9704-105 (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
3/3
Date 2 11 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
DAID (Soo. 7044, Business & Professionals r .nriP)
( ) 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 maintaiwworkers' 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.
a�Y" ti.'.1 t5 ►.'`iJl'1.1� r.?i;�'i-,�.Y��ia
(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: if -14-r3 T Applicant V-tt 12 (
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 h
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 enteraupon
the above-mentioned property for inspection purposes. sr
1'Z` `' l
Signature (Owner/Agent) ± 1. `. s �- Date a '
BUILDINGPERMIT PERMIT# CONTROL#
5032DATE 4/221972219% VALUATION �Igf.ilj .fall LOT TRACT
JOB SITE APN
ADDRESS 56-325 RIVIRRAu//ums�ss,,
OWNER CONTRACTOR / DESIGNER/ ENGINEER
«. ��
DON RAYLOR. - R011 EDWARD'S CONS -T RUCTION
'56-32.5 MIEKA 710-920 FtE81"IN DIUV
Ulk QUINA CA. 3 253 LA (21;.31A1` A CA 92253
('760.775-71;13 C- BI..#f' 3212
USE OF PERMIT
A O N
.A) S> itOi,>t4? t�ODtfi( N
PLAN Cf.tf.XX FEE 101-�#��1-�I�3�J-31.8 $134 55
t't'1Tit�t'1'!t1,tF:'1°1t,11+.11�1:1; 1(13-f1(31).:1.111-(N.K? h»137.f)f't
101-0*1121-000 $"A.Q?
I4,A;k 1141C:AL j,V.t,ii.(Gi-yt��it/�flei..�lZij�tfia 1 ti)
1Tr(JNCJ k1t.1,10N 1=e.F RVISW 1131'l -2 fI-W)
a
PAIS7 -I l'CA1. ('_1QNL 11VJC`1'10N AND PLA N 01 ECl~ $;171 5ft
1.1s �u' �' : � 1'��C>'� ' : � $0.00
APR 2 9 1997 Tr TAII, vv."i r F11,EN 1)11ij;1NONV S391."
CITY OF LIA O. PINTA
RECEIPT DATE y BY DATE FINALED INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Root Deck D
Exhaust Fans
O.K to Wrap
F.A.U.
Compressor
Insulation—// L / T,
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROVALS
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
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)
L Desert Sands Unified School District
Notice: 82-879 Highway 111
Indio,
Document Cannot Be Duplicated
619-77755 92201
-3500
CERTIFICATE OF COMPLIANCE
Date 4/28/97 APN # 761-461-028
No. 15468 Jurisdiction - ----/
Owner Name Don Baylor Permit #
No. 56325 Street Riviera Lob #
City La quinta zip 92253 study Ar ra 206
Tract # Lot # Square Footage 260
Type of Development Residential Addition No. of Units 1
Comments
ice
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
This certifies that school facility fees imposed pursuant to Government Code 53080. in the amount of
0.00 X 260 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 Telephone 775-7.933
Name. on the check
By Dr. Carol McGrew'.
Administrator in Charge ✓'
Fee collected /exempted by Pauline Pearson Exempt $0,OD
Signature
A 18.2 P4 A I A A JnlVk-
Check No. n/a
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
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 anther 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
APR -29-97 TUE 2 26 PM MOMARCH GRUP"-� "".-.� "' F I �jx,, �1�y�71b 51-11 �` .:P 3
{�
J
PGA NVEST II RESIDENTIAL ASSOCIATION,'INC; ,
P,O. BOX 1282, '—A. QUiNTA, CA
92253 ;,
', �,.. • '`" ' .; "f"� (619) 776-5100 FAX (619) 776,5 111
�.
April 29, 1997
bon Saylor
.
56 325 Riviera
La Qulnta, CA 92253
' C
RE: FGA WEST 11 Residential Assoclation
Architectural Variance - Room Addition/Expansion 156 325 Riviera
Dear Mr, Baylor:
' Thank you for plans submitted for the above -referenced residence regarding a room addition/expansion,
•tr
' Please' be advised. that the. Architectural Committee of PGA WEST 11 Residential Association, In
'
conjunction, with the Board of Dlrectoes, has arproved your plans with the following cordltlons:
;.
• 1) Need irrigation plan.
'
2) General contractor must interface with•Mlguel Valeniuela of Valley Gardening Services'(399.1844)
regarding any change to the existing association landscape/irrigation,
R.egarding the Installation of your' cart garage, which' was completed last year, the Architectural
Committee and 0oard of Directors respectfully request that you consider changing out your cart and
4
earage doors to a style which matches the original design elements of the tilt -up garage door. Since that
time, the'association has required that new cart doors' match the design of the existing zara`ge doors. For
an example of this, please see the new cart garage door at the Ferraro residence at 56 180 Riviera. Both
„f
; T- •�r.
the garage and cart door match, and have incorporated the original design elemente of the tilt garages
�' "•
door, thereby malntalning the architectural integrity of the developer's original desigrL For information
N
regarding the source of the Ferraro'i rew cart garage, please contact General Conuractcr Bob Edwards..'
Thank you for your cooperation in this matter, and should you iiave any questions, pi;se`do not hesitate -
to contact me or my assistant, John Monahan, at 776-5100.
r,
'
t
Sincerely, , r' " y'; k4 t,, ,-
' PGA WEST II RESIDF,NTIAL ASCOCATIQN. �- _.• """ ' "'
•„
-""``'sr,•..
• For the Architectural Committee• ��
" , "
y;
John H. Handel, Association Manager =t
t
'per •,,� r ��, �, r
. � 1,..
Don Troy, Chairman •. ,
d
]ohn Monahan, .Assi5wnt Manager
` -, *• Unit Filer