11-0991 (PLBG)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, CALIFORNIA 92253
T4'!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MATZKIN EARL R
79322 LIGA
LA QUINTA, CA 92253
Contractor: r
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/14/11
Applicant: Architect or Engineer: TOPMAN BUILDERS IN-
P.O.
N•P.O. BOX 10202 � ?0l1qq1
PALM DESERT, CA 9 25
(760)497-7654 Cl
LiC. No.: 455121 ryQ� ��
pI�u X F�rwe!tB,�rl%� — A
--------------------------------—-------—---—----------------—-----------—--------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Businesd Professionals Code, and my License is in full force and effect.
License lass: B C29 C53 License No.: 455121
/Date ntractor:
OWNER-BUI ER DECLARATION _
I hereby affirm under penalty of perjury that I am exempt from a Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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).:
(_ 1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law,).
( ) I am exempt under Sec. - , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 and pulicy number are:
Carrier EXEMPT Policy Number EXEMPT
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
1 3700 of theJeebol Code,q%kall forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPE TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND VIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS f$1 00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 app ication and state that he above information is correct. I agree to comply with all
city d county ordinances an state laws relating to bui ing construction, and hereby authorize representatives
o isVounttt to enter upo the above-mentioned Went( r inspection purposes.
(Applicant or Agent):
Application Number:.
11-000 0 0991 .
Property Address: _
79322 LIGA
APN:
772-130-051- -
Application description:
PLUMBING
Property Zoning:
LOW DENSITY RESIDENTIAL
Application valuation:
1000
T4'!t 4 4 Q"
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
Owner:
MATZKIN EARL R
79322 LIGA
LA QUINTA, CA 92253
Contractor: r
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Date: 9/14/11
Applicant: Architect or Engineer: TOPMAN BUILDERS IN-
P.O.
N•P.O. BOX 10202 � ?0l1qq1
PALM DESERT, CA 9 25
(760)497-7654 Cl
LiC. No.: 455121 ryQ� ��
pI�u X F�rwe!tB,�rl%� — A
--------------------------------—-------—---—----------------—-----------—--------------
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of the Businesd Professionals Code, and my License is in full force and effect.
License lass: B C29 C53 License No.: 455121
/Date ntractor:
OWNER-BUI ER DECLARATION _
I hereby affirm under penalty of perjury that I am exempt from a Contractor's State License Law for the
following reason (Sec. 7031.5, Business and Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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).:
(_ 1 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 and Professions Code: The
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she did not build or
improve for the purpose of sale.).
(_ 1 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed
pursuant to the Contractors' State License Law,).
( ) I am exempt under Sec. - , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name:
Lender's Address:
LQPERMIT
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 and pulicy number are:
Carrier EXEMPT Policy Number EXEMPT
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
1 3700 of theJeebol Code,q%kall forthwith comply with those provisions.
WARNING: FAILURE TO SECURE WORKERS' COMPE TION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND VIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS f$1 00,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. _
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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 app ication and state that he above information is correct. I agree to comply with all
city d county ordinances an state laws relating to bui ing construction, and hereby authorize representatives
o isVounttt to enter upo the above-mentioned Went( r inspection purposes.
(Applicant or Agent):
Application Number . . . . . 11-00000991
Permit . . . .PLUMBING
Additional desc .
Permit Fee . . . . 18.00 Plan Check Fee
4.50
Issue Date . . . . Valuation . . .
. 0
Expiration Date 3/12/12
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
3.00
----------------------------------------------------------------------------
Special Notes and Comments
RUN 40 L.F. 1" GAS LINE & 40 L.F.
