ADDN (9709-030)LICENSED CONTRACTOR DECLARATION
I rereby 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
ate + – I Signature of Contractor
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
peAl rt rmance of the work for which this permit is issued.
( I have and will maintain workers' compensation insurance, as required by
SI ctlon 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.
(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 provisionsfof Section' 3700 of the Labor
Code, ose
I shall forthwith comply witAthovi5i ns.
Date: 19-4 Applicant -4(, � E � tom -
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
co�n�truction, and hereby authorize representatives of this City to enter upon
th4 above-mentioned property for I s eetion purposes.
Vsignature (Owner/Agent) i;Lt-r Date—
L'
BUILDINGPERMIT PERMIT N CONTRO�.••
DATE VALUATION 31..6S Z9 LOT TRACT
JOB SITE
ADDRESS 'i APN 76t-d+l-itS3
OWNER CONTRACTOR/DESIGNER/ENGINEER
13RI)CE & A IT)Y 404WAR'IZ. 1W)H Ff)"'AR(YK ('0NS1104-1110N
+e,�'02 j'eij; k .* iy-!)2U FIi 9FA DRIVE
LA (PINTA ('A 101253 LA Q(IINFA ('A 42253
!!60)T7S- 79.23 f'931,6 Z71"
USE OF PERMIT
A!.)k )N
t8"r :)-i-. R(X,'*M AIX)ti uN Air NEW f C AkA�R
tiatitiu tf✓ :'Aitl'� +it I Iwo) 81•
411it'tx'Yigl,('t)N4"iitlk"'1'f!)NnIdT)I�i.AMf."i11;!'t� •+''
WSW TIRE, NUU FEES
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
15,411M. I'D
$341.36
PLAN FE+T:
101-tKX)-:9 iq- 41 K
('f Ni"3 VI' ("1'f{)N I -A-11
1ftl �lftll dt`R-tIlill
"�Sf?t ll(>
NWA- (1.1!4110,11. x'Lrt
iIN.(M..9?I =I
S21.�J
E IAi(.''Il Ik,'A.L I -Ek
ft31.-tli)t)-42U-iM
St6 15
4i'Ft+.►J.I(yfyfc 't'1t?TVF}F'
40AI) i13f-000-241.4X?(?
$1 %
(IRA 1)1N(IVI-
11)14wifII-V a1lK)
Vf100
411it'tx'Yigl,('t)N4"iitlk"'1'f!)NnIdT)I�i.AMf."i11;!'t� •+''
WSW TIRE, NUU FEES
RECEIPT I DATE I BY I DATE FINALED I INSPECTOR
15,411M. I'D
$341.36
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs A
Underground Ducts
Forms 8 Footings
Ducts
Slab Grade
Retum Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
0. K. to Wrap
F.A.U.
Framing
Compressor
Insulation /
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
BLOCKWALL AP ROVALS
POOLS - SPAS
Steel:
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I I
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
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G. F.I.
Smoke Detectors
Temp. Use of Power
yFinal
• Utility Notice (Perm)
COMMENTS:
.ti�� 1`l7'-10Wa
�
/"'v `'� j?,4dZ SEc><cr�J
err/
PYVAI OIL 134-Oc- 40orx—
4017
_
6�//J 7 Ar,
t 2-��b�8
�� 9 -7
ehapf:Ftei
Desert Sands Unified School District
Notice: 82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 9/17/97
No. 16089
Owner Name Bruce & Judy Schwartz
No.56902 . Street Merion
City La Quinta
Tract #
Type of Development
Comments
Lot #
Residential Addition
ami y room extension
APN # 761-451-033
Jurisdiction La Quinta
zip 92253
Square Footage
Permit #
Log #
Study Area
187
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:
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 187 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
Fees Paid By n/a
Name on the check
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Pauline Pearson Exempt
Signature -
Telephone ''775-7933
ref $0.00.
Check No. n/a "'— -
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
ibove will begin to run from the date on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
*llect them on the District('s)(s') behalf, whichever is earlier.
Collector: Attach a copy of county or city plan check application form to district copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting
xiiJ 1$-97 P:4I�li 3:18 Fr:i r:411iIR V Jk11UF'
a�
PGAWEST.
August 15,1997
Mr. & Mrs. Bruce Schwartz
56-902 Merion
La Quinta, CA 92253
Fx:; 1-1-. 619 776 5111 F. 1
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(619) 776-5100 FAX(619)776-5111
RE: Architectural Variance Request for 56-902 Merion.
Mr. & Mrs. Schwartz:
The Architectural Committee is pleased to inform you that it has approved your
preliminary Architectural variance request for a Golf C art and Room Addition
at the above referenced address pending the following:
1. The new Golf Cart garage door must match existing garage door.
2. Submittal and approval of a landscape plan drawn by a licensed
landscape architect.
Please call me at (760)776-5100 if you have any question's or concerns.
Sinc
John J. Monahan
Assistant ,Association Manager
CC: John Handel, Association Manager
Board of Directors
Unit File
IW
i
cw t.
`� ��- o� 74
14440AAMA
+
TO 30Vd 3dV3SGNV739VZ�IN 9ZOEMOV609t OZ:9T t66T/VO/ZT
AM.
lop,
INC.
Milo,
1 It
IW
i
cw t.
`� ��- o� 74
14440AAMA
+
TO 30Vd 3dV3SGNV739VZ�IN 9ZOEMOV609t OZ:9T t66T/VO/ZT
Tityl
P.O. BOX 1504 1 iNo. 07640
Building 78-105 CALLE ESTADO 1 '
Address 56-902 Marion LA QUINTA, CALIFORNIA 92253 1 ,
Owner
Mailing '
Address 42-600 Cope Stet Suite 200
City Zip Tel.
Palm Desert 52264 558-2823
Contractor
Address
ty - IZip ITel.
State Lic. City
& Classif. Lic. # U8
Arch., Engr.,
Designer
Address Tel.
CityI Zip I State
Lic. #
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
SIGNATURE �vd £� .:�.� - s �^-"""- -, F..%1 '' DATE
(/ OWNER -BUILDER DECLARATION
1 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 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.)
❑ 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.)
❑ 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
❑ 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 thip 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: It, 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
Ihereby 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
BUILDING: TYPE CONST. OCC. GRP.
A.P. Number
Legal Description TrUt 25454-1
Project Description Phase H6 Ptah W29R
Sq. Ft.No. No. Dw.
Size 2545 Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep.
Plan Chk. Bal. ZMAn
Const. 061 -so
Mech. -78.00
Electrical 123-19
Plumbing MAO
S.M.I.
13.44
Grading
Driveway Enc.
Infrastructure 4030.60
TOTAL 1 ,Q 3 "'I(� . <"1 0_1
REMARKS
10
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 DATEINSPECTOjR
Issued by: Date 4/23e 9p/�
ermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SO. FT.
POR. SO. FT. ®
GAR. SO, FT. ®
CAR P. SO. FT.
WALL SO. FT.
SO 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
AS (ROUGH)
[
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEOUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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.
SO. FT. ® c
BATH TUB
FINAL INSP//- / ^ -06
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/. c
SEWAGE DISPOSAL
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 COND. SOLAR
SETBACK
GROUND PLUMBIN
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
ER OR SEg;—li�%T b
ROUGH WIRING
DUCT WORK
ROCK STORAGE
�JJFOUND. REINF. — ')
AS (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//- / ^ -06
RAMING
FINAL INSP.
RILROOFING ✓
r� r
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
THING
MESH
1 SULATION/SOUND 2
0-
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL