GRES (9603-033)LICENSED CONTRACTOR DECLARATION
I hereby affirm 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 # Licj:Class S Exp. Date (iiki
Date Signatureof Contractor
OWNER -BUILDER DECLARATION
I hereby affirm that 1 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 Policy No.
(This section^aieed r 6Vbb completed if the permit valuationai'fo' r'•$1'bb.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
Code, I shall forthwith comply with those provisions.
Pate: Applicant
Warning: Failure to secure Workers' Compensation coverage is unlawful and shall
subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this application agrees to, & shall, indemnify
& hold harmless the City of Indian Wells, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon the
above-mentioned property for inspection purposes.
FS nature (Owner/Agent) Date
ALCM
BUILDING PERMIT
PERMITi
r s.e, a we x
DATE
VALUATION LOT TRACT "
W 8/96
JOB SITE ADDRESS
APN
R
OWNER `" ` `
CONTRACTOR `
1161t VT)t,'t!A1RPS', t ,O NS i.R11 r "PON
_.
It%cmf 4) C i irsiD',n itItVIVfir
It 0. �,I A.,'t MCKI SAL ?t{),i t--M$'A1
"ria rh'U17',jCc"�'n l.,Y�rl:
-a „t14. r-tt L1.
+Tlf At.Efllt;Af
LAQii.ttv;tll (°A "12253
Iak (A JINT4 VA 97213
�..:....
DESIGNER/ENGINEER
USE OF PERMIT
FEE DESCRIPTION
FEES
U1U A',4 fCrlti;k'f Kt 175.00 St
ESTIMATED G03T OF CO1of `Tkt[►C`is ION
.3,4 30.00
f'jh'RM.1T FRE SUMMARY
KAN CHFCf: W, 10tAX110-439-31.5 $=13:67
CONS''rRIX i". ON VCurti 101...0001 418-000 563.01)
J1r_1C1.C111Ci\L FRE, 101-WOA20-000 SGML 0
S'PC)NCrNIOT10N 1 - It:[Mn 101-000-241-OW$:50
GRADING T;iFi 101-000-423-000 520.00
St.WrO'iA.iL CONS"M1.1MON AND PLAN CHE,C K
S151,67
LESS PRP -.PATI) FEIS
s0,(9)
o -,.s
Art, PERNUT. vr,, :ouF, stow
S�!�iot'r7
MAR 11 1996
BY
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
TINSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing W I J 9Compressor
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
POOLS - SPAS
BLOCKWALL AP ROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Ping. 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)
1U `.j 0 u11 11 !4 ++1a1IV! V 1Wk rk U fl V a V U i Y 7 11 V;
�,;
PGA WEST II RESIDENTIAL ASSOCIATION, I.NC.
P.0, Box 1282,i La 00inia, CA 92253
March 8,'1996
John & Linda Muckel
6024 Ocean Terrace
Rancho Palos Verdes CA 9027>
Re: Architectural Variance Request -,57-205 Merion:
A
-Dear Mr. & Mrs. Muckel:
10
-'Tha'for
nkyou your request io conitr'uct a cart garage at the above -referenced addiAs at'PGA
or
West. The plahs submitted were approved, subject to the following conditions:
1) Plans and Specifications for the cart garage comply with all applicable La Quinta
building codes/safety ordinances.
2), Submit a sample.6f both the Arizona sun pebbles and native Granite stained
r boulders prior to purchase and installation for review and approval by the
Architectural Committee.- Please review front yard boulders at 56-690
Merion for approved size and locations. Native Granite stained boulders
must be similar or, less in size and exhibit similar brown tones'
`3)''5iibnut a'p icture " of the Crown of Thorns to our manager John
plant property
Handel, for review and approval by the Committee:
4) Subn-Lit a sample or installed location for the hardscape proposed on plans.,,,,',,
Both the Board and, Architectural Committee are pleased with the design of the cart garage
I
proposed on your plan s. Please note that any further exterior change orders to that which is
depicted on these plans MUSt first be sub-mAted to the Architectural Committee for their approval -
prior to the work cornmen6ig. We lo&- fonvard to th6 finished product, and should your"';
contractor have any questions, he may contact John Handel at, 360•-4161'.,
Sincerely,
PGA WEST 11 RESIDENTIAL ASSOCIATION
Don Troy, Chairman'
Architectural Committee -rt
M. Board of Directors
John Handel, The Nionarch &UP
\\mooarcb\users%john\pgari-,Tvm%ickelarch. approva[3,8.96.doc.
40
TA
YP.O. BOX 1504 , N Q'. 07228"
Building78-105 CALLE ESTADO
Address57_205 He rion LA QUINTA, CALIFORNIA 92253'
Owner 1— -
Sunrise.Company f BUILDING: -TYPE CONST. - OCC: GRP. -
.. Mailing ~
Address42400 Cook Street Suite 200 A.P. Number PGA -
City Zip - Tel.
