GRES (0302-048)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
�✓� W 857x3 zY' r1.2C
Die 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:
( ) 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 jyt,o ; ployeso ftls Policy No. Wuja1e9N0_3
(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 lo the workers' compensation' pr'rovisionst'of Section 3700 of the Labor
Coode�„J ¢hall forthwith comply wiith,thosetp,&ovlslons.
,Date; JJ t�! ? Applicant '�a�
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.
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 forinspection•purposes.
"'Signature (Owner/Age',t)(• := •.-- '` ` � Date,
BUILDING PERMIT PERMIT#
DATE VALUATION LOT TRACT
94,x.1.4. 1 2,5499-.1
JOB SITE
ADDRESS
APN
OWNER
CONTRACTOR/DESIGNER/EN 1NEER
LAQ1,1lVrA. CA 92233
'i A`Q)TRNI1A CA 92253
�ci�i�?5•5�2. �
USE OF PERMIT
CARAC}1t.Ofit CATZIP ?RT
6tff,'I V CART OA,.R. CILt ADDII.1O14 ( 10 2.1i)/HOA.APPROti AXE C:" 141"10AXD. .
fits!&C11 ICARPOR T 24100 I'#f+'
MAW FM? SX71♦19MsbRY '
CONSTRUCTION 1`B.% 101.000.418.000 0a
Pl.Aed CH:VXX "T.; 3601-000.439-3`8 $56.31
,VLEC'i'PIC&L "LO 101.000.420.0017 $19.30
TR.ONO!!6CJ` IONP �RF..SItj 10#.-Ori0-24'-1-00 $.sus
Liii I3�if} 1'aC i 101.000 '�jt -01) i e Y a
s
�J
16�
FEB 10 1003
CITY OF LA QUINTA
FINANCE DEPT.
92 MA-TOTAT,OON9'.r.{GC£;+ M1.0,14AND �"[Ab� F �
�1��.11
T; .9 3 p4l.'PAIDIS 1
$0,00
TTF
'S 1)11y4 NIDW
S168111
14
RECEIPT
DATE / j Jam••°BY
t
DAT IN ED
INS E TOR
f
6
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
A
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
O3
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation
Vents
Fireplace P.L.
Grills
Fireplace T.O.
Fans 8 Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
41
Final
Final PIZ
BLOCKWALL APPROVALi
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
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fbdures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
.X
-4
4
Din #
City of La Quinta
Building ar Safery Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
1 Building Permit Application and Tracking Sheet
Permit #
0362--- dy
Project Address: 5-6 -7 �EP!10 "
%%mcr's Name:
A. P. Number:
Address: Lj 6 --7
Legal Dcscriptjj-A.�-�� 61-r 77k- Z5 V 59-/
Contractor:V05;
0 Address:
C
Cin-. ST. Zip: (A, QQ)
cicphonc:
P*Project Description:
City. ST. Zip:>
Telephone: 77�
State Lic. #
Cine Lic.
—4EAL=Emps�Zcsigricr
Address: 4 � -6 0,
City. ST. Zip:
Telephone:
Construction Tv T-pe: Occupancy:
State Lic.
e e) New Add'n Alter Repair Demo
V Name of Contact Person:
Sq. Ft.:
4tones:
I # Units:
Telephone 4 of Contact Person: 'c2
2�
Estimate au,
APPLICANT: DO NOT WRITE BELOW THIS LINE
Submittal
Req'd
Rec'd
TR.-%CKING
PERMIT FEES
Plan Sets
Plan Check submitted
//0 7103
Item
Amount
Structural C21CS.
Reviewed. ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 C21CS.
Plans picked up
Construction
V1,
V
Flood plain plan
Plans resubmitted
Mechanical
A// A—
Grading plan
2"' Review. read%- for correct ions/issue
Electrical
Subcontactor List
Grant Deed
Called Contact Person
Plans picked up
Plumbing
SAM.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:-
Review. readv for corrections/issue
Developer Impact Fee
Planning Approval
Called Contact Person
03
A.I.P.P.
Pub. Wks. Appr
Date of permit issue
7
School Fees
711 `,SSV, -e—,
Total Permit Fees
Feb 05 03 08:46a
FROM : MONARCH
December 20, 2002
BOB EDWARDS CONSTRUTION 760 775 9093 p.2
PHONE N0. : 760 776 5111 Dec. 30 2002 12:34PM.PI
Mr. & Mrs. Frank Newell
270 Argonne Ave.,
Long Beach, CA 90803-1763
PGA WE,33T11 RE51D13NT1.AL ASSOC:lATION, INC,
P.O. [LOX 1232. LA QUINTA, CA 92253
(760) 77651 UA FAX (760) 776-5111
Reference: 56.770 Merion. - Architecturdl Request - Golf Cart Garage and Additional Landscaping
Dear Ivlr. & Mrs. Newell:
The Architectural Committee and Landscape Committee reviewed your plans for the installation of a golf
cart garage and additional landscaping. The Architectural Committee aP1mved your plans.
