DEMO (0004-170)LICENSED CONTRACTOR DECLARATION
c11_ here7taffirm 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
c a C21 0513112(
Date,1Signature of Contractor p
''
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).
( ) 1, 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 CLAREWDON NS, Cf Policy No. 02KROD16040
(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 shall forthwith comply with those provisionsr''', L
Date:i�/�i��'1r„r: Applicant `\ r tl S i .v. ) t :.
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 hereby authorize representatives of this City to enter upon
the above-mentioned property for inspection purposes. %
Signature (Owner/Agent) %' �' �� '” S Date
BUILDING PERMIT PERMIT
//// JF
DATE
1� VALUATION LOT � 4110 TRACT
t
JOB SITE
APN
ADDRESS 79 's MMOM
OWNER
CONTRACTOR / DESIGNER / ENGINEER
ROB .' 1~I':URY
DFMO TJNMMM, INC.
79,i955I�MTON
81150 AVE 50 ...a a
1A QiibTrA CA 92253
INDIO C 92267
(7600)773.5884 - 3;f1 1-546
USE OF PERMIT
DEM01MON
t's'
DEMOLITION OF IXISTMO POOL AND DECKIN3 0 ONLY
VALUATION 15,000.00 LS
XS3.:J11lMAMD COST OF CONStTc0'C.f,'iON
75,(300.(10
PMW,V M SUN04l RY
DEM0.161TJON FBE 101.000-423-000 $45.00
OT.TB I OT,AL COMMUCTIOV AND PLAN MCK
$45.00
LE33 PRE -PAM MS
$0,00
TOTAL A r.ft ff Sr�VX l D"U: iso W
%1
RECEIPT
DATE
-BY( r/ ',i
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
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
POOLS -SPAS
BLOCKWALL APPROV S
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)
March 28, 2000
Mr. & Mrs. Robert Feury
15 Union Avenue
Rutherford, N.J. 07070-1273
Reference: 79-985 Merion
Architectural and Landscaping Changes -
Addition of Pool, Spa, BBQ, Outdoor Fireplace, Landscaping
Dear Mr. & Mrs. Feury:
TU Landscape Committee and the Condominium Architectural Committee reviewed the resubmittal of
your drawings tq instalLa_pool,=spa, BBQ, outdoor fireplace and landscaping and wish to advise that your
plans, as revised on March 15, 2000, have been approved
Please contact Raphael Villareal, supervisor for Valley Gardening Service, at 760/399-1844 and Carol
Fuller, the Association Manager, prior to any irrigation modifications associated with this change. Upon
completion of changes, please contact Carol Fuller. Damage to the landscaping, i.e., shrubs, trees, flowers
and turf is the responsibility of the contractor. The landscaping must be brought back to its original
condition when the project is completed
Approvals given by the Architectural Committee are good for only six months from the date on the
approval letter. After that time a new application must be submitted
In the meantime, if you have any questions, please feel free to contact Carol Fuller, Association Manager,
at 76on76-5100. Ext. 20.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
t
For the Condominium Architectural Committee
ti
Carol Fuller .
Association Manager
/clf
cc: Board of Director
Unit File
C�OpC7
I•' OWNER -BUILDER DECLARATION
I heieby'affirm that I amtexempt from the Contra6orSs License Law. for the following
Estimated Valuation "
-'reason: (Sec. 7031:5,Busine'ss and Professions Code:iAny 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.
a
- PERMIT:% .
• 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 or 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 -
- _
Plan Chk. Bal.. .,
Const:
•"
Mech.
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
�5 3j 3BR,:
or Improvemenl-_ 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.)
•• Plumbing
❑ I; as•ow�nei.of the property, am exclusively contracting with licensed contractors to con-
struct the' projecC (Sec. 7044, Business and Professions Code: The Contractor's License Law
does'not apply -.to an'owner of property who builds of improves thereon, and who contracts for
P.O. BOX 1504
N o . 08469
Building
Address
;r
J �� LIQ
'� ;'
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
Owner
e e
WORKERS' COMPENSATION DECLARATION
I hereby affirm that,I have a certificate of consent I.o self -insure, or a certificate of '
• Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
R a t . PUB
a , 1
Policy No. Com an '
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. -
Mailing
`m
• .
Front Setback from Cbntef Line
BUILDING: TYPE CONSTr.-_-
OCC:.GRP.- -
Address • ,,
,w te
n A.P. Number kA -WEST
- TRACT #25499-3
City .
Zip
-rer. 7.
