9811-134 (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
6849-5 % I3 l�
ate !� Signature of Contractor r.?
V 9 —-L,
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.
STA1'E r€IIVV 2_"_000X013
(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 s' all f rthwith comply with those prQvis�ons.O }
Date: Applicant 1%j"&/ .C•i/
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. K d
1. Each person upon whose behalf this application is made & each person at I
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 fDir, rii sp e'tion purposes. ,
Si�ature (Owner/Agent) +,t�-rr { •f -Date `S-�1
y w e c i-�:.. c✓ s
BUILDING PERMIT
PERMTN;
99114
0 LOT
DATE VALUATION 7265
TRACT
JOB SITE —
ADDRESS 57-427 RIVIERA
'%bpi-at>�l-Oie
nfli"
OWNER. jJ
JC
CONTRACTOR / DESIGNER / ENGINEER
CHARLES COOLS
BOB E1: WARDS rONai'12LiCTION
37427 RIVIERA
79.!)20 FIESTA DRIVE
JA QUINT.A CA 92251A
VA nUIN1'A. CA 92n3
(76{11775-7933 CI3I,ff '3212
USE OF PERMIT
R S.IDEN 1AL Ai)U�'!ON
350 S.F. A, I TtkC:IM) GUESTHOUSE
Cilli`t'OA4 CON�i rR.UCT11't�:.i�T 350.00 3W.
ENT1!MATEDWw4il''01 pNST-RUIGTIC :r
27,`af;W,91
PERMIT VCR, SUMMARY
t•,V)N. 11tL C"I10N FE 101-000-418-000
P:f,.AKd14r, K.§•,t„i3 1014W -439-31R
1 17xi 101 -00"0.1121 -gilt!
$39. 0
WIA,; RICAL FEE WI -IC -Q-420-000.
$27„ d5
, e,o- t47i't(• E)•rt*f."t'f' owl I f._F_ - PtEl1'n 101 -W -24114 X)
firr
f.tl�,lf�l.ivCl.I~1✓�. y .� lU�-t�Al.�"4�101�V
ep$((:.,^3
D4V.t�r�
a
P. €i-`I'i`►"V f,0WNKIR 11`:'I I N1 !SND P AN C I-1Ei1:,►e'.
�f33 F�7
LESS
2 1998
PRF -PAID FEES
$0,00
��V
- =J)TAL .PjC .11' Ei'H.FN
DUE NOW
$03.67
FS`
1 ��,,�� Y
�.
F
i
�
.f 5 Ate, ..
RECEIPT
r
DATE
BY ! '�' �.,,r
DATE FINALED
INSPECTOR
I
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
le
Underground Ducts
Forms & Footings
IzZDucts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
y Q
Exhaust Fans
O. K. to Wrap
40 a a z
F.A.U.
Framing
Compressor
Insulation
Zk124 e -IL
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation .
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
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
/. ,30 -
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: '
Final
Utility Notice (Perm)
COMMENTS:
!w LICENSED CONTRACTOR DECLARATION
U) I hereby affirm under penalty of perjury that I am licensed under provisions of
F— Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
W Professionals Code, and my License.is in full force and effect.
M License k• Lic. Class Exp. Date
W 684857 B 3/31/00
Z r, Date Signature of Contractor
,O�
H OWNER -BUILDER DECLARATION
WI hereby affirm under penalty of perjury that I am exempt from the Contractor's
a License Law for the following reason:
Z( ) 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).
C0 () I am exempt under Section , B&P.C. for this reason
NDate Signature of Owner
O a,
Q WORKER'S COMPENSATION DECLARATION
CL CL Z I hereby affirm under penalty of perjury one of the following declarations:
' O () 1 have and will maintain a certificate of consent to self -insure for workers'
W �= compensation, as provided for by Section 3700 of the Labor Code, for the
�
Q performance of the work for which this permit is issued.
