CGAR (0202-054)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that l 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
.B 1316' , `' �� r r 31.3112"
Date ` " 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
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:
Carder Policy No.
I,»01014 [143 C01 W03•161 -10M
(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
Code, I shalldforthwith comply wlth_,those'"provlslons. ! �
Date' f.t ! Applicant t-«�_ �J'! ,
—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 requestand 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 upomy4fl,
the above-mentioned property for inspection purposes. ,
Signature (Owner/Agent).'-,'--,^f' i �L `` Date •f �' M
ea, _
BUILDING PERMIT PERMIT#
DATE I VALUATION LOT �I,Qj' F�{� TRACT
uW
JOB SITE
ADDRESS
APN
57-30.1 WCAMON,
.7674441-017
OWNER
CONTRACTOR / DESIGNER / ENGINEER
OEMR-CAE; P & 4:7fi MC—ill •'fid RtrRWXff
:4.OB EDWARDS, CON9 xii3MON,
57303 MM -1, ON'
79-920 M TTADRIVE
LA QtJ1 A' CA 92233
Y.A QUINTA CA 927,53
(760)315-7W-43 C11,1;91 1.3312,
USE OF PERMIT
GARAGE, 010, CARPORT
t: O1,1',CG,Ar,7 O/,611,A,.C$4: ADDI--TION 0415 SY,jFklOA A,T°PRCSVA.L C47M7,R1v ED.
CONVYR'JL"•'1'1O1 FER 101-000,41,8-000 oil
PLAN CHECK MIX -
101 000-42t}4*0
STA014a33eR0']ion Gausi'o, 101=,00Q -s.41 •40 -+;3R
AiJWO ku
5r A. o 'c
F 22 1j1U1
it "OF
S 168.11
_ IiNs Am -3
_.
i
MOO
TOTM,:P:L�;�urMOM 5 DUE NOW
$1.68AX
RECEIPT
DATE
BY
DATE FINALED
INSPECTOR
.y
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
Exhaust Fans
O. K. to Wrap
F.A.U.
Framing
'Insulation
Compressor
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
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. 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:
V - • - - - i r � - * .V- , v.,, 1 o N is -o,^ p 1SecA-5 E
CONnUT"" 14r Lvkf Ne -&L, P2/ceJ v,P o2 /1C1Po r7 A % oo . PF -IL % o /3 �✓R�+rJis
AF-OU-tS T cprykc� d Com— A-kz.[ h /ba /or rG.,G�-�
Bin #
City Of La Quinta
Building S Safery Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinra, CA 92253 - (760) 777-7012
in
Buildg Permit Application and Tracking Sheet
Permrr
—0!:>
�
Project Address: 5 7 — �jQr
�Ifer.c:;LL
Owner's Name: X MR!4
A. P. Number: W Z ^ 03/— O/
Address: X
Leeal Desorption:
Cin. ST. Zip: Y, �( 9225'@
Telephone: ,
Contractor: K
Address:
Project Descnpnon: X
Cin. ST. Zip: y t
cA. �uS3
G•.� C�'
Telephone: X '775 7"f-53
7rcxL
State Lic. #: X, 46 %
City Lic.;::
�+-F+egm Designer: P�DIU�j
Address: -6
City. ST. Zip:FAzkf
Telephone: 346 ` e 5r,--,
Construction Type: Occupancy:
State Lic. #:
Project hype (circle one) Ne%% Add'n Alter Repair Demo
Sq. Ft.: '216r Stones: r Q Units
Name of Contact Person: x
�
Telephone = of Contact Person: X .___ %C% 3 3
Estimated Value of Protect: X
Z,710
APPLICANT: DO NOT WRITE BELOW THIS LINE
a
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted
-7/6/0 7—
Amount
Structural Cities.
Reviewed. read• for corrections
/rQy Plan Check Deposit
Truss Calcs.
aX
Called Contact� c�rson �
o4��j/0'. Plan Check Balance
Title 24 Calcs.
Plans picked up
U Z Construction
Mechanical
aAlllectrical
lumbing
S I I
Grading
Developer Impact Fee
Flood plain plan
Plans resubmitted r
Grading plan
:" Review. readv for correctioTissue
Subcontactor List
Called Contact Person
Grant Deed
Plans picked up
H.O.A. Approval
Plans resubmitted
IN HOUSE:-
'^' Review. ready for corrections/issue
Planning Approval
Called Contact Person
A 1 P P
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees
V - • - - - i r � - * .V- , v.,, 1 o N is -o,^ p 1SecA-5 E
CONnUT"" 14r Lvkf Ne -&L, P2/ceJ v,P o2 /1C1Po r7 A % oo . PF -IL % o /3 �✓R�+rJis
AF-OU-tS T cprykc� d Com— A-kz.[ h /ba /or rG.,G�-�
Notice:
Document Cannot -Be Duplicated
Desert Sands ViAried School District
47-950 Dune Palms Road
La Quinta, CA 92253
760-771-8515
CERTIFICATE OF COMPLIANCE
Date 2/21/02 APN# 762-031-017
No. 22975 Jurisdiction La Quinta
Owner NameGeorge and Nancy Burnett "Permit #0202-054.
