0111-289 (GRES)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. Pate
N � ' : in..(
�
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. 704.4, Business & Professionals
Code). I!
O I am exempt under Section , B&P.C. for this reason'
Date Signature of Owner r
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 worl.ers' compensation insurance carrier & policy no. are:
Carrier -Policy IN,� Policy No W(113-1
61
(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, app agree that if I should become
subject to)he afb
orkers' compensn pRo isdl1of Sectio 3700 of the Labor
Code, t al b with comply wit . hose11provlsl nns J
Date: Applicant—
Warning:
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'uthorize representatives of this City to en er Upon
the, above-mentioned pro ertyffor • spection p rposes,
I
W
Signature (Owner/Agent), v Dat I
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0111.•-289 TRACT
JOB SITE
APN
ADDRESS
564MKRI MA
OWNER
CONTRACTOR/DESIGNER/EN (NEER
MR. &, WS. DAVE C°..r�RM014
BOB :IW33WMD8 Ct::N.211'14131C.LI.i N
$6423 WMA
19.05 20 FEWA?DFOE .
LA QUIM,,A, CIA 92253
;0AQuIm i, CA 92`253
(760)775--/933 CSIX 3213
USE OF PERMIT
03AR AAF, OR C1RP0,R17
C1€.°•i i+ C:AWY LIAR A.Ctfl' .A.TlDITIOW ?'70 V
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1. ARAWCA.+RPORT By
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PLM4 (111AWK FEE 3. 01 _000439-3,18 M&O
CONST9,UCTION ME 101-000-418-M $63.00
k?i;,'.Ei"" IRIC:ALg'CK 101,10043.420.000 SA175
gi a'$ OMO 14It3TIaM P&M REM) 101-0004A 1.000 $.50
CDF 4DIXG Fri 1?' 101 -000 -423 -WO %20160
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11 ' N"SiS: UC:r'.1013 IN14D PLAN (M -OK
$149.20,
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of , Jt3
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$149.20
RECEIPT
DATE Ifs �B
DATE FINALED
INSPECTOR
0 f -
'� r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Forms & Footings
_
y///�
Underground Ducts
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof DeckExhaust
_
Fans
O.K. to Wrap
j�p OZ
F.A.U.
Framing
jf� y
(�(/
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
//js��
�j//,G _�✓l%
Final
/�f��C��
Final
POOLS -SPAS
BLOCKWALL APPROVALS
steel
Set Backs
Electric Bond
Footings i
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
Pluming 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)
I ELECTRICAL. APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voftage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
Bin #
City of La Quinta
Building 8t Safety Division
P.O. Box 150_4, 78-495 Calle Tampico
` ' La Quinta, CAS 92253,- (760),777-7012
Building Permit Application and Tracking Sheet
Permit #
ON.., g
Project Address:Z5 11 V it14-
Owner's Name: X c4k�LS(11('
A. P. Number:
Address: X 56 - 4 -ZS P!ii ( f ( EafL-
Legal Description:
Contractor:�{�
X
City, ST, Zip: K
«>'>•::::::«.>:<:::::::>::<:<:>:>:>::::>::;;;:>, ;::>
Telephone:
Address:
Project Description: X
City, ST, Zip:
d tr CM2;t
Telephone: e. hn
K7 o 7 7
State Lic. # : k, City Lic. #:
, Designer:
•'
Address: -4- ( —6 ZS — 74- - Z
City, ST, Zip: O-LLM
Telephone:
ne: CJ
State Lic.
Name of Contact Person: x
Con t ruction Type:
P e: Occupancy:
Project ect type (circle eone) New Add'n n Alter Repair Demo
Sq. Ft.:/X, # Stories: #Units:
Telephone # of Contact Person: 77S-- 7`�> zj
Estimated Value of Project: x
APPLICANT: DO NOT WRITE:BELOW THIS LINE
#
Submittal
Req'd Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections'
!t' Plan Check Deposit
Truss Calcs.
i y
Called Contact Person
Plan Check Balance •
Title 24 Calcs.
Plans picked up
Construction o
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"d Review, ready for corrections/issue
Electricallw-- •
I
Subcontactor List
Called Contact Person
Plumbing
Grant Deed.
Plans picked up
S.M.I. c
H.O.A. ApprovalIli
q
Plans resubmitted
Grading •
��
IN HOUSE:-
''d Review, readv for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
,c,
S 5 yiie_
4�otal Permit Fees
November 26, 2001
Mr. David Carlson
889 Mohican Court
Walnut Creek, CA 94598
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 56-425 Riviera, La Quinta, CA 92253
Architectural Request - Addition of Golf Cart Garage & Additional Landscaping
Dear Mr. Carlson:
The Architectural Committee and Landscape Committee reviewed your plans at the November 13, 2001
and November 14, 2001 meetings respectively for the addition of a golf cart garage and additional
landscaping and unanimously approved your application as submitted.
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 Conumttee's decision with regard to project design will be final. Please refer to
the Architectural Rules for all required submittals.
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.
Please note that if the Mediterranean Fan Palm, due to its relocation:, does not live the homeowner will be
responsible to replace the tree. Please match the existing bender board, which is a brownish Trex-like
material that was recently installed at your home..
Please contact Javier Contreras, supervisor for Valley Gardening Service at 760/399-1844 and Carol Fuller,
the Association Manager, prior to any irrigation modifications associated with this change. 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.
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
if you have any additional questions or concerns, please do not hesitate to contact Carol Fuller, Association
Manager, at 760/776-5100, Ext. 20.
Sincerely,
PGA WEST lI RESIDENTIAL ASSOCIATION
For the Architectural Committee
For the Landscape Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF ❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY ❑ ��� ✓
INSPECTION ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER !"
PERFORMED ❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION`. -- ���e�A e /�1 REPORT SEOUENCE NO.
TYPE F �TR,LLCTURE O� PERMIT IINOO.. l/.tea /'c_l DAj� h DAY OF WEEK
MATERIAL `DESCRIPTION ARCHITECT S�P OR V HRS. CHARGED
c
ENGINEER -81 t Gl- ASSISTANTS HRS. CHARGED
INSPECTION GENERALJ SUB
DATE CONTRACTOR .QtiI'ps -tCONTRACTOR
l (
� / �1 �� -�nM, (' Cl•ll\ 9 _ C o �M D S is�n �+ ��%dY\�
I I COPY SENT TO CLIENT ❑ 1 CONJ40WED ON NEXT PAGE ❑ 1 PAGE OF I
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
"EOFTR
E OF REGISTE D INSPECTOR
PORT REGISTER NUMBER