0108-136 (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
,t. t s�sl�
Date r., l�Signature of Contractor ' f r .
- -.-OWNER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( )-:T,'Jas ownerof,the property, or my employees with wages as their sole
compensation, will Vdo the work, and .the structure is not intended or offered for
sale (Secy 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
S ction 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:
Cartier Policy No.
LH01014 INS Cou C C1,1 -10"M
(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, 9shall forthwith comply wiih thosefp'rovvisions.
Date�a��R r i Applicant '-L42 -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 restrictioris 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. ,
f
� ... l €
Signature (Owner/Agent)17 �'>- Dat t 7r'
BUILDING PERMIT PERMIT#
DATE VALUATION LOT 0108-1,36 TRACT
%�J r
JOB SITE/ _s
APN
ADDRESS
W-089 XI.' .."1'4A.761.
-4W-031
OWNER JY
CONTRACTOR / DESIGNER / EN (NEER
.l�f�&.LYa 6'.i' a, iY�A.�a',GY'•Sii.` iz,
FJV��.Illf�q'iyI J1,7 �6i Vr�wii'tl F3.i,�A4.F.J�I.AF./�9
T
yy80-p0rF;S�yI�{�y
A CIA, 2 233
la9�9t79Iy / ^
TA 253
(760)775e7933 C.T. 1, 3212
USE OF PERMIT
C;A14TA,PMITIONb (0Z1'.-CHFf3) A553P - PERMIT 1309S NOT 3'N ICT.uor
BLOCK WALW_-. . y
t';"lJ�i9'Gl� Ce:51S,'a'Yi':d)'G`l!'I�73v is�5.t�ll,Sl� '
:STWXXI.43) COST OF CONSIrMUM10N
6,223.
A EIW yhJxRtrMy
.
i'O1J'`,I'IPUCT)CY a FFM 101_000.41€ -ow
PN:A1+ (1143 11 EE
MECHA, FEE 101-000421-000! mso;
PLIUMB3140 MIR 148,00
STIL .1140 A94JR'3CJ?Y k" +. 38k?A i1.1 .' D 130-24. e 'ii.b2
t
ORAK?C:klti ,FW,
SEP 14.2001
CITY OF LA RUINtlt
FINANCE DEPT,
.._,_._sr
'SUB- CT1 AT, MINIM :t)'(MON ,AM PLAN CHEC,X
�%3t's.t15
LFW PRE-FAIDM<?S:"
�i.e3fi3
• . TWO x19.5.1 8 EXTRU ' TF 731 eed D VE N0 W
! e�0 aS7y67
RECEIPT
DATEJ BY
DATE FINALED
INSPECTOR
J, 1E f ! r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
_
Underground Ducts
Forms & Footings
9_
��
Ducts
Slab Grade
vv
Retum Air
Steel
Roof Deck
_
C4
Combustion Air
Exhaust Fans
_
O.K. to Wrap/�
�_
F.A.U.
Framing
Compressor
Insulation
-
004
Vents
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
_
&P.
Drywall - Int. Lath
Final
7;_A// 6
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.
Waste Lines
_
��
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
`�/Tae
Encapsulation
Gas Piping
iih-----
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)
Bin #
b
Permit #
Project Address: g0
//
A. P. Number: "/4 /_
City Of La Quinta
Building 8i Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777.7012
Building Permit Application and Tracking Sheet
tE( U1 5—:� Owner's Name: ( �
0 3 Address: �� --(�g� 7�Hff UIET--�,
City. ST, Zip: 6,6,t�, �jl�i� CIOL
Contractor: F:;:eD�—Telephone:
Address: 79�i� pp Project Description: ��j( 4--D1�
City. ST, Zip: L,;--- fit%( %L-('��.
Telephone: -7
7
l
State Lic. N: X684 05- 7 City Lic. #:
Arch.. Eng esigner: 0� 'F1
Address: �—1 ��j 2s ���TG —7
City. ST, Zip: - C� 9zz�
Telephone: `
Z
State Lic. #:
Name of Contact Person:O
Telephone # of Contact Person: 77
Construction Type:
Project type (circle
Sq. Ft.:
Estimated Value of
vStl,
Occupancy:
=i�e%%! Add'n Alter Repair Demo
# Stories: 1— # Units:
ect:
#
3
Submittal
Plan Sets
Calcs.
Truss Calcs.
Title 24 Calcs.Plans
APPLICANT: DO NOT WRITE BELOW THIS
Req'd Rec'd TRACKING
Plan Check submitted
Reviewed, ready for corrections
Called Contact Person
picked up
LINE
8
PERMIT FEES
Item Amount
Plan Check Deposit
Plan Check Balance e
Construction
jStructural
Flood plain plan
Grading plan
Plans resubmitted
2"a Review, ready for corrections/issue
/
Mechanical
Electrical '
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Planning Approval
'"' Review, ready for corrections/issue
Called Contact Person
Developer Impact Fee
A.I.P. P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
F]
Notice:
Document Cannot Be Duplicated
Date 9/6/01
No. 22463
Desert Sands Unified School District
47-950 Dune Palms Road
La Quinta, CA 92253,
760-771-8515
CERTIFICATE OF COMPLIANCE
Jurisdiction
owner NameM & M Phil Schaefer
No. 80-089 Street Riviera
City La Quinta zip 92253
APN# 761-480-031
Permit #
Log #
Study Area
Tract # Lot # Square Footage. 465
Type of Development Residential Addition No. of Units 1
Comments
Casita Addition (Detached) of 465 sq. ft.
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X . 465 or $ 953.25 the property listed above and that building
permits and/or Certificates of Occupancy for this square footage in this proposed, project may nowabe issued W
Fees Paid By CC / 1 st Bank - Bob Edwards Telephone 760-775-7933
Name on the check
By Dr. Doris Wilson '
Superintendent 4 r v� j�T.-.:4 .'
Fee collected /exempted by Annette Barlow Payment Received $953.25
�
Signature 7 �� Y;��V(/
Check No. 59925
IOTICE: 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
bove 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
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
August 16, 2001
Mr. Philip Schaefer
4101 S. Tacoma Way
Tacoma, WA 98409
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Reference: 80-089 Riviera, La Quinta, CA
Architectural Change Request — Addition of Barbecue, Pool, Spa and Casita
Dear Mr. Schaefer:
The Architectural Committee reviewed your resubmitted plans to add a barbecue, pool, spa and casita at its
August 14, 2001 meeting and approved your plans with the understanding, based on a conversation
between Carol Fuller and Pat from California Pools, that the- wall height nor the water feature exceed 27" in
height. Please resubmit a drawing showing this measurement.
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 Committee's decision with regard to project design will be final. Please refer to
the Architectural Rules for all required submittals.
Please contact Raphael Villareal, 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.
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.
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 II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File
City of La Quinta
Developers Project Approval Form
Prior to the issuance of Building Permits for the project listed below, the following Departmental
clearances must be obtained. Please return this form to the Building and Safety Department only
after approval. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Detached Guest House
80-089 Riviera
Applicant Contact: Bob Edwards 775-7933
Application / Circulation Date:
8- .2� -o /
Date
Community Development Department
d T F74c 1 -ti -b
Christine di Iorio, Plann ng Manager D _ ate
Public Works Department
Steve Speer, Senior Engineer
Building and Safety Department
Greg Butler, Building & Safety Manager
Date