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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
684857 B HIC 03/31/2(
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 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:
Carrier CA INDEMNITY INS Policy No. N805727311
(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 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
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0006-403 TRACT
$40975.40
JOB SITE
APN
ADDRESS 56-263 RIVIKEZA
761 YL -04-5
OWNER
CONTRACTOR/DESIGNER/EN (NEER
JIM SEVERNS
BOB EDWARDS CONSTRUCTION
56-265 RIVIERA
79-920 FIMADRIVE
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)775-7933 CBL# 3212
USE OF PERMIT
RESIDENTIAL ADDITION
526 S. F. ADDITION & INTERIOR REMODEL - PER APPROVED PLANS
OONLY
CUSTOWCONSTRUCTION 526.00 SF
4-V
EST MATED COSI' OF CONSTRUCTION
40,975.40
PERMIT FEE SUMMARY
PLAN CHECK FEE 101-000-439-318 5231.40
CONSTRUCTION FEE 101-000-418-000 $356.00
MECHANICAL FEE 101-000.421.000 $29.50
ELECTRICAL FEE ' 101-000-420-000 $45.75
PLUMBING FEE 101-000-419-000 $27.00
STRONO MOTION FEE - RESID 101-000-241-000 $4.10
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$693.75
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$693.75
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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 7/14/00 APN # 751-461-025
No. 20725 Jurisdiction La Quinta
Owner NameRM Severns Permit #
No, 56-265 Street `Riviera Log #
city La Quinta zip 92253 study Area
Tract # Lot # Square Footage 526
Type of Development' Single Family Residence 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 replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the fmllowing reason:'
EXEMPTION NOT APPLICABLE �.
This certifies that school facility fees imposed pursuant to , Government Code 53080 in the amount of-' .r
2.05 X 526 or $ 1,078.30 the property listed above and that buisiding
permits. and/or Certificates of Occupancy for this square footage in this proposed project may now;be issued`j'" Y J
f.
Fees Paid By cc First Bank Telephone 775 -7933 -
Name on the check
�By Dr. Doris -Wilson
bupermtenoent
Fee collected /exempted by Sheryl Simmons Payment Received $1,078.30 ,
Check No. 54874
Signatur
NOTICE: 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
above 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
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
F fF.
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Y
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 fmllowing reason:'
EXEMPTION NOT APPLICABLE �.
This certifies that school facility fees imposed pursuant to , Government Code 53080 in the amount of-' .r
2.05 X 526 or $ 1,078.30 the property listed above and that buisiding
permits. and/or Certificates of Occupancy for this square footage in this proposed project may now;be issued`j'" Y J
f.
Fees Paid By cc First Bank Telephone 775 -7933 -
Name on the check
�By Dr. Doris -Wilson
bupermtenoent
Fee collected /exempted by Sheryl Simmons Payment Received $1,078.30 ,
Check No. 54874
Signatur
NOTICE: 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
above 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
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
F fF.
Bits # .
City of La Quints
-
Building 81 Safety Division
P.O. Box 1504
'
78-495'Calle Tampico
Petmft #La
Quinta, CA 92253
A43
Building Permit Application and. Tracking Sheet
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Name of Contact
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TRANSMITTAL
To: Christine. di Iorio
From: Greg Butler
Subject: 56-625 Riviera
Date: July 10, 2000
In the words of the infamous Mark Harold, can they build this addition?
Thanks,
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TRANSMITTAL
To: Christine. di Iorio
From: Greg Butler
Subject: 56-625 Riviera
Date: July 10, 2000
In the words of the infamous Mark Harold, can they build this addition?
Thanks,
t ,
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May 2, 2000
Mr. Tim Severns
56-265 Riviera
La Quinta, CA 92253
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FA -X(760)776-5111
Reference: Architectural Change for Ru akn Addition glyd,� » ptttg`+ It is
Dear Mr. Severns:
The Board thanks you for attending its meeting on Monday, April 24, 2000. As agreed at the Board
meeting, several Board members inspected your home and approved your application as resubmitted (dated
4/2/00).
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 to the architectural guidelines
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 to
project design will be final. Please refer to the PUD Architectural Guidelines and Application for
Change for all require! submittals.
Please contact Raphael Villareal, supervisor for Valley Gardeniug Service at 760/399-1844 and Carol
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 be brought back to its original
condition when the project is completed.
Approvals given by the Architectural Committee are good for only six months from the date on the
approval letter_ After that time a new application must be submitted.
In the meantime, if you have any questions, pi cage fed ftc-e M, zoalaet Carol Fulleg,
at 7601776-5100,'Ea-t. 20.
Sincerely,
PGA WEST I1 RESIDENTIAL ASSOCIATION
For the Board of Directors
-Carol Fuller
Association Manager
/cif
cc: Board of Directors
Unit File