0009-075 (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
6114 Y7 Bt
mc_
t 12
Date/' h Signature of Contractor,✓JS.a�^'
�a✓
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
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
{It111M"AMITY INS W801'7273II
(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, avid agree that if I should become
subject to the workers' compensation pr(pisions of Section'3700 of the Labor
Code, I shall forthwith comply with those pr visions.
Date: t/A - �i—i Applicant+j,,-, 1 1161,%tr.£4s
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 hist
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,ins eection purpo `es..
ignature (Owner/Agent)4 �iva.ss'- � a. "o Datew .
BUILDING PERMIT PERMIT #
DATE VALUATION LOT TRACT
J /
JOB SITE d
APN
ADDRESS
OWNER
CONTRACTOR /DESIGNER / EN INEER
DAWD MAMON.f4LD
BOB FiDWMVS CONSPRL7ME014
80.356MVIR..
79^9201:iS�'�"i'.�DFJVI. `
1;A QiJl;`nk CAA 512258
LA. T,A.� 4"'.r'��^��9y2253
•
j��lU7.J^.�)P
ry y+V]
(9 60Y? O N °' T Y 3 J �.Iid.AJY� 3212
d 2
USE OFF PERMIT
( Q
C.f'.:RTAS lt:30M AD'I7f. ION ,. M.A."THR. 8197)IZ,1OM 1F.X'V. ANS1UX (N94 3F..
CVI STOW CiiNXTRUCTION Ww 3F
EnT'I uD cour Or cosintua['.I. iq
4097.60
FERUMFEW SUMMARY
C"014MUCTION FEE 101-M -416-000 1393.00
F?IIL&N CHECK DIM 101-000-439- 318 V,40.5e
MECI1AMICA L PEP, 101--000-423-000
81930,50
i?I:.FV.:1.TRICAJ',, Y.7%. .101 i11)� 0551.79
km'11.40 Pat 0.1.000- •19.000 346.531
`;7'Rf�1;�83 :tJ4Ca�'Ya;il� 1~'i+,E: • ffF�;IU 1 �?1-t)C3(3-��11-f3�'t �l.fti
GRRaT,MO fit' 101,000-423-000 $QEi,lig
f
SU./3ID..}. C'9,7.-• l;()N Ch.T; C -MOR AI7I-) PIA'M 1011EIC .
$868.04
m : i�wlxD 1R.&4PAD) :1. Z
$0.00
RECEIPT
DATE A BY
DATE FINALED
INSPECTOR
r
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms& Footings
/ /
Ducts
Slab Grade
_
`�
Retum Air
Steel
Combustion Air
Roof Deck
/
Exhaust Fans
O.K. to Wrap
_ _ _
�l/�/�
F.A.U.
Framing
_ _
�Q!/� _
Compressor
Insulation
/� 5'
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wali Insulation
Condensate Lines
Party Wali Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final
_
00-
POOLS - SPAS
BLOCKWALL
APPROVAL:b
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Waste Lines
�Q�/O0 m
Electric Final
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Sewer Connection
_
_Z/0.M*
;—E -T
Pool Cover
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 Powe
Final
Utility Notice (Perm)
. .. ........
City of. Quinta
Building a Safery Division
P.O. Box 1504
Pennif.#
78-495 Calle Tanipico
La QuinEa, CA 92253
Building Permit Application and Tracking Sheet
Project Address: Qcl�
Owner's Name: L
A: P. Number: 580 -o 1 '5
Address:
Legal Description: Let VeJiAor
28540-2--
Ciry,ST, Zip: (Q,
Contractor:
Telephone:- '.--
Address:e
3k, ;VCFJ20
Project Description:
City.ST. Zip:
Telephone:
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CA JAA6T9 P— 6&pecotA
Statel-ic.#:
gity Lic. #: -?24 e-
tt
r-YAAASIA �E;94 .507- TOIA t.
Arch.. Etter- Designer:
7�
Address:
City, ST. Zip:
Telephone:
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Construction Type: Occupancy:
State Lic. 9: S-SOLO
...............
<e -�f): New Add'n Alter Repair Demo
Projept (circl�.o
Name of Contact Person: -
Sq. t.j
# Stories:
# Units:
Telephone 0 of Contact Person: 7 75
Estima`t�ee of Projecti: 4; 4'- L LI) 0. 0
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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 . 10/10/00. w
No. 21068
Owner NameDayid MacDonald
No. 80-336 Street Riviera
City La Quinta
APN # 761-580-013
Jurisdiction La Quinta
Permit #0009-075
Log #
Zip 92253 Study Area
Tract # Lot # Square Footage 594
Type of Development Residential Addition
Comments
ition is a casitas room addition & master bedroom expansion.
r
w
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:
EXEMPTION NOT APPLICABLE
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
2.05 X 594 or $ 1,217.70 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 CC / 1 st Bank / Bob Edwards ;Telephony; 766--775-7933
Name on the checkf; =-
ByB Dr. Doris Wilson
fy ..
Superintendent
Fee collected /exempted by Annette Bartow
Signature
Payment Received $1,217.70
Check No. 56474
OTICE: 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 DeptJApplicant Copy - Applicant/Receipt Copy - Accounting
.4
z
May 23, 2000
PGA WEST II RESIDENTIAL ASSOCIATION, INC. .
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX (760) 776-5111
Mr. David MacDonald
966 Hungerford Drive, Suite 16A
Rockville, MD 20850
Reference: 80-336 Riviera
ArchitecturalChange Request — Bedroom Expansion & Ca
sita Addition
Dear Mr. MacDonald:
The Architectural Committee at its May 9, 2000 meeting has reviewed your plans to expand your
bedroom and, add a casita: The committee unanimously approved your application for both
projects.
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 PUD Architectural Guidelines and Application for
Change 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. Upon completion of changes, please contact Carol Fuller. 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.
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 'NEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board' of Directors
Unit File
City o La uinta
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-agly
q terroyal. Contact applicant for resolution of conditions preventing or delaying approval.
Project: Casita addition & Bedroom expansion - 80-336 Riviera
Applicant Contact: Bob Edwards - 760 775 7933
Application / Circulation Date: !r" d
Date
Community. D v opment Department
Christine Di Iorio, Planning Manager Date
Public Works Department
Steve Speer, Senior Engineer r Date
Building and Safety Department
Mark Harold, Building and Safety Department Manager. Date
Health Department
Fire Department
Schools fees Paid
Date
Date
Date
J. .
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
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑ OTHER J
JOB LOCATION
t
D
-2
(
REPORT SEOUENCE NO.
TVP OF S UCTURE
;'0G—�-� s
PERMIT NO.
—G 6
DATE
DAY OF WEEK
MATERI L DES
IPTION:
ARCHITECT -
IN PECTOr
NRS. CHARGED
�� • AJW
ENGINEER -
12 '
1AA
ASSISTANTS
MRS. CHARGED
INSPECTIO .GENERAL'
DATE
r r+� - ... SUB
`CONTRACTOR "CONTRACTClR
o
U
•
Y
� -
4
' COPY SENT TO CLIENT Oy
CON DON NEXT P
E
PAGE OF
CERTIFICATION OF COMPLIANCE', A
I HEREBY CERTIFY THAT I HAVEdNSPECTED TO THE BEST OF MY ''' SIG ATURE F REGISTERED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE _
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED `G 6O 5D37®3O
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE ` _
GOVERNING BUILDING LAWS. r DA OF R PORT REGISTER NUMBER