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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
65ell 20, ;53• 10/311°U
Date Signature of Contractor' ' =f / • •—
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:
Carrier Policy No.
STAIR FUND
(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 provisions.
Date: a: 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 applicaton agrees to, & shall, indemnify
& hold harmless the City of La Ouinta, 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)w_ / ' -' `^"' Date r
BUILDING PERMIT PERMIT#
DATE / VALUATION LOT1t�•( TRACT
�
i 1 r � !.
JOB SITE / _ •
APN
ADDRESS
c��o
3:4AS 13;FZC1i'1NDKXR PARK
-
OWNER
CONTRACTOR/DESIGNER/ENGINEER
7361 :3`&3MANA- A"i1 E
14-725 25 MM MUVu, 0A
RIVERSMI-AP, CA 92504
PIMM DWEIRT CA 92260
(760)"W-90(4 C'RU, 355
USE OF PERMIT
POOL ANDIM? PA.
POOL & SPAA £arra<'Y- ilARMN&1ARRIE uUALL BE IN PIAL hE.' ..AT PRE
PLAS TER, INSPECTIs' W,4'OOL EOU-O41F)IT Yk1CWY SKE 12 NOT MUtDED
IN 'I'H S IAX?fidt IT
POOT. •rA,T.JWOR ovPA tgO,)m Ls
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y�q?yy�y��x ye v�,�� �y'p y�y�,��ESTI
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P1..0 OHEICI. 'FAL 101
CONS7',RUIL"'i1014 iPRE 101.000-1'118-001 �ItsO.OQ
MF,C14et1.VICAIL FRE -- P0011. 101 -000-421 -010V $24100
f:.1,ECTRICA,L F&Y,, -. }BOOL 101-000-420-000 $450.00
P1,UM13t O FEE :- POOL 101--000.419.0,00 MOO
SUB-:t'trl`.AL COMYRY.DM)N ARD PIPS i.ITEM.
$393.00
LEE' R -RE -PAID MES
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pr+�$0.00
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RECEIPT
DATEBY
I I/" /"
"
I"
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE I
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
_
_/�/s/0
Footings
Main Drain
.Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
�J "-
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
Sewer Connection
Pool Cover
Encapsulation
Gas Piping
Gas Test
Appliances
Final
_
COMMENTS:
Final
Utiiity Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pofe
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 No (Perm)
Lyman & Joyce Eaton
9999 Hamilton Hills Lane
Fishers,_ Indiana 46038
Phone 317 590-3379
September 4, 2002
F A X
City Of L.aQuinta
Planning Department
Attn: DANNY
Re:_81645_Brown-Deer_Park
Dear Danny:
I am the owner of the above mentioned property at PGA West at the Norman
Course. I wanted to send you ttis note to let you know that we are going to use the
Golf Cart Garage as a utility roan only, If you have any questions I can be reached at
(317) 590-3379.
man Eaton
Z0 3!DVd df odg NOld3 V9066b8LZE 6Z :8Z Z00Z/90/60
INSULATION CERTIFICATE IC -1
C-81-645 BROWN.DEER PARK LA QUINTA
`— Number and Street City
Riverside 29347 1
County Tract No L her
Description of Installation
1 ROOF
Material
Thickness (inches)
2 CEILING
Batt or Blanket Tvoe BATT
Thickness (inches) 10
Loose Fill Type BLOWN INSULATION
Contractor's min installed weight square ft 0.485 Ib
Manufacturer's installed weight per square foot to achieve Thermal Resistance (R -Value) R-30
Brand Name •
Termal Resistance (R -Value)
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R-30
Brand CERTAINTEED
Minimum thickness 12 inches
3 EXTERIOR WALL
Frame Tvoe
A. Cavity Insulation
Material BATT
Thickness (inches) 61/4
B. Exterior Foam Sheathing
Material
Thickness (inches)
4 FLOOR OVER GARAGE AREA
Material
Thickness (inches)
5 SLAB FLOOR/PERIMETER
Material
Thickness (inches)
6 FOUNDATION WALL
Material
Thickness (inches)
Brand Name CERTAINTEED
Thermal Resistance (R -Value) R-19
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Brand Name
Thermal Resistance (R -Value)
Declaration
I hereby certify that the above insulation was installed in the building and the above location in conformance with the current
Energy Efficiency Standerds for residential buildings (Title 24, part 6, Califronia Code of Regulations) as indicated on the
Certificate of Complia e, where applicable.
