11817 (AR)s P.O. BOX 1504 N o .
Building 5�i^ 7Qi@Z��X3 78-105 CALLE ESTADO
Address LA QUINTA, CALIFORNIA 92253
Owner
Alen 11. Johnson
Mailing
Address coo VtV Architecture
City Zip Tel.
Pala: Desert., C.� 92260 _ .775-'-4b2
Contractor _
Address -
41-651 Corporate tray
City Zip Tela
Palm Desert, C:3 92260 779-9498
State Lic.' , ' . City
& Classif. S: 263228 Lic. #
Arch., Engr.; .
Designer, Vt Arehitectore
Address.-.- Tel.
41--905. Boards alk Ste. T 776•-4632
City + t Zip State,. -,Ar
Palm vest,, , C �,t;i"92260 Lic. # C_19e10
LICENSED CONTRACTOR'S DECLARATION.
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
70 0)
of Division 3 of the Business and Professions Code, and my license is in full force and
effect
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from'the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city orjcounty which requires a
permit to construct, alter, improve, demolish, or repair any structure, l prior to its issuance also
requires the applicant for such permit to file a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
> Division 3 of the Business and Professions Code, or thathe is exempt therefrom, and the basis
for the alleged' exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ 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, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or improves thereon and who does such work himself or through his own employees,
provided that such improvements are not intended or offered for sale. If, however, the building
orimprovement is sold within one year of completion, the owner -builder will have the burden
of proving that he did not build or improve for the purpose of sale.)
0 I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
O 1 am exempt under Sec. B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
1 hereby. affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No.' Company
o�y its filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
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.
Date Owner
NOTICE TO APPLICANT: If, after making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder is suspended for 180 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant~ -Date-
Mailing
ateMailing Address
City, State, Zip
a.6
�P
11817
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description '235 s s f . wood frame and stucco
Project Description addition to existing bedroom
with a clay rile roof. '
ji�. yLf APj1S;�SpyI.-..i ~t.5y .IZ
•
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date
Validated by:
Validation:
Permit
I
Sq. Ft. 235
Size
No.,
Stories
No. Dw.
Units
New ❑ Add
Alter ❑
Repair ❑ Demolition ❑
;f
;t
Estimated Valuation
$17,39€3.00
PERMIT
AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const.
X3`3. t3S7
Mech.
21.0 U
Electrical
Plumbing
.S.M.I.
. €3
Grading
Driveway Enc.
Infrastructure
TOTAL
1 • d
REMARKS
ji�. yLf APj1S;�SpyI.-..i ~t.5y .IZ
•
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date
Validated by:
Validation:
Permit
I
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING Fr-cS
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE
t�
BONDING
HEATING (ROUGH)
2ND FL. SQ. FT.
FORMS
YARD SPKLR SYSTEM
POR. SQ. FT. ®
MOBILEHOME SVC.
BAR SINK
GAR. SQ. FT. ®
POWER OUTLET
ROOF DRAINS
CAR P. SO. FT. ®
OTHER APPJEOUIP.
DRAINAGE PIPING
WALL SQ. FT.
TEMP. POLE
DRINKING FOUNTAIN.
SQ. FT. ®
GROUT
URINAL
ESTIMATED CONSTRUCTION VALUATION $
FINAL INSP.
WATER PIPING
NOTE: Not to be used as property tax valuation
WATER SYSTEM
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.000L HOOD
SIGN
WASH ER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRYTRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SPARK ARRESTOR
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
LATHING
SO.FT.GAR ® 3/ac
HOUSE SEWER
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEF7 PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK
GROUND PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCKSTORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ -Plus-X$-=$
LUMBER GR.
FINAL INSP.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATIONISOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL
x Y SLUR I SE COMPANY
DATE
0 2-40
:
HOMEOWNER APPLICANT NAME (S)
ADDR7 S - .% 5 a 1
; 47 5-93 ; 1:577 ; 5682144-
ARCIII`iIs;CT` IRAL APPROVAL APPLICATION
♦ ., vim'
ALL CONYMUMON DEBRIS CR13AIMD BY T111S MODIP1CAnON
MUST BE REMOVED FROM TI1$ COMPLEX DAILY
V)
-7 717 .3 5 2.G
(PRIMARY RESID
- 6195648487;= 2/ 2
F.SO N
IA
(PGA W
(LONG DISTANCE)
rOA WEST ADDRESS 4/30 V c
T1LA LOT
r,
MODIFICATION (S)
WORK SCHMULE COMMENCEMENT DATES ��A t' ,L� �4 �(j(+ PL nON BATE
CONTRACTOR (S7
TO TI -III ARCHrMCI'UItAI, COMMITTEE -
You are hereby advised that the above work is proposed find approval Is requested. Attached Is a drawing of the work to be done and types of materials to be used
Indicated on the drawings, We understand that building permits (of home Improvements are required by the City of La Quiets and that the cost of the permits or
responsibility of obtaining permits and subsequent Inspection will be borne by the applicant,
We acknowledge that all approved changes In the original design will be at our expense; that any and All damage to building structure, or other damage resulting fro
the construction of the proposed Improvement shall be it our (owner's) expense. Additionally, any maintenance of the petmittcd improvements shall be at the appticaw,
c.+rpense and the applicant agrees to hold the PGA West Residential Association harmless for the cost of maintenance of same. Homeowner agroeg to indemnity, deter
and hold harmless PGA West Residential Association, Its officers, agents and employees from any liability arising from execution of this application.
Signaurrta of
all owners Af/
ARCHt?MCTURAL CONTROL COMMnTER
APPROVED CONDITIONALLY APPROVBL) X DISAPPROVED
REASON POR CONDMONAL APPROVALOR DISAPPROVAL NIB 7Z) a dOAJAr-ever` o AJ RA& rJLj}yyo A).$
6MU7—kP 7b ! JS AfA, amzo A)
/e) ;36 - 9
ARCI);ITVCT'URAL CONTROL COMMUTES CHAIRMAN
In addition to this approval, you must obtain City approval for the requested modification as welt as any other accessary building permits. You are required to subrr
evidence of the Association approval to obtain the building permit. For this purpose, all blueprints and plans will be embossed with the Assoeiation,a teal, the signatu
of the Property Maaagef, and the date of the approval.
COMPLEMON WORK SIGNED OFV BY
f ' .
" � ►�,Y :SUNRISE CUNIPANY ; 47 5-93 ; 1, 55P14 5682144 6195648487; � 1/ 2
�. TRANSMITrAL COVER SHEET
DATE: April 54, 1993 -'
SUNUSE NUMBER OF PAGES: 2
C O 111 P A NY ( including cover)
SENT TO: Kelly BENT BY: Mary Drury
COMPANY NAME: City of La Quinta DEPARTMENT: Executive Office
FAX NO.: 564-8487 FAX NO: (619) 568-2144
TELEPHONE NO.: 564-2246 TELEPHONE NO: (619) 568-2828
TELECOPTER OPERATOR: M. Drury
REGARDING: Addition to Johnson Home/56-750 Merion - PGA West
Attached is the approved application as requested.
If you do not receive all the pages, please call back assoon as
possible at (619) 568-2828 and ask for the telecopier operator
listed above.
¢2-600 Cook Street, Suite 200, Palm Desart, Califors:ia 9.2260, Telephone (619) 568-2&)s
Builder of Amvirn's i'tnest Cuiihtry C)uh Cnw,muniffes