ADDN (9705-153)LICENSED CONTRACTOR DECLARATION
`I%hereby affirm under penalty_of perjury.that I am licensed underprovisions of
Cha0ter'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
11/98
/Date
I- Signature of Contractor&i�wti•,w
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) 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, 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
11 hereby affirm under penalty of perjury one of the following declarations:
O 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.
(%h 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 Policy No.
"TATS PUND
(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 provisions, , of Section 3700 of the Labor
Eode, I shall forthwith comply with/those r r6vis-i ns. 1
Date:` Si5_ `j I '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, indemni
& 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 v
work is not commenced within 180 days from date of issuance of suc a
permit, or cessation of work for 180 days will subject permit toscancellation.
I certify that I have read this application and state that the above inf0(rmdien iscorrect. 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 for inspection purposes:
Signature (Owner/Agent) (�` `'^ - -�' ` Date'57 'k
0
_,►rte,.- . ,
ROL#
5241....
PERMIT # CONT
BUILDING PERMIT
DATE VALUATION LOT TRACT
!/ $4,401'00 { r
! 1
JOB SITE'
APN
ADDRESS 157-0.84 MUI GN
�S►��B� I.��D�
OWNER
CONTRACTOR/DESIGNER/ENGINEER
AN DR 9W PADIMB ARD
801.1'1�f)WAPDSCoNsr,,�tir.n'oN
I 10 BOR:iHWICK L14
19-920 .Fit ST.A. DPLIVF
Jt I VFs R.1 HSN III (JOW
LA C, UUNTA CA, 92253
(76(1) f75-703°4CR IX 3212
USE OF PERMIT
CLIK111I�f CON131.1101LITION 190.00 SF
.!'€1R14`OT FCCNi1liMAUY
Pt. AN CHT3C"K, Fhh 101-000439-• 318 $105130
c-+?N;'>'IN t_ c,Ir1ON ta't`s 104 -W_ )-418-00x2 g f h� rtr►
LPi...000"'421 -000 $241150
i'fU.l`T10CA1.FVX 1.01 -000420 -WO
S'i'�il�c.'t•t4�:tD3'$w3N 1�';^ii?' � ii�:titla •t ()1-fii?41-Z�11.�1(1t3 $f..�12;
ai
r
?r
SUB-", AL .AND Pf AN C'.K.CK
'LESS N1 II TAID F FEE
$0.00
® 1997
TOrM, Pa�>RA-1,11: P EX. -4 DDC: N0W
s►�iz.v
'
��� fes,+, ,y
•
t.
REC'EIQT
DATE
BY'�
DATE FINALED
INSPECTOR
o;F
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
IA4
Underground Ducts
Forms & Footings
Ducts
Slab Grade
L Z
Return Air
Steel
I
Combustion Air
Roof Deck
AExhaust
Fans
O.K to Wrap
F.A.U.
Framing
Compressor
Insulation
f17
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
POOLS - SPAS
BLOCKWALL
APkOVALS
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)
1
y'
Notice:
Document Cannot Be Duplicated
Desert Sands Unified School District
82-879 Highway 111
Indio, CA 92201
619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/29/97 APN # , 761-451-040
No. 15579 Jurisdiction La Quinta
Owner Name Andrew P. Lombard Permit #
No. 57084 Street Merion Log #
City La Quinta zip 92253 Study Area 106
Tract # Lot # Square Footage 190
Type of Development Residential Addition f No. of Units 1
Comments
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
t
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 190 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
c' �° ,;77
Fees Paid By n/a Telephone 775 933
Name on the check NBy Dr. Doris Wilson -
Q
Superintendent"
17
�',4, "„ r
Fee collected /exempted by Pauline Pearson Exempt �� " 40007�
Check No. n/a
Signature �AL,_x CA 0 P�� A Qty
IOTICE: 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
bove 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
ollect 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
-21-97 '.!EES 8: 40 AM 1:4 "N'RH HOUF
�0.lf 4
t-x:r
f,
PGA WEST
May 20, 1997
Andrew Lombard
57-084 Merion
.La.Quinta CA 92253
FxY' NC. 619 776 5111 F 1
PGA WEST II RESIDENTIAL, ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(619) 776-5100 FAX(619)776-5111
.Re: Architectural Variance Request - Room Extension
57-084 Merion
Dear Mr. Lombard;
I am pleased to report that both the Architectural Committee and Board of Directors has
approved your preliminary pians submitted for the above referenced address, with the
following conditions:
1. Landscape Plans must be forwarded to the Association's Landscape Maintenance
Contractor (Valley Gardening Service - Miguel Valenzuela - (tel) 399-1844).
Please have :Bob Edwards contact Miguel to review the plans and approve of
any change to Association common area irrigation. Coordinate with VGS when
work is actually done to protect plant material In hot weather.
2. Submittal of 3 copies of final working drawings/plans.
3. Applicant must sign application, Conditions of Approval and Disclaimer,
and complete both the Agreement and Covenant Running with Land and
Notary Page.
Thank you for your submittal, and should you have any questions, please do not hesitate to
contact me or assistant manager John Monahan at (760) 776-5100.