ELECTRICAL FOR PRE -FAB BBQ HOOK-UP. 2010
CODES.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 18.00 .00 .00
18.00
Plan Check Total 4.50 .00 .00
4.50
Other Fee Total 1.00 .00 .00
1.00
Grand Total 23.50 .00 .00
23.50
LQPERMIT
v
CIRUS
COURSE HOMEOWNERS ASSOCIATION
NOTICE OF APPROVAL
Earl & Elaine Matzkin
5855 Teal Lane
Long Grove IL 60047
RE: 79322 Liga ,
Dear Earl & Elaine Matzkin:
July 05, 2011
Your Request for an architectural change has been approved. Specifically, you have approval to proceed with the following:
Request to remove grass and concrete and install pavers as replacement. Installl barbeque within an entertainment island.
Install a firepit within hardscape landscaping. Please keep materials to spec as submitted; adhere to layout of proposed gas
line placement and drainage plan.
We reserve the right to make a final inspection of the change to make sure it matches the Request you submitted for Approval. Please
follow the plan you submitted or submit an additional Request form if you cannot follow the original plan.
Your approval is conditional with the stipulation of the following:
You must follow all local building codes and setback requirements when making this change. A Building Permit may be needed. This
can be applied for at the City offices.
Our approval here is only based on the aesthetics of your proposed change. This approval should not be taken as any certification as to
the construction worthiness or structural integrity of the change you propose. If applicable, please be aware that you are responsible
for contacting the appropriate utility companies before digging.
Thank you for submitting your application and we look forward to receiving your notice of completion upon commencement of
completed work. For your convenience a "notice of completion" document has been attached. 4
We appreciate your cooperation in submitting this Request for Approval. An attractive Community helps all of us get the full value
from our homes when we decide to sell.
Sincerely,
Citrus Course HOA
Encl. 1
P.O Box 12920 Palm Desert, CA 92255 ' 41-865 Boardwalk, Suite 101, Palm Desert, CA 92255
760.346.9000 ' FAX 760.346.9997 ' www.citruscoursehoa.com
Bin '# , .... .:. .. .
.. City of La n[lII1l.Q •
�C
Building a Safety Division .
Box. 1504, 78-495 Calle Tampico ;
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #P.O.
nn \
Project Address: `7 3 ag g.
Owner's Name:
/ z K/ IV
A. P. Number:
Address: 7 9 3 0?{J! r4
Legal Description:
City, ST, Zip:
Contractor:,
RYie R 2 C'Y
e*°w^i::.>*''
.> .r :..
Telephone: rn .. ..::
Address: 336 e�- I eyes nLr
Project Description:
City, ST, Zip:? JIL W n � a_fr C/fi 221 l
C
C lJ�
Telephone6O ta ?- 7654
s
An •• /
State Lic.
City Lic. tE:
Arch., Engr., Designer:
/t
Address:
City, ST, Zip:
Telephone:rv " M� �'v� . �' .
State Lic. #: ->`>?ccf •: 'k _:k?x
Name of Contact Person: 10t9 -vg ,
Construction Type: Occupancy:
Project circle one): New Add'n Alter Repair Demo
Sq. Ft.:
# Stories:
# Units:
Telephone # of Contact Person :760 9 7- 76Sc
Estimated Value of Project: *1000
APPLICANT: DO NOT WRITE BELOW THIS LINE
# I
Submittal
Req'd
Recd
TRACKING PERMIT FEES
Plan Sets
Plan Check submitted Item Amount
Structural Cala.
Reviewed, ready for corrections Plan Check Deposit
Truss Cale s.
Called Contact Person Plan Check Balance
Title 24 Calcs.
Plans picked up Construction
Flood plain plan
Pians resubmitted Mechanical
Grading plan
2"' Review, ready for correctionmissue Electrical
Subcontactor List
Called Contact Person Plumbing
Grant Deed
Plans picked up S.M.I.
H.O.A. Approval
Plaits resubmitted Grading
IN HOUSE:-
Review, ready for correctionstissue Developer Impact Fee
Planning Approval
Called Contact Person A.I.P.P.
Pub. Wks. Appr
Date of permit issue
School Fees
Total Permit Fees