Side Setback from, Property. Line -
Lender's Name
ER��, .�
lContractor
Legal Description
FINAL DATE,
INSPECTOR'
This is a building permit when properly filled out, signed and validated, and is subject to
Project Description PHM
3P 41 im IS . ER
NATIONAL ®
M
Issued by:
Date Permit
Address
construction, and hereby authorize representatives sof this city -to enter the -above-.
mentioned property for inspection purposes.
i. ,Validated by:
Signature of applicant Date
City
Zip
Mailing Address
'' Validation;
City, State, Zip
State Lic.
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;
& Classif.
ric�t�t 2p
813
Lic. #
Sq. Ft. No.
No. Dw.
6
Size:. Stories
Units
Arch.; Engr.,
New ❑ Add ❑ Alter ❑ Repair ❑ Demolition:❑ -
Designer
Address
'
Tel
r,a�
'
,
' City
Zip
State
'
Lic. #
" J
' .ice-.,
' LICENSED CONTRACTOR'S
DECLARATION
hereby affi�ni that I am licensed under,,'provisions.of Chapter 9 (commencing with Section'
7000) of Division 3 -of the Business Professions
- and Code, and my license isrin full force and
• effect,01_``�
..�.) �' �r-•�r
_
,
..F
.-
„"E. .s . Y!-• ti...�..�'..">.�` '�'. fi f /•r., it v'i
•, IGNATUREy 1�1%• Yi : /`•^ i DN1E
I•' OWNER -BUILDER DECLARATION
I heieby'affirm that I amtexempt from the Contra6orSs License Law. for the following
Estimated Valuation "
-'reason: (Sec. 7031:5,Busine'ss and Professions Code:iAny 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.
a
- PERMIT:% .
• 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 or 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 -
- _
Plan Chk. Bal.. .,
Const:
•"
Mech.
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
Electrical <-
or Improvemenl-_ 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.)
•• Plumbing
❑ I; as•ow�nei.of the property, am exclusively contracting with licensed contractors to con-
struct the' projecC (Sec. 7044, Business and Professions Code: The Contractor's License Law
does'not apply -.to an'owner of property who builds of improves thereon, and who contracts for
,
S•M,I•
such'projects. with at contractor(s) licensed pursuant to the Contractor.'s License Law.) -
❑ I am exempt under Sec. B. & P.C. for this reason
'Grading
Driveway Enc.
Date Owner
Infrastructure
Date ,Owner
98
e e
WORKERS' COMPENSATION DECLARATION
I hereby affirm that,I have a certificate of consent I.o self -insure, or a certificate of '
• Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
R a t . PUB
a , 1
Policy No. Com an '
subject to the Workers' Compensation provisions of the Labor Code, you.must forthwith
AMOUNT1v 919
• P Y
❑ Copy is filed.witti the city. ❑ Certified copy is hereby furnished.
_ •,i,
TOTAL
CERTIFICATE OF EXEMPTION FROMREMARKS
•
WORKERS' COMPENSATION INSURANCE
_ (This section need not be completed if the permit is for one hundred dollars ($100) valuation
-
- - - •• • - -
or less.)y�
I certify- that in the performance of thg work for which this permit is issued, I shall not-;,.,.}
„KP.> n'f"6E..•,� y.. 14.
'employ any person in any manner so as to become subject to the Workers' Compensation -
•- -
;, e+taass W •as+.. .� ,+.
tt J.
Laws of California.
Date ,Owner
NOTICE TO APPLICANT. -,If, after -making this Certificate of Exemption you should become .
ZONE:
BY: -
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. -
-
• .
Front Setback from Cbntef Line
Rear Setback ftom Rear Prop. Line - '
CONSTRUCTION LENDING AGENCY
Side Street Setback from Center Line
. 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.) .
'
Side Setback from, Property. Line -
Lender's Name
Lender's Address
FINAL DATE,
INSPECTOR'
This is a building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 180 days.
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
construction, and hereby authorize representatives sof this city -to enter the -above-.
mentioned property for inspection purposes.
i. ,Validated by:
Signature of applicant Date
s
Mailing Address
'' Validation;
City, State, Zip
r
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CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
2ND FL. SQ. FT.
POR. SQ. FT. ®
GAR. SQ. FT. ®
CAR P. SQ. FT.
WALL SO. FT. ®
SQ 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
GAS (ROUGH)
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
OTHER APPIEQUIP.
LAUNDRY TRAY
AIR HANDLING UNIT CFM
TEMP. POLE
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
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SQ. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
SQ.FT.GAR @ V4c
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 PLUMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH)
METER LOOP
HEATING (FINAL)
OTHER APPIEQUIP.
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.
FRAMING
FINAL INSP.
ROOFING
REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
OCC.
FENCE FINAL
INSPECTOR'S SIGNATURES/INITIALS
GARDEN WALL FINAL