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61
LICENSED CONTRACTOR 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 Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp. Date
,1ky y
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
rco'ntractors to construct the project (Sec. 7044, Business & Professionals
Code):` `
0 am exempt under Section , B&P.C. fof ihisrreasom
Date ) f � , 0` . Signature of OwneF N
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 XX&Mk'3" Policy No.
(This section need not be completed if the permit valuation is for $100.00 or less).
J<) I certify that in the performance of the work for which this permit is issued,
Ilshall 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 Sectio�i'3700 of the Labor
Code, I shall forthwith comply with those p�oyi'sio
V6ate:I Applicant—
Warning:
pplicant Warning: Failure to secure Workers,Vgompensation coverage is unlawful and
shall subject an employer to criminalpenalties 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)"•%»�qq°'�, C Date '•i`'"p�
j r t4 5
BUILDING PERMIT PERMIT#
DATE a VALUATION LOT 01.1 �t1 TRACT
JOB'SIfE 6
APN
ADDRESS, •h1�F 7 67iaK..fY+FYx
OWNER
CONTRACTOR/DESIGNER/ENGINEER
80T 2.0PNCON
TC TJHJ.,A CORSIRV'Cl7iaW WC
55..163 301M, M1..13
PO BOX 366
LA, Q'UJ R%'i'.€# CA 92251
LA Q TTA CA. 92253
(760)564.4832 Cs b 3237
1
USE OF PERMIT
70 Sir Jr Ft TIC+ .t+"A`i t}`NTf0N PF1t„ 1, Pk0V r 0 f..A 0 1 NZWItKD VANS
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€ ONS`j'RUC:TION W1 101-000.418-000 $21.7.00
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NOV 16 2001
�r
WYOFLA UINTA
FP1NANrR: X61: "
RECEIPT
DATE
AY
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 APPROVALS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Pibg. Test
Final I I
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)
W.
NQU-02 01 14:50 FROM:MATZEK & ASSOC., INC 7145469024 TO:760 771 5782 PAGE:02
i
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JEFFREY A. MAIZEK- ASSOCIATES, INC.
C04190116 PIA14196 OHI6t
ARCHI'TECT'S BULLETIN
PROJECT : PGA West - Lot 52 (Vanderbeek) ARCHITECT'S BULLETIN NO: ®1
(#0002PGA)
OWNER: Southern Hills Development DATE OF ISSUANCE: November 02, 2001
La Quinta, CA
TO: Southern Hilis Development DISTRIBUTION TO:
55395 Southern Hills X OWNER
La Quinta. CA 92253 X ARCHITECT
Al. -TN: John Read/J.i.m Avenell X CONTRACTOR
® FIELD
❑ OTHER
The Work shall be carried out in accordance with the following supplemental instructions issued
in accordance with the Contract Documents without change in Contract Sum or Contract Time.
Prior to proceeding in accordance with these instructions, indicate your acceptance. of these
instructions for, minor change to the Work as consistent with the Contract Documents and return
a copy to the Architect.
. Description: LOT 52 - VANDFRBEE.K RESIDENCE FAMILY ROOM PATIO EXTENSION
Extend Family Room Patio; 5'-1 l `/a" to the rear to align with existing column line at that
location. Add new 16" x 18" square column. at that location and extend patio cover at that area to
match existing structure. Sec attachments for more information.
