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GRES (112-132)LICENSED CONTRACTOR DECLARATION -•-1 h6reby 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 '7 B Mei _ �' .3/.-u t Date �'�r Si nature of Contractor _` ' 9 OWNER -BUILDER DECLARATION I hereby affirmj,under penalty of perjury that I am exempt from the Contractor's License taw 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 LF1010N INS CO. 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 tojjthe workers' compensation provisions of Section 3700 of the Labor Code, I KIP t `QttQtwith comply with those provisions. Date: GG ii ii �� 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. 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 herebylithorize representatives of this City to enter up n the above-mentioned propert� or' a, tion pur,oses. Signature (Owner/Agent), Date�� y � �� Y T Y BUILDING PERMIT PERMIT# DATE" VALUATION LOT 01,11111r-13 TRACT $3,7 JOB SITE ADDRESS M11-9 I kW4MON APN OWNER�Y CONTRACTOR / DESIGNyER / EN (NEER �� RICK B .1 ELAWQstlg1 J..i-2, =Slap; T21.i��A.IC IG CONT1,�'LiUCrION .• .. 1396 s TOM RMEL 14 7:-92,U'1UE?,"TP<1XWK, LOS ANTORTAS CIA. 90017 Dk C,3MYTA CIA, � �3 0, 60YMP7933 ap"Up 1-212, USE OF PERMIT GARACYN ON, CAWKYRT GOL? CART 0ANAM AM P DDIT1C N 19i S.F. - £!MMC7i?JC'.ARPORtT 91,Uif V ! SIMM. I .mss COST OP CONS51RU(•T�ON ' A �j 'jr�� �p •j'''j'j�%�;(�J(• PM•�ITIC Sl �NMSA FP V A"A.a'..►1'My g'laA 4 CHECK FEE l Eft •C1f�tia+}3�»� � £� s�1�.4t5 CO MUC,YJON FU 101-000-418-000 & LUCT.IUCAL PEE 101.000.420.000 ii•t'[.t'YNO MOTION 3+'1£I -"I%•> ID 101-0,00-241-000 1-50 OkO,ii}1 Q FFY, 101,-000-423.000 NUN) a' a �3 LESS PRE -PAID P V $0.00 2001 1 g 113 VDi:ENOW '$1.499 . •N RECEIPT DATE BY DATE FINALED INSPECTOR INSPECTION RECORD OPERATION DATE INSPECTOR OPERATION DATE INSPECTOR BUILDING APPROVALS MECHANICAL APPROVALS Set Backs Underground Ducts Forms & Footings Ducts Slab Grade Return Air Steel Combustion Air Roof Deck / / 02 Exhaust Fans O.K. to Wrap F.A.U. Framing Compressor Insulation 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 Steel POOLS - SPAS Set Backs Electric Bond Footings Main Drain Bond Beam Approval to Cover Equipment Location Underground Electric c 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 Fixtures Main Service Sub Panels Exterior Receptacles G.F.I. Smoke Detectors Temp. Use of Power Final Utility Notice (Perm) COMMENTS: FROM : ! Fe ff�A FW NO. : W07765112 One. 17 2001 01:49PM P1 PGA WEST 11 RESIDENTIAL ASSOC'IAI-10N. INC. P.O. BOX 1282, LA QUINTA. CA 92253 (760) 776-5100 FAX (7610) 776.5111 Decenawl,13.211111 Mr. & Mrs. Rick Delautartr:r 3396 Stone Ridge Looe IAS Angeles CAW077-1730 Refcrcnoe: W'N7 Mchon. L:t Quoan Aro haeclura! (7uttiX Request - Golf Can GwaRc Ucar Mr. 1r! Mn. Uch, umm: The Arehitcelnml Contneiltce w d the L=dKW,, Cotmaillee h -0-c rorkwed roto plans for dw addition of a golf Can gdrade addiliod lOWSCil lug The ArChito%7ltrat Cow4nirtee tmadMuRr appta'ed your application. Rcx-ica* by the: Conunaltee is onir fpr @maw emefortlemv %ith the anhilwidel p1jW�lincs. It it life responsibilily of the o %tees to Gdh• wldotrslead and courorm to the archbertural guidelines criteria whet .: of nal all detiCkru= arc noted dutirrR review. It i11;dw the ouster's full rCv0v.%*iUf%. to liad viri:J- ilia csistiag crntditions. Thr Cmnini0 e's deciskm with rctprrd to pnjsw "So wit! N! 6 i l PICIsc 1t for 10 111c PUD AKIIirvanral Crnidclitmi and ApplictttiM for 01=W for 311 rceluirW stebtninals. Apf►ro+a1S Risen by the Areamaueral Committee :arc Rtmd for only tHc moults f ootn the d:1:c oil 111C apprkwil leiter. After tats+ tine a m -w a plirat must bt; siftdacd. 71w ktudw-w obnunitax les the follawlag cwtimcm: • If the Nkskm fan palm that is to bC relocated dies. tla: ttee vviU he rtpliwW at houtoowfiefs cvpaaso: and the tree OWI 1a w a itarnmtr of rote year. Upon eompk6w of your project, please couplets acrd return The NWtt.,c of Completion of A"teewrnl Chmge. 1f rtnt kv%V am alit Bond "Wioe►S orcoMms. pl dse do not 11``Sit;1te to conduct Carol Fuller. A..Vvwtinn %lannSer.:u 76N776.5I10, Ext. 211, Sineerrl�. PGA Wf -ST 11 RFS1DENTIAL ASSOC1A7M For Ardillc aural Canrunitux 1`01 11ec I..a,rdscape Contaaw (:arol Fulla Asmcunion Mhoger cc: ll trd of Dinxtors thlil Pik 41 REGISTERED INSPECTOR'S WEEKLY REPORT JON TANDY 37630 Medjool Ave. Palm Desert, CA 92211 Office (760) 772-7192 Fax (760) 772-7193 Pager (760) 776-3338 TYPE OF INSPECTION PERFORMED O REINFORCED CONCRETE TRUCT'STEEL ASSEMBLY ❑ POST TENSIONED CONCRETE ❑ ASPHALT ❑ REINFORCED MASONRY ❑ FIRE PROOFING e ' (QTHERi x / JOB LOCATiO LA ° REPORT SEQUENCE NO. TV ( $T `ICTURE�(„ I/l � V,�� PER�ITI ��` �IK \ I V DAY OF WEEK MATERIAL DESCRIPTION ARCCH CT--O(yOLS�if�Q$OL HRS. CHARGED ENGINEER ASSISTANTS HRS. CHARGED INSPECTION DATE GENERAL J SUB CONTRACTOR �(/a�FP�S' CONTRACTOR - — (/S VL /S i 1� 6-k L C4 �q ASK 4u- COPY SENT TO CLIENT ❑ CONYEON ON EXT PAGE ❑ PAGE OF CERTIFICATION OF COMPLIANCE I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MV 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. NAAqTUR O//F.'