Desert 92260 568-2828 Legal Description Tract. 24801, �
Contractor. Project Description •.Phase H Pi�>f} H18
stint
Address r
-' t I`•r
State Lic.
& ClassiP 130 '
Arch., Engr,,• ,
Designer -
Address. `
Tel.. -
. I Lic' �9E3
Sq. Ft. 233 No. No. Dw.
Size Stories Units ••
New ❑ Add ❑.: Alter ❑ Repair ❑
Demolition (i '
_..
.City
Zip
State
Lic. # l
- S
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm that I am licensed urider provisions of Chapter 9 (commencing with Section
• 70D0) of Division!3 of the 'Business -and Professions Code, and my license is•in fultforce and
effect{
d -
SIGNATURE DATE-
_ ' '' r. ' • OWNER -BUILDER DECLARATION
' I hereby, aftirm that I am exempt from the Contractor's License Law for the following,
• reason (Sec., 7031.5,Bustness, and Professions Code: Any city or county which requires a
,• permit to constnxt, atter, 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
Estimated Valuation
• ,q pti �y ,
S/ V
W0.470 '
PERMIT AMOUNT -
. _ ..
Plan Chk. Dep., -
Plan Chk. Bal. i
�Y
CODS{. `
builds or unproves 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 unprove for the purpose of sale.) - i
�
Mech. •; l Ll. ' , ,
70,50:
- Y 0 e
Electrical 11.7'
•c
,
Plumbing ��d
' O I, as owner of the property, am exclusively' contracting with licensed contractors to coo-
struct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law --
_
S. M.1. - •. s+�•.
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractors) licensed pursuant to the Contractor's License Law.)
' ❑ I am exempt under Sec B. 8 P.C. for this reason
Grading
Driveway Enc.
:Date owner
Infrastructure P3,.835.60
,•Less.
Credit , 1,917.8?; _
WORKERS' COMPENSATION DECLARATION ' s
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.)
Infra Due• � ���. fl
_
Policy No. Company '
❑ Copy is filed with the city. ❑ Certified copy is hereby furnished.
3 r`
TOTAL415 -A �y
' CERTIFICATE OF EXEMPTION FROM
WORKERW 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 c
REMARKS - T .a s<vn n a ;14 > z -_?a O }. i (•^
-y(r�
' Date ... •Owner - v . '
NOTICE TO APPLICANT: ft, 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. - .-
�
ZONE: BY: -
- -
Minimum Setback_ Distances:
Front Setback from Center Line
• Rear Setback from Rear Prop. Line '
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
Side Street Setback from Center Line
n
Side Setback from Property Line - '
,
Lenders Address
FINAL DATE- INSPECTOR
;,
c� �.g�ty� ;
- This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work Ihereunderis suspended for 180 days.
I Ce5ity that 1 have read this application and state that the above information is correct
1 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. ,
d property for inspection purposes Y ,
...of
Issued by Date Gf i3 7 Permit '
V8l idated by '
.Signature applicant Date'
Mailing Address ?
-
Validation: 4 r
City,- State, Zip
5`7r �ti•'• • ,ti.1 ..t •'^ 1,: 7'"i 'k•,• `t � , '.I.:.'.F. '. •.i - � .. • `.
• `4 `i, tti~ 4 ~ n .l.l r
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL SQ. FT. ® $
UNITS
SLAB GRADE
ROUGH PLUMB.
YARD SPKLR SYSTEM
2ND FL SO. FT.
STORAGE TANK
FORMS
EWER OR S?rTL AL
MOBILEHOME SVC.
BAR SINK
POR. SQ. FT. ®
ROCK STORAGE
14TOUND. REINF. __?_ ry
V !/
GAR. SO. FT. ®
POWER OUTLET
ROOF DRAINS
HEATING (FINAL)
OTHER APPJEOUIP.
DRAINAGE PIPING
CAR P. I SQ. FT. ®
TEMP. POLE
WALL SQ. FT.
DRINKING FOUNTAIN,
SQ FT ®
URINAL
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
=$
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
r// w 3
LAUNDRY TRAY
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.
SO. FT. ® c
BATH TUB
SPARK ARRESTOR
SO. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. 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 FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR GOND. SOLAR
SETBACK
OUND PLUMPIG i�
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
EWER OR S?rTL AL
ROUGH WIRING
DUCT WORK
ROCK STORAGE
14TOUND. REINF. __?_ ry
V !/
AS (ROUGFy!E'-�j
v
METER LOOP
HEATING (FINAL)
OTHER APPJEOUIP.
REIN F. 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—
'ROOFING
FINAL INSP.
,q � � !
r// w 3
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
SULATION/SOUND� f2�v
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
1