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11018 (AR)T4ti�v 4 4 Q,9AM Buildin Address 55-8885 Congressional Owner Charles Shub n P.O. BOX 1504 78-105 CALLE ESTADO LA QUINTA, CALIFORNIA 92253 Address same as above City Zip Tel. L Quints: X2253 Contractor Soutf. Paint Construction Address 77-999 Wolf Rd Suite 102 CityZip Tel.: Bermuda Dunes x2241 345-5521 State Lic. City &Classif. 4477$93 Lic.# 1134 Arch:, Engr., Designeikit SChillle Address Tel. 164. Granada. 714/492-4867 CityZip State San Clemente 9 672.. Lic. # 3913 f LICENSED CONTRACTOR'S DECLARATION I hereby affirm thatill amliicensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3'of ttierBusiness and Professions Code, and my license is in full force and Jr OWNER -BUILDER DECLARATION I hereby affirm that (am exempt from theContractors License Law for the following reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires- a permit to constnrcl, after, improve, demolish, or repair any structure, prior to its issuance also requires the applicant for such pennft.to file a signed statement that he is licensed. pursuant to 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 subjects the applicant to a civil penalty of not more than Ove hundred dollars ($500). ❑ 1, 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 builds or improves thereon and who does such work .himself or through his. own enipfoyees, provided that such improvements are not intended or offered for sale. O, however, the -building or improvement is sold within one year of completion, the owner -builder wig have the burden of proving that he did not build or Improve for the purpose of sale.) ❑ I, as owner of the property, am exclusively contracting with licensed contractors to con- struct the project. (Sec. 7044, Business and Professions Code:. The Contractor's License Law does not apply to an owner of property *who builds or improves thereon, and who contracts for such projects with a contractor(s) licensed pursuant to the Contractor's License Law.) O 1 am exempt under Sec. B. & P.C. for this reason Date Owner i WORKERS' COMPENSATIONDECLARATION 1 hereby affirm that I have a certificate of consent to self -insure, or a certificate of Workers Compensation Insurance, or a certified copy thereof. (Sec.. 3800, Labor Code.) - Policy No. Company ❑ Copy is filed with the city. O Certified copy is hereby furnished. i CERTIFICATE OF EXEMPTION FROM WORKERS'COMPENSATIONINSURANCE or i ss.section need not be completed If the permit is for one -hundred dollars (E 100) valuation I certify that in the performance of thg work for'which this permit is issued, I shall note employ any person in any manner so'as to become subject to the Workers' Compensation Laws of California 1 r Date Owner '�+ NOTICE TO APPUCANT: O, aaking this 'Certificate of Exemption you should become subject to the Workers' Compensation' provislons 'of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. . CONSTRUCTION LENDING AGENCY 1hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued. (Sec. 3097, Civil Code.) Lenders Name Lender's Address This is a building permit when properly filled out, signed and validated, and is subject to expiration if work thereunder is suspended for 180 days. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives 'of this city to enter the above-. mentioned property for inspection purposes. Signature of applicant Date' Mailing Address City, State, Zip No. 11018 BUILDING: TYPE CONST. OCC. GRP.. A.P. Number Legal Description Project Description Room .hddition Sq. Ft. 575 Size - No. No. Dw. Stories Units New ❑ Add ❑ Alter O Repair ❑ -Demolition ❑ Estimated Valuation 42,550 -PERMIT AMOUNT Plan Chk. Dep. r Plan Chk. Bal. 239.85 Const. . 369.00 Mech:' =, 27.00 Electrical 35.10 Plumbing 41.00 S.M.I. 4.30 Grading Driveway Enc. Infrastructure .y ,tS? z.;ra? $. A�t�t►y , � 1_-92� F1 � .�� .L4 TOTAL REMARKS ZONE: BY: Minimum Setback Distances, Front Setback from Center Line Rear Setback from Rear Prop. Line Side Street Setback from Center Line Side Setback from. Property Line FINAL DATE INSPECTOR Issued by:. Date Permit Validated by: Validation: CONSTRUCTION ESTIMATE NO. ELECTRICAL FEES NO. PLUMBING FEES IST FL. SO. FT. ® $ UNITS ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK YARD SPKLR SYSTEM 2ND FL. SO. FT. DUCT WORK ROCKSTORAGE FOUND. REINF. MOBILEHOME SVC. BAR SINK POR. SO. FT. ® REINF. STEEL GAS (FINAL) TEMP. POLE GAR. SO. FT. ® POWER OUTLET ROOF DRAINS WATER HEATER SERVICE FINAL INSP. DRAINAGE PIPING CAR P. I SO. FT. WATER SYSTEM FINAL INS _ FINAL INSP. $ �J GRADING cu. yd. plus x$ WALL SO. FT. LUMBER GR. DRINKING FOUNTAIN. SO FT ® A p� ` �� �✓ / I _ V/ r)(� /\ URINAL