151 KALMUS. DRIVE 0 SUITE 5-200 6 COSTA MESA ® CALIFORNIA 0 92626
PHONE: (714) 546-9335 FAX: (714) 546.6021
; HOAK & SHAH ASSOCIATES, Inc. SUN M ►T ePG
CONSULTING ENGINEERS LOT- 52BY /,A WQST JOB NO. 0 I -4
y r� Q
3920 E. CORONADO STREET, SUITE 203 —
ANAHEIM, CALIFORNIA 92807 fg[.A,.j 2_A g(J�E� �� . DATE V ";-1 t
PHONE: (714) 632-1865 FAX (714) 632-1314
PATI D CX'>"EIJS I O tJ SH_oF.—�
Q� i ESS/p/�� PAkTIAL F441-11 �6 f2 -'3/Z
� CZ a CITY OF LA Q U i NTA-�NSPEe�Io>v FES OF X30
No. C 0 6i 12 � BUILDING & SAFETY QEF tLANS
BE CHARGED IF THE APPROVED
3 0 AND JOB CARD ARE NOT ON
� * APPROVED-
R CONSTRUCTION SITE FOR A SCHEDULED
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HOAK & SHAH ASSOCIATES, Inc. gUH H I iG PCS A W ST JOB NO. O__
CONSULTING ENGINEERS
3920 E. CORONADO STREET, SUITE 203 LOT 52 - V,4 tJ r7 F -_R i5E GK BY ,G .'::5^!i
ANAHEIM, CALIFORNIA 92807 % 2 -,4 DATE I0 I el.
PHONE: (714) 632-1865 FAX: (714) 632-1314
_ - ® PA -T 10 CX T CoIJ 0, SH'b I OF 2
PAarlA L FOOdc)A -IOA) �i
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NDU-02 01 14:51 FROM:MATZEK 8 ASSOC., INC 7145468024 TO:760 771 5782 PAGE:04
CITY OF LA CSU I
BUILDING.& SAFETY DEPT.
APPROVED
-. FOR CONSTRUCTIO
n6 ROOF DRAIN ANO
QY OVERFLOW, REFP
CLASS 'A' BUILT UP ROOF � TO 18 DATE
'—
BY
TYP. AT ALL FLAT ROOF
AREAS SLOPE 3189 PER FOOT
TO DRAIN AS INDICATED ON 1
ROOF PLAN.
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DATE "�`•:''
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DATE,
"� WOZPCAA r1oV. Z 2001
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NOV-02 01 14:51 FROM:MATZEK 8 ASSOC., INC 7145468024
TO:760 771 5782 PAGE:05
CITY OF LA QUINTA
BUILDING& SAFETY Q.Nt.
APPROVE
FOR CONSTRUCT 10
DATE BY
LINO OF BUILT-UP J
ROOFING .AEYON0
,.
PARAPET WALL
-NOV-02 01 14:51 FROM:MATZEK & ASSOC., INC 714546e024 TO:760 771 5782 PAGE:06
CITY OF LA QUINTA
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& ASSOCIATES
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PROJECT NAME 1%
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.NOV-02 01 14:51 FROM:MATZEK & ASSOC., INC 7145468024 TO:760 771 5782 PAGE:07
CITY OF LA QUINTA
BUILDING & SAFETY DEPT.
APPROVED
FOR CONSTRUCTIO
A
9
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BUILT-UP RoOkNG
TOP OF WALL
PI.00R JOISTS
RP.l=eB TO FRAMIN6
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PARAPET WALL
BRAM. REFER TO
FRAMING PLAN
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21,112
A ENEWAI
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YOUNG ENGINEERING SERVICES
Engineering Architecture•Surveying• Building & Safety Services
Letter of Transmittal
To: City of La Quinta Date: 11/8/01
Project: PC# 0111-011 (1" check)
57-725 Black Diamond
Attn: Greg Butler W.O.:
Tel No.: Tract No.:
f We are forwarding: By Messenger By Mail X Your Pickup
No. of Copies Description:
1 Plans (City approved set)
1 Structural calculations (City approved set)
1 Supplemental plans (81/2x11 wet -signed)
Comments: Structural plans are approvable for patio extension.
This Material Sent for:
Your Files X Per Your Request
Your Review Approval
Checking At the request of:
Other
By: John W. Thompson
Phone # 760-342-9214
47-159 Youngs Lane, Indio, CA 92201 (760) 342-9214
Bronz Young