Sincerely,
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
For the Architectural Committee
By
JOHN H. HANDEL, ASSOCIATION MANAGER
cc: Don Troy, Archtrectural Chairman
Bob Edwards, General Contractor
John Monahan,Assistant Manager
Unit File
\\monarch\usersvohn\DgareszUombard arch ok 5.20.97.doc
TAI
•
t P.O. BOX 1504 No . 07654
1 &105 CALLE ESTADO
Building 7
57 M Me ton Y
'Address ���: .: LA QUINTA, CALIFORNIA 92253
Owner
Sunrise C"alAyt 1
»:.ri.n ..• r-. -- `'' BUILDING: ;TYPE CONST. OCC: GRP --
Mailing w
Address 42-600-.Cok. Si. Suite 200 A.P. Number
City Zip Tel:
Palm 8sf.' "i _ .. ' Q �Q %8_2828. Legal Description - Tract -3moo-7
Contractor Project Description i4Aa4±n 2H P1 an MR
y
`,. Address
City Zip, Tel.. ie
a'
State Lic.
& Classif: 2 � Lic. / 328, - Sq. Ft. 26 No No. Dw. ;
Size Stories Units.
Arch:, Engr.,
' . Designer :'S New ❑ Add ❑ Alter ❑ Repair ❑ Demolition El
}
Address Tel.
City e; _ . ; Zip State : �•
•� x _ ',' Lic. #
` LICENSED CONTRACTOR'S DECLARATION
.I'hereby affirm thatf am_ licensed under provisions of Chapter 9 (commencing with Section
7000) of DMsion 3 o the Business and Professions Code, and my license is in full force and
effect. ra r ,.,w,�,L.�,:+•-"• ,.• ,ri•�q+ /: ♦ -
��""'�YJ'A-.h - -
SIGNATURE. iO—*-. — ,,�_. 7 c,r*'� "' DME -. •1 ,
{k*a OWNER -BUILDER DECLARATION
I hereby affirm thatiI,arr exempt from the Contractor's License Law for the following Estimated Valuation 1191.449, 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 suchpermit tofile a signed statement.that.he is licensed pursuant to PERMIT. AMOUNT •',a:
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. Plan Chk. Dep. , }'•
subjects the -applicant to a civil penalty of not more than five hundred dollars ($500). a t
O I, as owner of the property, or my employees with wages as their sole compensation, will Plan' Chk. Bal. .40
do the work, and the structure is not intended dr offered for sale. (Sec. 7044, Buisness andCOf1St. �r�
Professions Code: The Contractor's License Law does not apply to an owner of property who 9i�1s
builds or improves thereon and who does such -work himself or through his own employees, Mech. � �'
,provided that such improvements are not intended or. offered for sale. If, however, the building, t�q�j • .' ,*A
'or improvement is sold within one year of completion, the owner -builder will have .the burden Electrical J' iLJ i9' '
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- : Plumbing
��
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's 'License Law �, p��
does nota 1 to an owner of ro ert . who builds or improves thereon, and who contracts for - - 13.44
�
PPY li P Y P S.M.I. `. t.
such projects with a contractor(s) licensed'pursuant to the Contractor's license Law.) •. --•
Grading
0'1 am exempt under Sec. B. & P.C. for this reason
Driveway Enc.
Date. Owner Infrastructure 4407.60
Lai fredi t 2 ' 53.80 c
WORKERS' COMPENSATION DECLARATION. '+
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.
TOTAL 4'0'270.83
CERTIFICATE OF EXEMPTION FROM REMARKS "
`.WORKERS' COMPENSATION INSURANCE' t
(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 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.S
Date Owned - 1'
NOTICE TO APPLICANT. making this Certificate of Exemption you should become ZONE: � � BY: - f
subject to the Workers' Compensation provisions of the Labor. Code, you must forthwith - -
comply with such provisions or this permit shall be deemed revoked.; Minimum Setback Distances:
Front Setback,from Center Line.
Rear Setback from Rear Prop. Line
CONSTRUCTION LENDING AGENCY Side Street Setback"from Center Line
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.) Side Setback from Property Line -
Lender's Name • '` �•
Lender's AddressS ' r
This is a building permit when properly filled out, signed and validated, and is subject to FINAL' DATE INSPECTOR
expiration if work thereunder is suspended for 180 days.-' {,r• •' 4//0
I certify that I have read this application and state that the above information is correct.. ISSued by: Date Permit
I agree to comply with all city and county ordinances and state laws. relating to building c
construction, and hereby authorize representatives *,of this city to enter the above--
mentioned property for inspectionpurposes. < Validated by:
Signature of applicant Date'
Mailing.Address Validation:
City, State, Zip
Y -S t i9 :;{!i j . ♦ r, rd <• i„, -.r, rf r ii•TM ..4„A �a r.. 3•. -t,..r y::;
R ! ..-y. •Y� t.,{ +r'', ,; '-'S a.- ''`„� •, 'r -."a, J.*• `tc .,;t, r ,,: ., ,,y rp �"4 7`."-,.
a<,
''` '.or' ��.' a.. � ..,. .; :r'S' •t- .•
,�r 4 " .. k•-L:r•=•r.�':<.. . �i� 3 L •}'r. t. <_ ..
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SO. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ, FT. ®
CAR P. SQ. FT.
WALL SQ. FT. ®
SQ FJ ®
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
l,IIAS (ROUGH) C �j)
O v
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPJEQUIP.
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
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 1Vi c
SEWAGE DISPOSAL
, . /
SQ.FT.GAR ® 214c
HOUSE SEWER
REMARKS:
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 PLU
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
WER OR SE �
ROUGH WIRING
DUCT WORK
ROCK STORAGE
/
OUND. REINF. 1 �O
`J
l,IIAS (ROUGH) C �j)
O v
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.
)feFj NAL INSP/ -,
,(�/ j
EVIL FRAMING �� 7-q
%1+�
FINAL INSP.
OOFING - Zr)j
, . /
/� Q, /
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
J
(/ THING
MESH
14INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
GARDEN WALL FINAL