ESTIMATED CONSTRUCTION VALUATION $ WATER PIPING NOTE: Not to be used as property tax valuation VENTILATION"�% FLOOR DRAIN MECHANICAL FEES FIRE ZONE ROOFING WATER SOFTENER VENT SYSTEM FAN EVAP.COOL HOOD SIGN WASHER(AUTO)(DISH) APPLIANCE DRYER GARBAGE DISPOSAL FURNACE UNIT WALL FLOOR SUSPENDED LAUNDRY TRAY AIR HANDLING UNIT CFM 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. SO. FT. ® c BATH TUB SO. FT. ® c WATER HEATER MAX. HEATER OUTPUT, B.T.U. SO. FT. RESID ® 11/4 c SEWAGE DISPOSAL SO.FT.GAR ® 3/ac HOUSE SEWER FENCE FINAL 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 ROUND PLUMBING 7-3 d UNDERGROUND A.C. UNIT COLL. AREA SLAB GRADE ROUGH PLUMB. BONDING HEATING (ROUGH) STORAGE TANK FORMS SEWER OR SEPTIC TANK OUGH WIRING. 7 /3 DUCT WORK ROCKSTORAGE FOUND. REINF. GAS (ROUGH) METER LOOP HEATING (FINAL) OTHER APP./EOUIP. REINF. STEEL GAS (FINAL) TEMP. POLE GROUT WATER HEATER SERVICE FINAL INSP. BOND BEAM WATER SYSTEM FINAL INS _ FINAL INSP. $ �J GRADING cu. yd. plus x$ $ LUMBER GR. /J AMING Le—ROOFING A p� ` �� �✓ / I _ V/ r)(� /\ REMARKS:�7/3 VENTILATION"�% FIRE ZONE ROOFING FIREPLACE SPARK ARRESTOR GAR. FIREWALL LATHING —a Z MESH SULATION/SOUND FINISH GRADING / FINAL INSPECTION CERT. OCC. FENCE FINAL INSPECTOR'S SIGNATURESIINITIALS GARDEN WALL FINAL ORI -em ARCHITECTURAL APPROVAL APPLICATION ALL CONSTRUCTION DEBRIS CREATED BY THIS MODIFICATION MUST BE REMOVED FROM THE COMPLEX DAILY POA WEV Fl=f k AiS C=N. INC. Date Homeowner Applicant Names) Address Telepho (PGA West) ( PGA West Address' �� `yyY/� �i�Of✓� L. Tract !2t 3 -Z t 15 Modification(s) Requested(2)�1QQ/t��J � �"jA-i%}f%(o'10,t/ Work Schedule Commencement Date v/ ) —1 ,'n/%� Completion Date " J COntrdCLOr (S) / l/Y V v -So (moi �5 TO THE ARCHITECTURAL COMMITTEE: -77— � ' )=F You are hereby advised that the above work is proposed and approval is requested. Attached is a drawing of the work to be done and types of materials to be used as indicated on the drawings. We understand that building permits for home improvements are required by the City of La Quinta and that the cost of the permits and responsibility of obtaining permits and subsequent inspection will be borne by the applicant. We 'acknowledge that -ail approved changes in the original design will be at our experse; that any and all damage to building structure, or other damage resulting from the construction of the proposed improvement shall be at our (owner's) expense. Additionally, any maintenance of the permitted improvements shall be at the applicant's expense and the applicant agrees to hold the PGA West Residential Association harmless for the cost of maintenance of same. Homeowner agrees to indemnify, defend and hold harmless PGA West Residential As3or.�ation, its officers,�(enTs and employees from any liability arising from execution of is application. Signatures o all owners Approved ARCHITECTURAL CONTROL COMMITTEE Conditionally Approved Disappr.ovPd Reason for Conditional Approval or Disapproval L��� U/6�-L �L'e� A-- P&A &J 2 �� ��' GRZ�S/GA . AcG �►-l-�o e.i Gt 6i �x�— ��0 2C r��c, Saar t� PAR?- ate y(,�LYj Signature ��� vG��g 1` �• Architectural Con of Committee Chairman In addition to this approval, you must obtain City approval for the requested modification as well as any other necessary building permits. You are required to submit evidence of the Association approval to obtain the building permit. For this purpose, all blueprints and pians will be embossed with the Association's seal, the signature of the Property �i Manager, and the date of the approval. Completed Work Signed off by Date DESERT SANDS UNIFIED SCHOOL DISTRICT 82-879 Highway 111 NOTICE: Indio, CA 92201 Document Cannot Be Duplicated (619) 347-8631 Date 6/11/92 Type of Permit I La Quinta No. F11473 Permit # Owner Name Charles Shubin Log # No. 55885 street Congressional City La Quinta zip 92253 Study Area 106 APN # I I Tract # Lot # Square Footage 1575 Type of Development Residential Addition No. of units 1� Comments 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: EXEMPTION NOT APPLICABLE This certifies that school facility fees imposed pursuant to Government Code 53080 in the amount of 1.58 X 575 or $ 908.50* have been paid to D.S.U.S.D. for 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 Private Label Marketing, Inc. Telephone ( Name on the check By James E. Lively Assistant Superintendent, Business Services Fee collected /exempted by Shellev D. Bennett Payment Recei�,edr Signature r iheck No. 7554 Collector: Attach a copy of county or city plan check application form to district `copy for all-pdivers. D(.cQ Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt Copy - Accounting