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 architeAural guidelines criteria whether
Or not all deficiencies ate 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.
The Landscape Committee is unsure of how many Indian Hawthornes err: to be added. Please advise.
Please contact Javier Contreras, ,9uPcJVis0r for Valley Gardening &.Lardseape at 760n76-6667and Carol
Fuller. the Association NGurager, ptiorto any irrigation modifications associated with this change. Damage
to the landscaping, i.e., shrubs, trees. flowers and turf is the responsibility of the cotttmctor. The
landscaping must be brought back to its original condition when the project is completed.
Approvals given by the Architectural COtnmittec are good for only six months from the date on the
approval letter. After that tune a new application must be submitted.
Upon completion of your project, please complete and realm The Notice of Completion of Architectural
Change. .
If you have any additional questions or concerns, please do nothesitate t ) contact Carol Fuller, Association
Manager, at 7601776-51;00, Ext 20.
Sincerely,
PGA WEST 11 RES15ENTIAL ASSOCIATION
For the Architectural Committee
For the Landscape Committee
Carol Fuller; CCAM
Association Manager
M. Board of Directors
Unit File
0
A
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
�SPECIAL INSPECTIONFax. (760) 772-7193
Pager (760) 776-3338
REGISTERED INSPECTOR S WEEKLY REPORT
TYPE OF
INSPECTION
PERFORMED
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALT
❑ REINFORCED MASONRY ❑ FIRE PROOFING
❑
HER
�\
JOB LOCATION`
-
" - -�
- p \
q � 0- _ -'�W�
REPORT SEQUENCE NO.
TYPE OF STRUCT E
t4n �Q q _
G l
PERMIT NO.
DAT
1►
u3
DAY OF WEEK
MATERIAL DESCRIPTION
ARCHIT
INSP T
HRS. CHARGED
�ex
PSS i o
ENGINEER
ASSISTANTS
HRS. CHARGED
INSPECTION
DATE
GENERAL SUB
CONTRACTOR CONTRACTOR_
ozv m a4 3
w
Us
+J' -V
VDLr
V
I COPY SENT TO CLIENT ❑ I CONTINUED ON NEXT PAGE O I PAGE OF I
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
IG ATU E OF REGISTERED INS TOR
DATE OFR PORT REGISTER NUMBER /
.Ti� 4 4 Q".
Building
Address 51"M Mrfm
Owner
Address 9- C
City I Zip ITel.
Contractor
Hatioul Lang# A Mortgage
Address
ty
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
State Lic.I City
& Classif. 28813(3 Lic. # 328
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
i LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
'_effect t
SIGNATUREZ4 7
D TF
1
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contr#ctor's License law for the following
reason: (Sec. 7031.5,Business and Professions Code.,,Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, 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 that. he 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 five 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
or improvement 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.)
❑ 1, 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.)
❑ 1 am exempt under Sec. B. & P.C. for this reason
Date owner
WORKERS' COMPENSATION DECLARATION
I 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 Copy is 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 anyParson in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: If, alter 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 Address
City, State, Zip
No. 07644
14 -1)?
BUILDING: TYPE CONST. OCC. GRP.
.P. Number
Legal Description irRCt 2541-9-1
Project Description ,ta fiv PMR HM
Sq. Ft. 2M No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal.
Const. 1,042.00
Mech. 73.00
Electrical
Plumbing 1 5D
S.M.I.
15.05
Grading
Driveway Enc.
Infrastructure
-1-ass Credit _2*4MR9
_Infra BUD P,417 -RQ
TOTAL 1 44.681.73t p —
REMARKS
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 DATEINSPECTOR(�
Issued by: Date 4/23/9 ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT. ®
WALL SO. FT.
SQ FT ®
ESTIMATED CONSTRUCTION VALUATION $
UNITS
MOBILEHOME SVC.
POWER OUTLET
YARD SPKLR SYSTEM
BAR SINK
ROOF DRAINS
DRAINAGE PIPING
DRINKING FOUNTAIN
URINAL
WATER PIPING
NOTE: Not to be used as property tax valuation
BONDING
FLOOR DRAIN
MECHANICAL FEES
FORMS
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
"{[�GGAS
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
LAUNDRYTRAY
AIR HANDLING UNIT CFM
TEMP. POLE
KITCHEN SINK
ABSORPTION SYSTEM B.T.U.
TEMP USE PERMIT SVC
WATER CLOSET'
COMPRESSOR HP
POLE,TEMIPERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER. B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 1% c
SEWAGE DISPOSAL
�/� ` / _I �G�—
SO.FT.GAR ® 3/ac
HOUSE SEWER
VENTILATION
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
OUND PLUMBINUNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SE 16)4
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.3-2(ROUGH)
I/
"{[�GGAS
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
(FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
GRADING
cu. yd.
$ plus x$
=$
LUMBER GR.
FINAL INSP.
FRAMING -Ab
FINAL INSP.
//////
!/1ROOFING �lV L(�
�/� ` / _I �G�—
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
`INSULATION/SOUND7— , f
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESJINITIALS
GARDEN WALL FINAL