9712-006 (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 k Lic. ClassExp. Date
684857 B .. 3/31198
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
Carver STATE FUND Policy No. 22997-9882
(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, indemnity
& 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 PeRM19712-006 COROL&
6352
DATE VALUATION 527,265.00 LOT TRACT
JOB SITE 5&"2 RIVIERA
APN 761-461-067
ADDRESS
OWNER
CONTRACTOR/DESIGNER/ENGINEER
STEVEN 8t: NANCY BUECHELE
BOB EDWARDS CONSTRUCTION
56642 RIVIERA
79-920 FIESTA DRIVE
LA QUINTA CA 92253
LA QUINTA CA 92253
(760)775-7933 CBL# 3212
USE OF PERMIT
ADDN
350 S.F. ROOM ADDITION AND ATRIUM ENCLOSURE
CUSTOM CONSTRUCTION 350.00 SF
ESTIMATED COST OF CONSTRUCTION
27.265.00
PERMIT FEE SUMMARY
PLAN CHECK FEE 101-000-439-318 $176.48
CONSTRUCTION FEE 101-000-418-000 $271.50
MECHANICAL FEE 101-000-421-000 551.50
ELECTRICAL FEE 101-000-420-000 $27.25
PLUMBING FEE 1014000-419-000 $45.00
STRONG MOTION FEE - RESID 101-000-241-M $2.73
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$574.46
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
$574.46
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
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
t)ii ii V" ii Aij;04A
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 Sianature 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-- — - ----Policy No-. - - - --
t' y !'Y 1`t iwiJi Vwllvt iiY�/1
1, "INO
(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: ADolicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties'and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes.
Signature (Owner/Agent) Date
BUILDINGPER I 1 PERMIT# CONTROL "01'r—
"�V 2
DATE
DATE VALUATION« S LOT TRACT M
JOB ADDRESS :� 642 R'IAN�I!i�.R
APN ,
OWNER CONTRACTOR/DESIGNER/ENGINEER
ti,}i: 'VlN4 le1! (t1Jta1 };}:A!,.'i K,f N..11♦11( 1,
.-AA�4: KIVitailN ti —920 (SIC'. irA DRIVL,
I.A4,t?INTA t`,A. 9,12 S'A ),A(;f)INTA t'A
t'lif)")'75.^+ltd (10,1 121? l
2 i3
USE OF PERMIT
11.1.)1 ify PAID
,i'+!! `�.!' 't2t_h,+(vt FktYlrt:.l�.;t� :Uvl? :► f �tI_�t\�t l:lvc t.t +;�r�ri .
DEC 311997
91TY OF LA
UINTA
s
,q
r JJ R tl,i.:.k'J.r e. f.'I.NI7 0AW I i.•elN."t a.*.::.'\'�+t. /,V..
4.11
_ -- y�y-t eX f:l--`4
r'CN'4TV1Cr"Tteamf''Fh Irlf.rg< iAIN.fif')t1 l
A 1-1 J Ail J, J101 000 411110VIX)
Ial.11I—M IN(I Fk}i 101-(XiU-4I940) S0 40)
%'f R )N44 U i'1'tr N PRF , RV If i If))41 VO S ?$
TA1(YrAf.('!)INS!'Iff}('"l7 )N ANI) PJ,A1ri))1"'
((fFf'((f.7.t1.4n
F JQ+ ,.S t)(+1 -IOW
sl.�74.44
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
..w
f
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
9 -
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
a -/
Exhaust Fans
0. K. to Wrap
_
F.A.U.
Framing
- _
Compressor
Insulation
a - _ ¢ 6
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Fin at
Final
BLOCKWALL APPROVALS
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
- 3 i
Encapsulation
Gas Piping
, Q
Gas Test
Appliances
Final
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)
COMMENTS:
.404 M -T vPAar
--*we tee,
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 12/30/97
No. 16461
Owner NameSteven & Nancy Buechele
No, 56-642
City La Quinta
Tract #
Street Riviera
Lot #
Type of Development Residential Addition
Comments
APN # . 761-461-067
Jurisdiction La Quinta
Permit #
Log #
92253 Study Area
Square Footage 350
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 i om paying school fees at this time due to the following
reason:
Residential Additionj 500 Sq Feet or Less
This certifies that school facility fees imposed pursuant to
0.00 X 350 or $ 0.00
permits and/or Certificates of Occupancy for this square.foi
Fees Paid By N/A
on
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Ellen Fatlno
Signature2C/
:overnment Code 53080 in the amount of
the property listed above and that building
.age in this proposed project may now be issued
Teleph'une775-79.33
^.•, '-fir 'r
9.1.' i A
f
Exempt $..0 00 � ;(
Check No. N/A
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 Isssued 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
; 14
PGAWEST.