2,3A 2/20/01 PARAGON INSULATION
Item #s ignature, to Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s
Signature, Date
Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Item #s Signature, Date Installing Subcontractor (Co. Name) OR
General Contract (Co. Name) OR Owner
Coachella Valley Unified School District
83-733 Avenue 55, Thermal, CA 92274
(760) 398-5909 — Fax (760) 398-1224
Project Name:
Owner's Name: . Richard & Diane Eaton
This Box For District Use Only
DEVELOPER FEES PAID
AREA:
AMOUNT
LEVEL ONE AMOUNT:
LEVEL TWO AMOUNT:
MITIGATION AMOUNT:
COMMAND. AMOUNT:
DATE:
RECEIPT:
CHECK #:
INITIALS:
CERTIFICATE OF COMPLIANCE
(California Education Code 17620)
Project Address: 81-645 Brown Deer Park, La Quinta, CA 92253
Project Description: Room Addition
APN: 767 330 040
Tract #:
Type of Development: Residential XX
Total Square Feet of Building Area:
Commercial
323
Date: April 30, 2003
Phone No. 760 964-1316
Lot #'s:
Industrial
Certification of Applicant/Owners: The person signing certifies that the above information is correct and makes this statement under
penalty of perjury and further represents that he/she is authorized to sign on behalf of the owner/developer.
Dated: Signature:
*********************************** *** ****************************
SCHOOL DISTRICT'S REQUIREMENTS FOR THE ABOVE PROJECT HAVE BEEN OR WILL BE SATISFIED IN
ACCORDANCE WITH ONE OF THE FOLLOWING: (CIRCLE ONE)
Education Code Gov. Code Project
17620 65995 Approval
Number of Sq.Ft. 323
Amount per Sq.Ft. $ 0.00
Amount Collected $ 0.00
Building Permit Application Completed: Yes/No
By: Carey M. Carlson, Asst. Supt., Business Services
Agreement Existing Not Subject to Fee
Prior to 1/1/87 Requirement
Note:
Pursuant to AB -181, Room Additions for 500 sq. ft. o� r less,
are exempt from developer fees
Certificate issued by: Marcela Valdez, Facilities Clerk Signature:
NOTICE OF 90 DAY PERIOD FOR PROTEST OF FEES AND STATEMENT OF FEES
Section 66020 of the Government Code asserted by Assembly Bill 3081, effective January 1, 1997, requires that this District provide (1) a wri en not a to the
project appellant, at the time of payment of school fees, mitigation payment or other exactions ("Fees"), of the 90 -day period to protest the i of these
Fees and (2) the amount of the fees. Therefore, in accordance with section 66020 of the Government code and other applicable law, this Notice shall serve to
advise you that the 90 -day protest period in regard to such Fees or the validity thereof, commences with the payment of the fees or performance of any other
requirements as described in section 66020 of the Government code. Additionally, the amount of the fees imposed is as herein set forth, whether payable at this
time or in whole or in part prior to issuance of a Certificate of Occupancy. As in the latter, the 90 days starts on the date hereof. This Certificate of
Compliance is valid for thirty (30) days from the date of issuance. Extension will be granted only for good cause, as determined by the School District, and up
to three (3) such extensions may be granted. At such time as this Certificate expires, if a building permit has not been issued for the project that is the subject
of this Certificate, the owner will be reimbursed all fees that were paid to obtain this Certificate of Compliance.
�lY':c,''mydoc idcalees%cirtiiicate oi'compliance ti)rm uiblec170 US. Edoc 1/16/03 T