% U U ( ) 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
rn H permit is issued. My workers' compensation insurance carrier & policy no. are:
v Z Carrier Policy No.
ob O STATE FUND 229-9840009882
J (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
3 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, 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.
certify that 1 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 PERMIT#
9811-134
_
DATE VALUATION 527 moo LOT TRACT
W�
�1y5q
JOB SITE
ADDRESS �TIERA
APN 761-560-012
OWNER ' /
CONTRACTOR / DESIGNER / ENGINEER
CHARLES GOULD
BOB EDWARDS CONSTRUCTION
37-427 RMERA
79-920 FIESTA DRIVE
LA QUINTA CA 92253
LA QUINTA CA 92253 d
(760)775-7933 CBL# 3212
USE OF PERMIT
RESIDENTIAL ADDITION
350 S.F. ATTACHED GUEST HOUSE
CUSTOM CONSTRUCTION 350.00 SF
ESTIMATED COST OF CONSTRUCTION
27,265.00
PERMIT FEE SUMMARY
CONSTRUCTION FEE 101-000-418-000 $271.50
PLAN CHECK FEE 101-000-439-318 $223.19
MECHANICAL FEE 101-000421-000 $39.50
ELECTRICAL FEE 101-000-420-000 527.25
PLUMBING FEE 1014110419400 $49.50
STRONG MOTION FEE - RESID 101-000-241-000 $7.73
GRADING FEE 101-000423-000 $20.00
SUB -TOTAL CONSTRUCTION AND PLAN CHECK
$633:67
LESS PRE -PAID FEES
$0.00
TOTAL PERMIT FEES DUE NOW
5633.67
1
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
09
(Il
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
Date 11/25/98
No. .18048
Owner NameCharles Gould
CERTIFICATE OF COMPLIANCE
N
APN # 761-560-012
Jurisdiction La Quinta
Permit #
No. 57-427 Street Riviera Log #
City La Quinta zip 92253, Study Area
Tract # Lot # Square Footage 350
Type of Development Residential Addition
Comments
kddition of attached guest house
No. of Units
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 .
I *14A►M
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X ,350 or $ 0.00 1 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 N/A
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by ' Ellen Patino
0
Signature
Exempt
Telephone' 775-7933
"r 4
r7' ry A
$0.00
Check No. N/A 1.
40TICE: 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 sssued or on which they are paid to the District(s) or to another public entity authorized to
bllect 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
J
ro
NVU-20-98 FRI 1:54 PM r:4HAR".H GROUP
PGA W, EST.'m
November 4, 1998
Mrs. Elaine Gould
57-427 Riviera
La Quinta, CA 92253
RE: Architectural Change Request
Dear Mrs. Gould:
FAX N0. 619 77'6 5111 P. 1
5
i
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA. CA 92253
(760) 776-5100 FAX (760) 776-511 l
The Planned Unit Development Architectural Committee has reviewed your plans for a
room addition t your PGA WEST home. We are pleased to inform you that your
application has been approved. Please contact Miguel Valenzuela at (760) 399-1844 to
coordinate any irrigation changes that are needed.
Please note that this approval is good for a period of six months and will expire on May
4, 1998. Please contact me at (760) 776-5100 to coordinate an inspection of your
improvement and the refund of your performance deposit.
Sincerely
John J. Monahan
Association Manager
CC: Unit File
Board of Directors
01
BOB EDWARDS CONS MUMON i
cowrQAc ,s S!M K rwww +Ieomy
79-920 Piesen Drive
Ln Quints, Odif mis 92293
(760) 775-7933 - (760) 775-9993 ftz
December 29, 1998 R
city or La Quinta
Mr. Mark Harold
Department of Building and. Safety
78 495 Calle Tampico
La. Quinta, California 92253
Dear Mark,
Pursuant wi*similar request for sewer variance on the hook up of a guest
house bathroom to an existing sewer -line. The guest house at 57-427 Riviera
has RI .6 gallon toilet as does the .main house. These guest houses are used
only a few occasions a year and in the past the City has allowed us to connect
our sever line to the existing sewer. i would request that variance for this
property as well.
Thank you.
Respeetfully,
Bob Edwards'
lays