�REGISTERE NSPECTOR DAT OF RE ORT REGISTER NUMRFR \ T 0 0 Wit 4 4 Q" P.O. BOX 1504 Building 78-105 56-317 Merion LA QUINTAC Address CALIFORNIA 92253 Sunrise Company Mailing Address 42-600 Cook Street Suite 200 City Zip Tel. Palo Desert 92260 1 568-2828 Contractor National fortgage b sand Address Sam Zip I Tela State Lic. I City & Classif. 288130 Lic. # 398 Arch., Engr., Designer Address Tel. CityI Zip I State I Lic. If LICENSED CONTRACTOR'S DECLARATION I hereby affirm that 1 am licensed under Provisions of Chapter 9 (commencing with Section 700D) 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. 7031.5,13usimess and Professions Code: Any city or county which requires a permit to construct. ater, Improve, demolish, or repair any structure, prior to its issuance also requires the appicant for such permit to fie a signed statement that he is licensed pursuant to the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of Oivsion 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 live hundred dollars (S500). ❑ 1, 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 buids or improves thereon and who does such work hknself or through his own employees, provided that such improvements are not intended or offered for sale. ff, however, the building or Improvement is sold within one year of completion, the owner -budder will have the burden of proving that he did not build or improve for the purpose of safe.) ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to con- struct the projecL (Sec. 7044, Business and Professions Code: The Contractor's License Law does not appy to an owner of property who builds or improves thereon, and who contracts for such prq*ft 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 peedt is for one hundred dollars (S 100) valuation or less.) I certify that in the performance of thg 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. ff, after makig this Certificate of Exemption you. should become 'subject to the Workers' Compensation provisions of the Labor Code, you must forthwith comp* 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 Lenders 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. 1 certity that 1 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 Addrr City, State, Zip S,3 No. 07244 BUILDING: TYPE CONST. OCC: GRP. A.P. Number W Legal Description Tract 24801 Project Description Phase 5H — Plan H3A Sq. Ft. 28" Size No. No. Dw. Stories Units New ❑ Add ❑ Alter ❑ Repair ❑ Demolition ❑ Estimated Valuation $214,923 PERMIT AMOUNT Plan Chk. Dep. Plan Chk. Bal. ;538.56 Const. A,U* • Mech. 73. Electrical 132. J 1 Plumbing o#.bu S.M.I. Grading Driveway Enc. Infrastructure -ss re Ureolt 2,417.ug Infra Due U,411.b9 TOTAL s / . / .S `-- ! { 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 DATE INSPECTOR Issued by: Date 2/28/90 Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES 1ST FL. SO. FT. ® $ UNITS COLL. AREA 2ND FL SQ. FT. YARD SPKLR SYSTEM BONDING MOBILEHOME SVC. BAR SINK POR. SO. FT. ® XWER OR SEPTIC GAR. SQ. FT. ® POWER OUTLET ROOF DRAINS FOUND. REINF DRAINAGE PIPING CAR P. SQ. FT. HEATING (FINAL) OTHER APPJEQUIP. WALL SQ. FT. DRINKING FOUNTAIN. SQ FT ® URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation FINAL INSP. FLOOR DRAIN MECHANICAL FEES WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER FINAL INS)�vs�, GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED ROOFING li6-Ir-,ed ` LAUNDRY TRAY AIR HANDLING UNIT CFM `7�l 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 SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 1 Va c SEWAGE DISPOSAL GAR. FIREWALL SQ.FT.GAR ® V4c HOUSE SEWER THING 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 ROUND PLUMBING UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS XWER OR SEPTIC ROUGH WIRING. DUCT WORK ROCK STORAGE FOUND. REINF GAS (ROUGH) A • -G} G METER LOOP HEATING (FINAL) OTHER APPJEQUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM GRADING cu. yd. $ plus x$ -$ LUMBER GR. FINAL INS)�vs�, el FRAMING 6" _ fjl 111lllffffff'''"' FINAL INSP. ROOFING li6-Ir-,ed ` -,e `7�l REMARKS: VENTILATION FIRE ZONE ROOFING ' FIREPLACE SPARK ARRESTOR GAR. FIREWALL THING MESH ���jjj ULATIONISOUND /- �V I FINISH GRADING FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS ' GARDEN WALL FINAL