9904-137 (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 # Lia Class Exp. Date
68,1857 8 :113t/00
Date —7 - `?4 Signature of Contracto�;L
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`(S6d. /U44, business & t ruiesslund15 Cude).
( ) 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 Signature of Owner.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I ( ) 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:
Carrier - Policy No.
` TA'111 MIND 129-_"-00ftJ32
(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 j and agree that if I should become
subject to the workers' compensation, provisions of, -,Section 3700 of the Labor
Code, I shall forthwith comply with those ptoovisionsV
.6ate: Applicant �/�r'"'AJ L , L-2-•
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 insp/ection purposes.
7
Signature (Owner/Agent) �r� `t-n�- Date
BUILDING PERMIT PERMIT#
M4.4.':7
DATE VALUATIONBd•�3tli!1& 'jo LOT TRACT
ADDRESS 56-140 �,8'n"IE- RA JOB SfTE
APN 761-461-007
OWNER
CONTRACTOR / DESIGNER / ENGINEER
'N,&1ALL1.A_@1 t' & M. j\RY ILEE1.1101,'MI _:S
RIOfa EDryAMS CION 1111,Y7101k;
18:L,YIUt
79-920 FIT'ST.A T)R.1VE
IRVINE CA 92612
LA Q LltNTA Lam. 92253
(W)775-71933 CBT ,# 3217
U36 OF PERMIT i
ii;E;Si�j�.l•J �.'i.Al, .t�lJl�3'!'�1.3N
574 S.1". ATTAC-WM) OUC rT: Ii{5USE AUDiTIGN
'Mi 101, , - CUS T ON''t 121.00 10F
CUSTOM t;;ONSTRUCTI'ON 453SK1 S['
°E S7'IMA'I`E+ D COST OF C"ONSTIZUC',g"If1'i
PERMH FEZ 8i1M1iAicR
PLAN C'REC;`K.FEE 101 -01W -439-31h' $244.0
Ctli` RTRt K; I tC)1V i i?!a I01 4W-41 8-000 .'Ni
IaLtC'11RIC L 1'03 101 000 -X110 -M 09
:s`T110W &101 iCiN F01- ISI -D 101-000-241-000
51.113-'i01'A.1.. Cf3%+1k+""!`1241i"'IIOW .!'±1 C)111,AN 04EY":'1{.
glir"! U51
LESS 111111-11AID FEE:
$0.00
'i'MAL PE.1$i1U'i!' P1± ES i3i}�, NOW
$4".98
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
F.A.U.
Framing G
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 I WAW/POOLS
BLOCKWALL APPROVALS
- SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. 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
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)
COMMENTS:
Notice:
Document Cannot Be Duplicated
Date 5/7/99
No. 18706
' r
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Owner NameWilliam R. & Mary Lee Holmes
Jurisdiction
APN # 761-46f-007.
La Quinta
Permit # .
No. 56-140 Street Riviera Log #
City La Quinta Zip 92253 Study Area
Tract # Lot #
Type of Development Residential Addition
Comments
Square Footage 57.4 .
kttac.hed guest house a ition Y
F
No. of Units
At the present time, the Desert Sands Unified School District does not collect fees ,on garages/caiports, covered
patios/walkways, residential additions under 500 square feet, detached accessory structures or teplace'ment mobilehomes.
It has been determined the above-named owner is exempt from paying school sfees at this -time due 'to ttie. following'.'
r
reason:
` �rj4 • f.. r t � .. _
EXEMPTION NOT APPLICABLE',,,,"
This certifies that school facility fees imposed pursuant to Government Code 53080' in the amount of
1.93 X 574 or $ 1,107.82 the property'listed above and'that,b�'lding
0
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
\tiA l
Fees Paid By CC/1st Bank - Bob Edwards Telephoner 77.5-7933, ,
Name on the check,
By Dr. Doris Wilson -
Superintendent
„
Fee collected /exempted by Ellen Patmo Payment Received $1 107.82' ' ` �.
Check No. 50440,'•
Signature
10TICE: Pursuant of 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
bove will begin to run 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
ollect 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
® �� af, JON TANDY
NTA37630 MEdjool Ave.
