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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 A effect.
License # Lic.Class '� Exp. Date
Date r� 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 fo'r by Section 3700 of the Labor Code, for the
performance of the work fol 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.
,f y� � is r•�2121511-93-00094S ,
IST
(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 inany manner so as to become subject to the
workers' compensation laws of Califbrniar and/ agree that if I should become
subject to the workers' compensati p provis 9s"OfAection 3700('6f the Labor
Code, I�s`hall fo hwith comply wit` thos
pr visions. �•_.�
v�ate:. �1 , 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. Lagree to comply with all,City, and State laws relating to the building.;.
construction, and hereby authorise representatives of this City to enter upon':,'
the Bove mentioned property for ins tion purpose's.
vSignature (Owner/Agents __Date ��•
PERMIT # CONTROL #
BUILDING PERMIT
DATE VALUATION LOT `� TRACT a
$23.370.041, ` aaggi
XB SITE
ADDRESS °`� ;1 APN
65 RIVIERA .76 i_461-040
OWNER I CONTRACTOR/DESIGNER/ENGINEER
820 N MOUN'iAM AVE ii.108
UPLAND
I USE OF PERMIT
Bt313�1? 1 r a i3s COINS• RUCTION
;� -caZ,j I�.I1;
"STA MVC
C
CA 91.786 L:A iQIt.(1N A. CA " 25.3
(1(50)'175-7933 C43L O, 32:11.
X500 S. -F. PtOoK `'romi. [ON
...6A i
UN 2 6 1999
CUM'VON 1 C N 3'17EEti�`.`i 100 300..00 8F
�ATYOF LA
- - • - iSRJT5-TIYF,�?1, 0, 'MVCT!0N',kNt1MANNS,HEC-K–...� _w _._.$523.2!x..
WESS i?lC�i•i�'/•�ili.d=LFS g42.pU
'8'O; A1, P ER,KVT FIC Qd:lla�,-!IOW I $523.29,
RECEIPT DATE ) BY DATE FINALED INSPECTOR
Pf',RSi IT'9i°EE SL1t@'i.I ARY
PIZA.N C?X-C':A; FE13
101.000-439.319
rUNk:,'17k1ti„, 10NIFFly
ti11-0f?0 �1.R-0f1t!
�"c,z3.tu)
LRAst MI C`AL tW
$5.50
PLUMBING NG FF6
109.-000-41.9.000
5:;3.00
i`1'RONO NKYrtoN� .0"3 RX30
16.1400-2 4)-000
n,34,
GRADIING AUX
1.01-000423A00
$20:011
- - • - iSRJT5-TIYF,�?1, 0, 'MVCT!0N',kNt1MANNS,HEC-K–...� _w _._.$523.2!x..
WESS i?lC�i•i�'/•�ili.d=LFS g42.pU
'8'O; A1, P ER,KVT FIC Qd:lla�,-!IOW I $523.29,
RECEIPT DATE ) BY DATE FINALED INSPECTOR
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Slab Grade fQ
Ducts
Return Air
Steel
Combustion Air r
Roof Deck /P
Exhaust Fans
O.K to Wrap 7
F.A.U.
Framing
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 -
-y
Final d
BLOCK LL AP ROVALS
Final
POOLS - 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
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
ClWly Notice (Perm)
i
Bin #
City. of- La Quinta
_
Safety Division
P.O. Box 1.504
e_ it :#...:.:::::::::::.::::::::::::.
78-495 Calle Tampico
La Q uinta CA 92253.
Building Permit Application arid•Tracking Sheet
Project Address: (e —. Sa ,.5
(MZ4 -Owner's
Name:
A. P. Number: ..
Address:
Legal'Description: • •
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City,ST,'Zip: " -
ntra t r: -
Co c o
Telephone:
Address: 2,0 ^
-
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PI
Project Description: rte_ 1
.Ort
City.ST. Zip:
-
l
Telephone: �, S
2 : -19 T7
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State Lic # : -��G�� l � - •
City LIC -1: Z
Arch.. Lngr., Designer:
Address:
Cite. ST, Zip:
C
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Telephone: I L([` -
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.z
Construcuori Type: Occupancy:. "
t.
ic. #: 3 �.O
`Proctr le one,' New
DemoectaState
Alter Repair
_T#
Name of Contact'Person: G
Sq. Ft.: 36U
#. Stories:
Units:
Telephone'# of Contact Person: TS— % 33
Estimated Vatue of Project: e 0.0m R3'370•Do
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
FEES
!ST FL. S FT S
UNITS
STORAGE TANK
FORMS
2ND FL. SQ FT .�,
ROUGH WIRING
5jj0LUjMBING
ROCK STORAGE
FOR SO_ FT .g
♦ MOBILEHOME SVC.
HEATING (FINAL►
GAR SO FT. -q
I POWER OUTLET
ROOF DRAINS
TEMP. POLE
CAR P jQ. FT 4
DRAINAGE PIPING
WATER HEATER
WALL SO FT %Z
FINAL INSP.
DRINKING FOUNTAIN
BOND BEAM
30 rT T
URINAL
_ $
ESTIMA'ED CONSTRUCTION VALUATION S
FINAL INSP.
FRAMING
FINAL INSP.