December 24, 1997
Mr. Steven Buechelle
56-642 Riviera
La Quinta, CA 92253
RE: Architectural change request for
Dear Mr. & Mrs. Beuchelle:
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX(760)776-5111
referenced property
The Architectural Committee and the Board of Directors Is pleased to lnform you
that it has approved the room addition for your PGA WEST home. Please note
that this approval is good until June 24, 1998. If work is not begun by that time,
a new application will be required.
Please contact me at (760) 776-5100 if
Sincerely,
John J. Monahan
Assistant Association. Manager
have any questions or concerns.
REGISTERED INSPECTOR'S WEEKLY REPORT
J
JON TA v�9
`� p
3580 Condalia A6:' 6
Yucca Valley, CA 9229' b
(760) 365-5045
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY O FIRE PROOFING
❑
❑ OTHER
JOB LOCW
6
!J`.-
_� I � l • i L A
f„�
U `� / ^
REPORT SEQUENCE N0.
��il
TYPE OF RUCTURE
_ 'e
�1J\Ae
PERMIT NO.
�'�t'w��K_
V
DATE
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHITECT
IU.C.FSiTOR�Ci
C
HRS. CHARGED
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERALSUB
FACTOR CONT��
CONTRACTOR
'i
U -s �1WL SEgov
COPY SENT TO CLIENT
CO ON NEXT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
�I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
��
—��-.::.,niin9enr_esw.esn o>ru 6o_..._.�
Applying demand factam—Table 220-30(4)
First 10.000 VA x 100% 1 0.0 0 0 VA
Remaining 33 6" VA x 40% . '�3't68VA
(totaQ 12'921 VA
2. HEATING OR A/C LOAO--Table 220-30(1)(2)(3)
Heating units (3 or less) . —�_ VA x 65% .
Heating units (4 or more) . VA x 40% a
(3) A/C unit . 00-- VA s 100% . '(7 aWD
Heat pump . 3 095-8 VA x 100% . 3�8
parsest kad) /7.06-0
¢e OT
1f Service: I . VA
V �!
PHASES t �`� VA A
'2 QUO V
t EXLSTINGI
PHASES
VA
VA VA •
"L-410 46bVA
A 161
}
i
)
Figure 2.14. The Optional calculation is used to determine the. VA and A for feeder circuits to dweling units located in an apartment
complex. Refer to Figure 2.23 for determining the VA and A ratingI of the neutral.
OPTIONAL CALCULATION—ONE-FAMILY OWELLING (NEW O
1. OTHER LOAOS-220.30(b)
General fighting toads -220.30(b)(2)
_ sq. ft. 'x 3 V.1
400 VA
Small aPofiance and laundry bads—M-30(b)(1)
VA x 3 —circuits
r
. g �a VA T
Special toads-220.30(bx3X_q
• 7-0. ca 0
OishwaSher in
SVA
Disposal •
VA
Compacor .
?oVA
Water heater
((''�� VA
VA
/ c2cT-
/5�•o VA
VA
A .
—
VA
�.. ..
VA
Ratao 6 VA
Applying demand factam—Table 220-30(4)
First 10.000 VA x 100% 1 0.0 0 0 VA
Remaining 33 6" VA x 40% . '�3't68VA
(totaQ 12'921 VA
2. HEATING OR A/C LOAO--Table 220-30(1)(2)(3)
Heating units (3 or less) . —�_ VA x 65% .
Heating units (4 or more) . VA x 40% a
(3) A/C unit . 00-- VA s 100% . '(7 aWD
Heat pump . 3 095-8 VA x 100% . 3�8
parsest kad) /7.06-0
¢e OT
1f Service: I . VA
V �!
PHASES t �`� VA A
'2 QUO V
t EXLSTINGI
PHASES
VA
VA VA •
"L-410 46bVA
A 161
}
i
)
Figure 2.14. The Optional calculation is used to determine the. VA and A for feeder circuits to dweling units located in an apartment
complex. Refer to Figure 2.23 for determining the VA and A ratingI of the neutral.