(610)775-71)33
CDTX 3212
USE OF PERMIT
Rt ,',S l)i;t J IAL A131.)i`l ioN
(JOIX CART 0AR A£ F ff ll S -T 14SE
£:L48,10M CONS'i".tZli('TiON
tlARAK31~%E;ARPORl'
120.W SP
177.013 S1°
xU13-'[t"yi'A [. CONSTRUCTION AID PUL I CI{EC�' X273.03
LESS PRF-VAID .l:'FES $0.00
$27105
JUL 12 1996
RECEIPT I DATE"./ I BY I DATE FINALED INSPECTOR
r .
FS—I'i1 iXfE D C09t OF CONSTIrIXfION
102,81.7.21E
PLAN r111;:CK CFA
101-4700-43U•31k
$93.0
CONS7'UCII.`ION M.
101-OW418-000
$144.0
M i ii`.NIC31., i+i3f
l.ijl-Oi)li�$7i-0 70
$.15.0(0
FLECIRIC 91. FEF.".
1014)00-420-(W
$19.20
«trON(.) f1 01'100 1+'I
r IZ.FRIO 10I' -ON -241 -WO
$1.28
xU13-'[t"yi'A [. CONSTRUCTION AID PUL I CI{EC�' X273.03
LESS PRF-VAID .l:'FES $0.00
$27105
JUL 12 1996
RECEIPT I DATE"./ I BY I DATE FINALED INSPECTOR
r .
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 10,
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
Final
Final 3 �
POOLS - SPAS
BLOCKWALL A PROVALS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground PI . 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.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Notice:
,Document Cannot Be Duplicated
r
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF. COMPLIANCE
Date 7/10/96
No 14680
Owner Name Roy C & Diane Cox
No. 56045 Street Riviera
City La Quinta
Tract # Lot #
Type of Development Residential Addition
Comments
Golf art arage, guest house
Jurisdiction
zip 92253
APN # '61-461-014 -.1
La Quinta
Permit #
Lcg #
Study Area 106•
Square Footage 120
No. of Units 1
At the present time, the Desert Sands Unified School District does not collect fees :)n garages/carports,
covered patios/walkways'residential additions under 500 square feet, detached accessory structures or
replacement mobilehomes. It has been determined the above-named owner is Exempt from paying
school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or. Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080
in the amount of 0.00 x 120 or $ 0.00
the property listed above and that building permits and/or Certificates of Occupancy for
this square footage in this proposed project may now be issued.
Fees Paid By N/A
Name on the check
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Pauline Pearson Exempt
Signatured4a 1 �x o� PI-e.t A A.6/V--
:Teleph.one. 775-77933
• .6
� Y
Check No. N/A
Collector: Attach a copy of county or city plan check application form to district copy for all wai%ers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
l d
PGA -.WEST lI RESIDENTIAL ASSOCIATION, INC.
June 25, 1996 P.O. Box 1,282 • La Quinta, CA 92253.
Mr. Roy Cox
56=045 Riviera
La Quinta CA 92253
Re: Architectural Request - Cart Garage/Guestroom expansion
Dear Mr. Cox:
I am pleased to report that the Board of Directors has approved your submittal of plans
for a cart garage and guest room expansion at the above -referenced residence with the
following conditions: ;
1.) City approval of a front yard setback variance from 20' to 17'.
2.) Submittal of a revised/upgraded Landscape Plan to the Landscape Chairman.
3.) Irrigation depicted on plans to be installed by the Association's landscape maintenance
contractor (Valley Gardening. Services).
Please contact Valley Gardening owner George Garza at399-1844, to review your
revised landscape plans, as well as for-,N,arding a copy of the plans to my offi�.e for review.
You may also have your general contractor contact me with any questions regarding site. .
preparation; and a final inspection upon completion.
Thank. you for your.patience'in this process, and we look forward to this fine addition to
PGA West iI Residential'Association.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION °
John K Handel
Association Manager
cc: , Board.of Directors
Unit File
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