MAY j 8 RSC,® Palm Desert, CA 92211
Office (760) 772-7192
INSPECTIONSPECIAL w �--w- _, ,-VFax (760) 772-7193
REGISTERED INSPECTOR'S WEEKLY REPORT Pager (760) 776-3338
TYPE OF
.INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCA N o
—( LA Outb
REPORT SEQUENCE NO.
TVP ��UCTURE 0 � MES
PERMIT N0.
O=)
'�5� 1
DAV OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
INSPcCTOR
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL C SUB
CONTRACTOR O C���� R CONTRACTOR
r`
S�eL'un
aK/
r
COPY SENT TO CLIENT O
CONTI
ON NEXT PAGE O
PAGE
OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
s NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
$ GOVERNING BUILDING LAWS.
_ V
TUREEG:STERED INS TOR
" - !o q-7
DATE OF REPORT REGISTER NUMBER
April 29, 1999
Mr. & Mrs. William Holmes
56-140 Riviera
La Quinta, CA 92253
POA WEST II RESIDENTIAL ASSOCIATION, INC.
PO. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
REFERENCE: Architectural Change Request for Landscaping and Lighting
Dear Mr. & Mrs. Holmes:
The Condominium Architectural Committee has reviewed your landscape and lighting
plans and has approved your plans based on the understanding -of a telephone
conversation between Ted Martens and Mrs. Holmes on Wednesday, April 28, 1999 as
follows.
:,: I It was pointed out by Mr. Martens that two species of plants on the
`landscaping plan were not in the plant pallet. Your plans specified eleven (11) Myers
ferns and five (5) Bird of Paradise. Per our conversation, please substitute something
on the approved plant palette (see attached) rather than using the requested plants.
The exterior lighting plan has four lighting fixtures. The recommendation is
that two of the four exterior lighting fixtures will be Association lighting as were
originally on the property and the additional two fixtures to be on the homeowner circuit
which will be switched from the house.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Condominium Architectural Committee
Carol Fuller
Association Manager
Attachment
cc: Board of Directors
Unit File
APR- 1-99 THU 3'.45 PM lviONA CH GROUP
Fxn IN. 619 7 6 5111 P. l
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776=5111
March 23, 1999
Mr. & Mrs. William Holmes
56-140 Riviera
La Quinta, CA 92253
RE: Request for permission to build room addition
Dear Mr. & Mrs. Holmes:
The Condominium Architectural Committee has reviewed your preliminary plans as
submitted by Bob Edwards for a room addition at your PGA WEST home. The
Committee Is please to Inform you that they have conceptually approved of this addition
and upon receipt of final plans including a complete landscape, lighting and irrigation
plan the committee will give it's final approval
Please contact me at (760) 776-5100` should you have any questions or concerns with
this. The next committee meeting is scheduled for April 15, 1999 at 3:00 p.m.
Sincerely.
For the Condominium Architectural Committee
John J. Monahan
Association Manager
CC: Board of Directors
Unit File
X.
C -of La
CityQuinta...
Building a Safety. Division
P.O.' Box 1504
..-Per # . ...... .... ...
'78-495 Calle Tampico
La.Quinia; CA 92253
. . .... .............
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ation an Tracking Sheet
Building Permit Application d
Project Address:
V V_Q6
Owner's Name:
A., P. N umber:
Address:: a
Legal Description:
City,ST. Zip: � GA
Contract 0
'Telephone
.. ......... *
.... ... .... xxxx
. . . .................................
. ......... .. . ........
Address: . -?c(—J2_(3
I�Uv
Project Description:
Ciry'ST, Zip: Qoi
T e iepp n e:
. ...... . ....
............. .
....................
State Lic.
City Lic. #: 9?,(2,
Arch.. Ener.. Designer: ?lik-W
Address:
'.
7.
Cit,:. ST, Zip:
e�
?i� )(
Telephone:
. ......................................
............ .
x
....... ... ...........
Construction Type-(QUkf Occupancy:
State Lic. #:
.......... ....................... .............. ..... .
................... x-,
.............................. :
................. .
.............. ......................
P roject type (circle one): New Add'n Alter Re air •Demo
p
Name of Contact Person:
Sq. Ft.:'.St
ories;
# Units:
Telephone of Contact Person:
4�
Estimated Value of Project: 5 149
,.,001f
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