0112-034 (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
684857
f ��� Signature of Contractor -
Kate
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 f6nder 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.
W 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.
i�I3�3IfY�l INV CO. W031.161-Aw7
(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 700 of the Labor
Code, I `sha I forthwith comply withfthose provisions.
Date:' iv ! Applicant eXC J-."_,.3 _-L
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned prop�ertytfor inspection purposes. 11A/oz, Sigriature•(Owner/Ageni)�'•• r`���''`.Datef
BUILDING PERMIT PERMITk
%/
DATE (/ VALUATION LOT 01.2-W4 TRT
. u/ 2- 09161390 1
JOB SITE r !
APN
ADDRESS dp♦,�af(�� ty�'pp•�V��Ny'Y�,�s3g'��')��qq
.9"8%i.k'�,6y9S'IA41 .
OWNER
CONTRACTOR/DESIGNER/EN INFFR�
MMMS T,1r1 C:J'ALTAiIO%)J3?'v�i!213
79890 wil'!I'� m,
799201WOT ADIUV
Lik Qt'f.(.trTTA CA 92253
LAS QY NTA (,A. 9225:5
(760)7757933 CRIX, 321,.7.
USE OF PERMIT
OFFICE, ADDITION TO MASTER ISIE1aI<:t OM (I15 3:It.) c! :317 4'INJ`
RMlD.AA1 H DDITION. TO MOT1140 DEM (301 f1..R), MECHANICAL
Cl,tm" (14 SY
CUSTOM (:Oii$'rI1LrCTION 30510D STS
f3ARAWCAi<;4at1RT 14.00 SIP
.k+:�":a�d�.7t�'a� �c��� '�� G"J.f�;�:��'C"",C:►1�
s�r�.:3.�C3
P)Kl�.t� .I'' 1;'yEE SI7MAMRIR
PLAN CHWK OW, 10143`Z1 439.318
C:'ONSTPI CTION FEE 1.01-000-418-000
M_,.4CH ANIC AI., .�"1^ .9 101-000.42.1.000 $12A
F:LgIC RICA), frEF, 1614100420a000N $nds
P1,UMBINt4,RZ, 10I. -000A19-000" $".bly
aT.tC,DHO IbIOTIO14 TeF-E RBSI0 101 -000 -tri -000, $m,''6
..:GRADM, 0 FEE, 103-000-4713-000 $20,00
;r
Ail 1 U All/
t
3UB!1NT%1C
V03.32
CpryOFLWVUMTA yrPRq�T.PyaiIX
$0100
FiB�>4lt�},CI` ®ter
_
_. ,.!DTAL YERJ.�'�':J1:(C nT1tiVPE NOW
RECEIPT
DATE
BYr
DATE FINALED
INSPECTOR
J1
0
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
14
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Q /VAWAV
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
OL
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
&"JAL
Final
Final _
BLOCKWALL APPROVALS
Steel
POOLS - SPAS
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
Sewer Connection
�/ QpZ ��Q,p��
Pool Cover
Encapsulation
Gas Piping
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
–• zrzr�
11111111""—j Notice (Perm)
COMMENTS:
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 1/10/02 APN# 761-530-006
No. 22813 Jurisdiction La Quinta
owner NameMr./Mrs. Peter Capabianco permit # 0112-034
No. 79-890 Street Riviera 100g#
City La Quinta Zip 92253 Study Area
Tract # - Lot # Square Footage 505
Type of Development New Residential Addition No. of Units
Comments
Office Addition to Master Bedroom - 115 sq. ft. & Sitting Rm/Bath Addition to Existing
Den - 391 sq. ft., Mechanical Closet - 14 sq. ft.
At the present time, the Desert Sands Unified School District does n6t 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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to in the amount of
2.05 X 505 or $ 1,035.25 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
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected
Signature
Telephone 760 775-7933
Payment Received . $1,035.25
Check No. 61299
NOTICE: Pursuant tVAssembly Bill 3081 (CHAP 549, STATS. 1 696) this will serve to notify you that the 9D -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
FROM : MONARCH
December 12. 2001
PHONE NO. : 760 776 5112 Jah. 08 2002 11:19AM P1
PGA WEST 1I RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QVINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Mr. & Mrs. Pctcr Capabianco
40 Seaver Street, Apt. lt>
Welteslev. MA 02481-6724
Reference: 79-890 Riviera. La Quints
Arcltitecturul and Landscape Request for a Room Addition. Roost Extension and
Additional Landscaping
Dear Mr. & Mrs. Capabianco:
The: Architectural Conurtittee wid the Laaulsoapc Conutlittec: (take reviewed }'our plans for it room .addition.
1-00111 extcttsion and additional landscaping. Tire Arctutcctural Cointilittee unanimously approved your
application.
Review by the Cotnnriuee is only for general Wnfonwitoe with the architectural guidelines. It is rhe
responsibility of the otvaer to UK understand and conform to the architectural bntidelunes criteria whether
or not all deficiencies are ttot(A during review. !t is also the owner's full responsibility to field verifj all
existing conditions. The Const ince's decision o th regard to ptnlcct design AAA! lx final. Please 1`0150 to
the Architectural Rules for all required submittals.
Tire landscape cortunittee has the following cotnntent
If the Mexican Fru paGn that is to be relocated dies. tlae tree lvi11 he replaced at hoinemN ttur'�
cxpcnsc and the tree shall luivc a warranty of one fear.
Pleasc coivact Javier Conirents. supervisor for Valley Gardening Service at 99-1844 and Carol Fuller.
the Association Manager. prior to any itrtibation modifications associated with this change. .Damage 10 tine
landscaping-i.e., shrubs. trees. flowers and tut is tare responsibility of the cortritctor. The landscaping
trust be brought hack to its original condition when the project is completed,
Approvals given by the Architectural Coiurnittce arta good 1'u• only six months from the date oat the
approval letter. After il><it rime a acm- application inust be sttbtnined.
Upon completion of your proicct. please complete and rctuni The Notice of Completion of. Archilecturttl
Change.
tf you have any additional queuions or concerts. please do not 1lesiruc to contactCarol Culler. Assa:ia 6011
ivlanaga. at 70(V776.310t). Ext. 20.
Sincerely.
PGA WEST It RESIDENTIAL ASSOCIATION
For the Architectural COtnmittcc
For the Landscape Committee
Carol Fuller
Association Manager
cc: Board of Di tactors
Unit File
E
Fm��
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
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY 'd -'po )0-f
❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
❑ REINFORCED MASONRY ❑ FIRE PROOFING
JOB LOCATION- � � = "" � ['1 Ui � 1
�( -�•�
REPORT SEQUENCE N0.
TYPE OF STRUCTURE
-SfP CAM i AWCD °RES @) WEST
PERMIT NO.
o 11-L - o 3LI
DATE
I - i S- OL
DAY OF WEEK
MATERIAL DESCRIPTION
SErzz. f-PDX �� 52�`j
ARCHITECT
►^�,cl.� Sl����z-.
INSPECTOR
-jz - '1>,
HRS. CHARGED
ENGINEER
ASSISTANTS
NRS. CHARGED
INSPECTION GENERAL�O rJ 1 W0.e _1 S CONTRACTOR
DATE CONTRACTOR p{ p�
-1S-o2
NDsEe-uED Iaup-V1AeTvT- 9 A. LA 60I2
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COPY SENT TO CLIENT ❑
CONTINUED ON NEXT PAGE ❑
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.
1/`' • � i
SIGNATURO INSPECTOR
(1(131 q7
DATE OF REPORT REGISTER NUMRFR