0007-127 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapte(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
- 684837 :a me 0�V
Dated / 46 Signature of Contractor �L� _ �i' ;
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 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
perform nce of the work for which this permit is issued.
(ave 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:
Carver CA NDEMINITY INS Policy No. 14807271B
(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' compensate n p ovi ns of Section 3700 of the Labor
Code, hal forthwith comply wit triose?"rov s C
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 6u on
the above-mentioned prope J r ins' ¢tion purposes.
Signature (Owner/Agent) :�`--•tDate?
BUILDING PERMIT PERMIT#
DATE VALUATION LOT W07427 TRACT
W2000 24801
JOB SITE
APN
ADDRESS 5 165 R1VT RA
761-461-020
OWNER
CONTRACTOR / DESIGNER./ EN 1NEER
BRUCE, XCHARDS
BOB k;IyWPAWS 40mmUC•I' oN
56-165 is rxr x*.A
79.920= , ` .tAW
LA QUINA CA 92233
LA QL1"11+1TA CA 92252
(760)775-7933 CBL1f 3212
USE OFFPERMIT
Li1rBM??W17EL ADDYfIOX
76 S.N. ROOM, AI,7L7TION PER APPROVEr) PLANS ONLY
CUSTOM CONEITRUCT ION 76.00 S
KSTV" D COSIr Or CONgTtu iTON
SX0.40
pj iii' FEE SUMMARY
ARY
PLAN ONE= i'EE 101.0100.439-318 $5,165
CONSTRUCV014 YZE 101-000-415-000 $91.00
ELECTRICAL. FEE 101.000-420.000 $19,50
-
STRONG MOTION PEP, - RESID 101-000-241-000
� ,"'tj, � J 1
•.ra
140
Stffl-TC7`1.AL CC)idbwlRICIC1109 AND PLAN CHECK
$153.74
I:IMS PRE -PAID F.I•:
$0,00
TOTAL HINT" IT YSFS DUE NOW
$14.0,74
RECEIPT
DATE
BY d
DAT FIN LED
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
Compressor
Insulation jJa
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wail Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV LS
POOLS -SPAS
Steel
Set Backs
Electric Bond
Footing's
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
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
e: t
--7-
R
Desert Sands Unified School District
1. 47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated .760-771-8515 . -
CERTIFICATE OF COMPLIANCE
Date 7/21/00 APN # 761-461-020
No. 20763 Jurisdiction La Quinta s'
Owner NameBruce Richards Permit #
No. 56165 Street Rivera
City La. Quinta Zip 92253
Tract # Lot # Square Footage
Type of Development Single Family Residence
Comments
By
76 Sq.Ft. Addition
Lag #
Study Area
76
No. of Units
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 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 f
This certifies that school facility fees imposed pursuant to Government Code 53080 in the am'%unt of *
0.00 X 76 or $ 0.00 the property fisted above and that bui=ding
permits and/or Certificates of Occupancy for this square footage in this proposed project may now be issued
Fees Paid By n/a Telephone 5775-7933-
Name
775-7933Name on the check
Dr. Doris Wilson
Superintendent'
Fee collected /exempted by Sheryl Simmons Exempt
Check No. n/a
Signat
IOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1898) this will serve to notify you that the 9"ay approval period in which you may protest the fees or other payment Identified
above will begin to run from the date on which the building or installation permit forthis project Is sssued or on which they are paid to the District(s) or to another public entity authorized to
onect 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
FROM MONARCH -ACCOUNTING
FGA »
May 23, 2000
PHONE NO. 760 776 5112 May. 23, 2000 03:21PM P1
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX I282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
' Mr. & Mrs. Bruce Richards
12202 N.E. 318� Place
Bellevue, WA 98005-1500
Reference: 56-165 Riviera
Architectural Change Request - Dining Room Expansion
Dear Mr. & Mrs. Richards:
The Architectural Committee at its May 9, 2000 meeting has reviewed your plans lo expand your
dining room. The committee unanimously approved your application.
Review by the Committee is only for general conformance with the architectural guidelines. It is
the responsibility of the owner to fully understand and conform tD the architectural guideline
criteria whether or not all deficiencies are noted during review. It is also the owner's full
responsibility to field verify all existing conditions. The Committee's decision with regard t0
project design will be final. Please refer to the PUD Architectural Guidelines and Application for
Change for all required submittals.
Please contact Raphael Villareal, supervisor for Valley Gardening Service at 760/359-1844 and
Carob Fuller, the Association Manager, prior to any irrigation modifications associated with this
change. Upon completion of.changes, please contact Carol Fuller. Damage to the landscaping,
i.e., shrubs, trees,. flowers and turf is the responsibility of the contractor. The landscaping must
5e brought back to its original condition when the project is completed.
Approvals given by the Architectural Committee are good for only six months fiom the date
on the approval letter. After that time a new application must be submitted.
If you have any additional questions or concerns, please do not hesitate to contac` Carol Fuller,
Association Manager, at 760/776-5100, Ext. 20.
.Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
x: Board of Directors
Unit File
■. ROBERI A • P I T CHF OR -D
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316 2856 922`60 i .
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A DINING ROOM EXPA.NS I ON. FORT oarsgY
MR11. & MRS 'BRUCE- R 1 CHARDS%
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MR. & : MRS : BRUCE R 1 CHARD5
56=165 RIVIERA
LA. QUI NTA , CALIFORNIA
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