0101-0251 (PATIO)79816 Arnold Palmer
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT
FPERMIT#
I hereby affirm under penalty of perjury that I am licensed under provisions of
es—' Chapter 9 (commencing with Section 7000)of Division 3 of the Business and DATE VALUATION LOT
TRACT
C'4 W Professionals Code,and my License is in full force and effect. 9 (;;f_ ?,
License# Lic.Class Exp.Date ' l •
-LU1JOB SITE r/• ADDRESS
APN
- - -4 ,, : 1 C ff . t` , . r Z:^__
}`i : {bt q9431.19 . 9' }1.a . , / ..L': + , .i _ ..
Z t- Date! ,11 Signature of Contractor i '"y`f ^ '' `"'" :^_ OWNER CONTRACTOR/DESIGNER/ENGINEER
O V
J U OCD WNER-BUILDER DECLARATION ORgr&..DMIAhOL1.4"W BOB M—WA MIq C:rNMUMIC 1
d I hereby affirm under penalty of perjury that I am exempt from the Contractor's 7983 16 ARNOIX PAU& 9-920111% OV
License Law for the following reason: I AQUYNIV';. CA 9:12'53 7..f1 QL' 1E2K`A CA. 92253
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 ?SOi? t97,3 E'3`L" ` 3212
sale(Sec.7044,Business&Professionals Code). USE OF PERMIT
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the project (Sec. 7044, Business & Professionals PATIM
x
Code).
co () I am exempt under Section B&P.C.for this reason ROOM 10€` ',~i:d.011O d UNDER tX1ST1NG ROOF STMC 'V''17ME.WO Si7`t`'ZIC`PU)'u :1,
_.O N„ Date Signature of Owner .4 aTvlt3 O€SDUC E V RP) . S' k ;P,TION
rn
d Q WORKER'S COMPENSATION DECLARATION
C) Z I hereby affirm under penalty of perjury one of the following declarations:
Lo O ( ) 1 have and will maintain a certificate of consent to self-insure for workers' PATIO COMERSION 70100,s;p
X Lu = compensation, as provided for by Section 3700 of the Labor Code, for the
O Q performance of the work for which this permit is issued. ,
CIO Q C) ( )` I have and will maintain workers'compensation insurance,as required by
O U Q S ction 3700 of the Labor Code, for the performance of the work for which this
Il Z permit is issued. My workers' compensation insurance carrier & policy no. are:
oD Z Carrier Policy No.
CA,IN,DRUNI'%'.rt'143 W180104-13D EGIUMI E D COST OF C.O.1'dEMUMICIN
Q (This section need not be completed if the permit valuation is for$100.00 or less).
-J ( ) I certify that in the performance of the work for which this permit is issued, P1 4N-IFIC K) 101•f r rn y, 533.10
I shall not employ any person in any manner so as to become subject to the C%3NYMUC`7'1CYN ME 101-000-4113-000 $54.00
workers' compensation laws of California, anWagree that if I should become f" l r " ')C c.Fz 101.000.420>000 $11;3
3 subject to the workers'compensation provisions of Sectiori 3700 of the Labor c , tFr.
.TRONO MOT if.)2 `ID Z C 1-sJt ti-2s&t 4►Q ,
Code,I shall forthwith comply with ihose provisions. ! >j
Date::!122// 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
6
addition to the cost of compensation,damages as provided for in Section 3706 1
of the Labor Code,interest and attorney's fees. 2 L `LOO '
IMPORTANT Application is hereby made to the Director of Building and Safety JAN
for a permit subject to the conditions and restrictions set forth on his e
application. 1' V 4
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 °. )gS-'1 tAaL.C91t 11 RC:1 TC? d 3AI.AT ("11t. 1(3 .:i
any permit issued as a result of this applicaton agrees to, &shall, indemnify a U=1 PRE,,,T ALD FIRMS
& hold harmless the City of La Quinta, its officers, agents and,`employees.
2.Any permit issued as a result of this application become's null and void if
I
Work is not commenced within 180 days from date of issuance"of such
C' ' 'lt i' `'`b 1 .;4;t
permit, or cessation of work for 180 days will subject permit to cancellation.
1 certify that I have read this application and state that the above information is IIIIIIIIIIIIIIIIIIIIIIIII
• correct. I agree to comply with all City, and State laws relating to the building 19
construction, and hereby authorize representatives of this City to enter upon IE
the above-mentioned property for inspection purposes. -
RECEIPT DATE ' } BY ^I DATf fINAL D INSPECTOR
Signature (Owner/Agent) f{ f ? -\4fr / bD77ate
V
`i r
INSPECTION RECORD
OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR
BUILDING APPROVALS MECHANICAL APPROVALS
Set Backs Underground Ducts
Forms&Footings /_2 Ducts
Slab Grade �/ 4Return Air
Steel Combustion Air
Roof Deck Exhaust Fans
O.K.to Wrap F.A.U.