No. 57-301 Street Merton Lag #
city La Quinta Zip •92253 Study Area•
Tract # Lot # Square Footage 215 s.f.
Type of Development Residential Addition . _ No. of Units 1
r Comments
golf cart addition to garage/carport
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
.k •
EXEMPT
This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of t
0.00 X 215 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 exempt: Donna Ricketson/Bob Edwards Const. Telephone 760/775-7933
Name on the check •'
By Dr. Doris Wilson
Superintendent
Fee collected /exempted by Crystal Scott Exempt $0Am, V
ry Check*No. -
Sign -at
ure
L
IOTICE: Pursuant to 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
Feb 21 02 11:19a BOB EDW.ARDS-CONSTRUTION 760 775 9093 p.2
110141RCH FAX NO. 7607765112 Feb. 20 2002 01:45PM P1,
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
PO. BOX 1292, LA QUINTA, CA 92253
PGA
cc (760) 776-5100 FAX (760) 776-5111
t T.
Janrn)ary 20, 2002
Mr. & Mrs. Burnett
57-301. Merion
La Quinta, CA 92253
Reference: Architectural Change Request - Addition of Golf Cart Garage
Dear Mr. & Mrs. Surrhett:
The Architectural Committee W)an;mouS;y approved your plans far the installation or a gc?f cart, garete.
Please reference page 5 of the Architectural Rules, that state: "ir,.7onies ariginaily built witih sectioma! ro;:
up garage doors, the golf cart garage door must be a sectional roll .i<p. In hornes with one-pies.e ;%up
garage doors, garage and got( cart garage doors may be replaced individual.y, If the owner choses, hitt a
sectional roll up door. In all• instances, the new and replacement doors must retain. as closely as passible
the,origahal design faSade. If you do not have a sectional roll up garage door and decide to repute it later,
the golf cart garage will need to be changed to match.
The color of the cart garage door must match the existing color the garage door and trim to °nairh exisdr,,;
structure. The the on the roof must match existing roof.
Reviety by the Committee is only for general confiirmance with the grthi[@!tt.riil is L+te
rm,wisibility of the owner to fully widerstana and ccnftrmh to t;k ,rcru;e:!tral Rues crl'e i<� !':I u!her ar -10t
all defy odes are thcted during review, It is aisc the ownees hili rns ,c-,6- b9 y too Feld verify at' yi-sling
conditions. The C:anmittee's decision with regard in project oesign wiR be final. Pieese refer to die
Arrhitertural Rules and Applicatior, for Architectural Change for 2!! re.Tuirrr; Sub-mltials.
It appears as though the Lee :ha! is to re removed is net geirlg to be replaced. If is roplantFd PoO dies,
the homeowner wili be resporslbic for replacing the tree.
Please contact )avier Contreras, supervsor for Valley Garrienlnq Service at 760/39* --!844 and Carol Folls.,
the Association Manager, prior W any irriyatlon modilkawns assn-nirted xvie! :ilii charge. DampgF: to the
lantkceping, i.P_., S'n'ubs: trees, flowers Mill turf is W.- responsibil"y of it -e caniractor. i:?e 1211dsC-2.Wg
must be. brought back to its oricinal condition when tthe project is corrpieted.
Approva5 given by the Ar&.!tectural Committee are gond for only sac ntont!* frcen the date. on
approval letter. After that time a Mw application rest be sutm:itted.
upon completion of your project, please cOmli!M and return The 'Notice of Completion of :ArcNtr-c!k,-r;i;
Change.
f you have ally additional questians or cencerrss, pleaso do not iiasb- to it) cr;nta !. C-arn! F Per, Asx cirri :r!
Manager, at 7601776-5100, Ext. 20.
Sincerely,
PGA WES i II RESIDENTIAL PSSOCIA T1;5I
Fur the Architectural Comrr.f;tee
Coroi Fuller
As;eciati�n Mar;d(�E:K .
cc' Board ()f Directors
Vii', fi;e
H
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
❑ REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY
❑ POST TENSIONED CONCRETE ❑ ASPHALTOTHER
O REINFORCED MASONRY ❑ FIRE PROOFING
D X
JOB LO _z = o
��t�oN A �,�t,
REPORT SEQUENCE NO.
TYPE- _ T - TIME^—"---
V
P.MIT NO.
D,pd� D AY OF WEEK a
`
MATERIAL DESCRIPTION
.
ARCHITECT
I-r/e HRS. CHARGED
a
•-
ENGINE q. C
ASSISTANTS HRS. CHARGED
INSPECTION-
DATE
-
--GENERALL 1 l SUB•
CONTRACTOR V G�r CONTRACTOR
US K
r`
i
COPY SENT TO CLIENT O
CONTINUED ON XT PAGE O
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT 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.
GTUR OF -R7>14EREME OR/
DA OF REP TV REGISTER NUMRF'RRO
V 6 •{1'