WATER PIPING
NOTE. Not to ce -,sea as.,rocerty !a,c wa:uauon
REMARK
VENTILATION
FLOOR DRAIN
FIRE ZONE ROOFING
MECHANICAL FEES
FIREPLACE
WATER SOFTENER
SPARK ARRESTOR
VENT SYSTEM FAN EVAP.COOL FOOD
SIGN
GAR. FIREWALL
WASHER(AUTONOISHI
LATHING
APPLIANCE DRYER
MESH
GARBAGE DISPOSAL
INSULATIOWSOUNO
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
FINAL INSPECTION
KITCHEN SINK
ABSORPTION SYSTEM B.T U
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE. TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SO. FT. 4 c
IBATH TUB
SO. FT. R c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ra 1!/. c
SEWAGE DISPOSAL
SO.FT.GAR 1p I..c
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE
PLUMB. FEE
�5•y�
33.00
STRUCTURE PLUMBING 1 / l/ ELECTRICAL HEATING li AIR COND. SOLAR
SETBACK
GROUND PLUMBING'
UNDERGROUND
A.C. UNIT
COLL AREA
SLAB GRADE
ROUGH PLUMB,
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL►
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
i plUs+_xs
_ $
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARK
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIOWSOUNO
FINISH GRADING
FINAL INSPECTION
CERT. OCC,
FENCE FINAL
IwOICM I V w .1 �11Yww I YwC.11w111wtp - --
GARDEN WALL FINAL '
_11M
FLAN CHECK CORRECTIONS
Date:
Job Address: 56 - 565 uc6r1 k
Contractor:
Plan checked by:
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PLAN CHECK CORRECTIONS
Dace:
Job Address: 5 6 - 545 121 u l L2+
Contractor: �h q�cu5
Plan checked by: A4i�n-►L
(1 P�OVIpE (�DM�ow�J�-5 �'S�OGIA-T(0�J
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JUt1-22-98 *041 1:38 PM . M'VN' P,'H GRuUF
May 27, 1998
'Mr. & Mrs. Andrew Woodbury
56-565 Riviera
La Quinta, CA 92253
FRIX NVO. 619 776 5111 F. 1
RE: Architectural Change request for 56-565 Riviera
Dear Mr. & Mrs. Woodbury,
It has been brought to our attention that you have recently installed a garage
door without first applying to the Architectural Committee. It is also noted that
the garage door you have Installed does not conform with the Associations
garage door guidelines.. The guidelines call for new garage doors to match the
facade of the original door. The committee asks that you please submit an
application for a garage door change that conforms to the policy.
The committee has reviewed your request for a room addition at the above /
referenced unit at PGA WEST. The committee is pleased to inform you that it/
has approved the room addition, contingent upon receipt of additional signed
adjacent neighbor approval form and corrections of the above mentioned non
conforming garage door.
Please note that this approval is good for a period of six months. If construction
is not begun by November 27, 1998 you will need to submit a new application.
Please contact me at (760) 776-5100 when work is complete to schedule an
inspection of your Improvement so that we may release your performance
deposit.
Sincerely,
For the Architectural Committee
John J. Monahan
Association Manager
CC: Hoard of Directors
A" q uvg�,v+-t,S
s A�- --
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 6/22/98 APN # 761-461-040
No. 17209 Jurisdiction La Quinta
Owner NameAndrew W. Woodbury
No. 56-565 Street Riviera
City La Quinta
Tract # Lot #
Type of Development Residential Addition
Comments
300 sq. ft. room addition.
Permit #
Log #
Zip 92253 Study Area
Square Footage 300
No. of Units 1
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
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 300 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 Bob Edwards Construction
Telephone ?75, ?933
Name on the check
::-, o ,
`;, '4 ;;' '
By Dr. Doris Wilson,
Superintendent
Fee collected /exempted by Juanita Green
Exempt $0.00
Check No. N/A
Signature
NOTICE: Pursuant of Assffibly 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
tolled them on the Dislrict('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
PGA WEST II RESIDENTIAL ASSOCIATION INC.
ADJACENT NEIGHBORS' APPROVAL
For Architectural Change Application
Applicant's Name: MMY 6 RITA WWDBM
Address of Proposed Change. 56-565 Riviera
Proposed Change: _ -§m@U ,addition
Dear Neighbors of the Applicant,
Your next door neighbors, as listed above, have applied to the Architectural Committee for
approval to make a modification, addition or change to the exterior of their residence. In cases where
there could possibly be any infringement on a neighbor's view or privacy, as they will be looking at the
room addition, cart garage, awning or golf ball protection screen, the Committee requires that the
applicant obtain the written consent of adjacent neighbors.
The Architectural Committee will take into account all comments from 'neigbborsbefore malting
its final determination on approval or denial of the application submitted. Now is the time to be heard if
you have any objections.- We appreciate your input. Thank you for cooperating in granting approval that
will not be unreasonably withheld..
Architectural Committee
Adjacent Neighbor's Name and Address (Please print):
xr /x Mr A Topa Bedroai=n 56-585 Riviera✓ Approval Disapproval (PIease Check One
Comments:
Signature:
Other Adjacent Neighbor's Name and Address (Please Print):
Approval Disapproval (Please Check One)
Comments:
Signature: Date:
Page 9.