Framing � Compressor
��
Insulation '7 3 Vents
Fireplace P.L. Grills
Fireplace T.O. Fans&Controls
Party Wall Insulation Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall-Int.Lath
Final
Finat �/0�0� !(��jpyl�OD`� 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
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 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 Power
Final
Utility Notice(Perm)
S
LICENSED CONTRACTOR DECLARATION BUILDING PERMIT ' PERMIT# `��
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 DATE VALUATION LOT 0101-251 TRACT
"Professionals Code,and my License is in full force and effect. �a�g;0 Q0ry1�
License# Lic.Class Exp.Date APN �I
JOB SITE I
ADDRESS
684857 B IRC 03/31/2( 79-816 ARNOLD PALMER - -
OWNER _ CONTRACTOR/DESIGNER/ENGINEER
Date Signature of Contractor
OWNER-BUILDER DECLARATION GEORGE&DIANA HOLLAND BOE EDWApoS CUNSTRUCTiON
I hereby affirm under penalty of perjury that I am exempt from the Contractor's 79816 ARNOLD PALW_R 79-920 F1&3 T-A i D FJ V E
License Law for the following reason: LA QUINTA CA 92253 LA QUI TA CA 92253 ('
( ) I, as owner of the property, or my employees with wages as their sole (760)775-7333 CBL# 3212
compensation,will do the work,and the structure is not intended or offered for
sale(Sec.7044, Business&Professionals Code). USE OF PERMIT
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct the project .(Sec. 7044, Business & Professionals RAXIO !� 1
Code). ROOM EXTENSION UNDER EXISTING}ROOF STRUCTURE. NO STRUCTURAL
() I am exempt under Section , B&P.C.for this:reason FRAMING REDUCE FENESTRATION
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
j ( ) I have and will maintain a certificate of consent to self-insure for workers' PATIO CONVERSION 70,00 SF
compensation, as provided for by Section 3700 of the Labor Code, for the
1 performance of the work for which this permit is issued.
j ( ) I have and will maintain workers'compensation insurance,&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:
CarrierPolicy No. ESTRI&ATED COST OF CONSTRUCTION 2,870.00
j CA I'NDEMNITY INS N805'727313
7 PER=FEE SUMMARY
(This section need not be completed if the permit valuation is for$100.00 or less). PLAN CHECK FEE 101-000-439-319
( ) 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 C014STRUCTION FEE 10 1-000-41 18-0010 $54.00
workers' compensation laws of California, and agree that if I should become ELECTRICAL FEE 101.000-420-000 $15,75
subject to the workers'compensation provisions of Section 3700 of the Labor STRONG IVIOTION FEE- RE-SID 101-000-241-000 x.50
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
Fir application.
1.Each person upon whose behalf this application is made&each person at SUI;-TOTPZ.•CONSTRUCTION AND PLANT CHECY $105.35
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 LESS PRE-PAID FEES $0.00
& hold harmless the City of La Quinta, its officers, agents and employees. I
2.Any permit issued as a result of this application becomes null and void if TOTA-T,PE_R_MTr FEES DVE 05.315
work is not commenced within 180 days from date of issuance of such
4 permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is IIIIIIIIIIIIIIIIIIIIIIIII 21
correct. I agree to comply with all City, and State laws relating to the building IE
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. RECEIPT DATE BY DATE FINALED INSPECTOR
Signature (Owner/Agent) Date
Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document Cannot Be Duplicated 760-771-8515
CERTIFICATE OF COMPLIANCE
Date 1/23/01 APN# 775-241-074
No. 21548 Jurisdiction La Quinta
Owner NameGeorge &Dianna Holland Permit#0101-251
No. 79-816 Street Arnold Palmer Log#
City La Quinta Zip 92253 Study Area
Tract# Lot# Square Footage 70
Type of Development Residential Addition No.of Units 1
Comments Patio Conversion- room extension under existing roof structure, no structural framing.
At the present time, the Desert Sands Unified School District does not collect fees on garages/carports, covered
patios/walkways,residential additions under 500 square feet,detached accessory structures or replacement mobilehomes. It
has been determined the above-named owner is exempt from paying school fees at this time due to the following reason:
Residential Addition 500 Sq Feet or Less
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 70 or$ 0.00 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
y�
rt
Fees Paid By N/A- Bob Edwards T-elephone' 760-775-7933
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected/exem ted by Annette Barlow Exempt $0.00
. Check No. N/A
Signature
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 sssued or on which they are paid to the Distdct(s)or to another public entity authorized to
collect them on the Districl('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
1
••vii 1.
\GAWS■
11"Wom Aasocu 101.tile.
March 7,2000
J.Nelson&JoanD.Hoffman
P.O. Box 7000
Snow M.Village,CO 816.15
Dear Mr. and Mrs.Hoffman:
Your request-for an architectural variance has been approved by Mr. Don Adolph.Architectural
Committee Chairman. Specifically, you have the approval to proceed with the construction of a
casita in the front courtyard of your 79-794 Arnold.Palmer residents. Upon completion, please
submit the enclosed Notice of Completion form to this office.
We reserve theright to make a final inspection of this change to make sure that it matches the
original request. An approval is based only on the aesthetics of your proposed plan and should not
be taken as any certification as to the construction worthiness or structural integrity of the proposed
change.
We appreciate your cooperation in submitting this request for approval. If I may be of further
assistance,please contact me at the HOA office,(760)771-1234 extension 15.
Sincerel ,
Kel4AcGalliwd
Operations Manager
cc: Architectural Committee
enclosure(1)
P.O.Boot 1060, La OWnta,California 92253.Te"hone 76+'-:71.1234 FA '3: _.