9607-111 (AR)t ; LICENSED CONTRACTOR DECLARATION
IF 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 #ri' Lic. Class Exp. Date
.`(W343 B f0/31197
r�'� �'I
Dates Signature of Contractq "''
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. r
( ) 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
,I ria � Hf INIY 1)61-96-iR�+46
.permit is "Issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
(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;bmploy 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 prove o
Date:'-' /� Applicarit����_
Warning: Failure to secure Workers' Compensation coverag 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 cessationofwork 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, urposes.
Sianature (Owner/AaentDate
�..-BUILDING PERMIT PERMIT# CONTR/q�OL�#96074.11.
/9 }p�
7 Q $6.330,M)
DATE VALUATION LOT' TRACT ,
kilt)
JOB SITE
ADDRESS
OWNER
CONTRACTOR / DESIGNER / ENGINEER
t;1,'..RK & SON D'RA.1?ROW,E1..14
01-D PASHIO:N C RAYT'S&tA2+d `!NC.
aio t i Pmmi-wii
42-220 GREENWAY, SIE..F
LA QF.IRTITA C.A 92253
PALM Dr,-SHRT CA 9'2!241
t, 094771-2314
(619)773•-0019 CK -0 1.8417
USE OF PERMIT
1d1,�iiIJIwLV'.1'dl\l, A1.1.Lf!'l.'lf..,)h!
98 SO. FT. CUSTOM. REMODEL
1051TIMATED WYPOIT CONSTRUCTION N
6.330.84.1
6�t4;.@di�9 !'fi8f �1;1,� �1,1(3ril ib�iA fel'
P1,A.N (3,1F.,CK 17• W 101-00.4:39-3111 i:R13. 0
C*QN!1r1't2!!C11J(X4 FEE 101=000.418.0 $90:00
N{F*0 JAidICAd: F'EJ-7 [Vol -000.421-000 iiS.4(1
13J.,W"f'ttiCAL FEE-, 101-000-420-000 $18.43
ftrl'ONG ]Yi0TIQN kWE - RPSfI t01 -00(1 -241 -(WO S.63
St f1.3ITY1'A.L CU1NS't"1".1JC 1'10 N AND PLAN CHECK
$182.56
LE 1,355 PXV-PAID iPPIES,
D0 '1',.
$0.00
IA$r 6'1�;1dmn lfiriFF—'(4)€Jf1 NOW
SIRZ.56
AUG 06 1996
gy
RECEIPT
DATE
BY"
r �i�41,
DATE FINALED
INSPECTOR
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
09
Slab Grade 4 z -344e
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 A P OVALS
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
Lift Notice (Perm)
o,
-
July 3, 1996
Dr. mid,Mrs. Frowein
55-61' 1• Pinehurst
La Quinta, Ca: 92253:
Dear Dr. and Mrs. Frowein,
Mr. Don Adolph%has reviewed your architecturalrvananee.request to complete a;room addition at
your 55-61.1 Puieliurst residence.` Approval is granted providuig the .following stipulations.are
fulfilled.
1. All new stucco..shall match texture'.of exist 91stucca;.
2. New addition color shall match.existing house color .
.3. Contractor agrees to abide by all PGA West Residential Association,. Inc. Rules and
Regulations as`specified by our Codes, Covenants;,and Restrictions:
Thank you for your cooperation. If youhave any`questions please contact the HOA_ 77171234.
Sincerely,
KeliytcGalliar'd-
Busmiess.Manager
PGA West Residential Association, Inc.
P.O. Box 1060,.La Ouinta, California 92253;`Telephone_619-7:71-1234 FAX 619-771-5125
Desert; Sands Unif ed,School District
Notice: 82-879 Highway 1.11
Indio,. CA° 92201' .
Document Cannot.Be Duplicated. 619-775-3500
CERTIFICATE.OF COMPLIANCE
Date 8/5/96 APN # . 769-411-057
No. 14787 Jurisdiction La Quinta
r Dirk & Sondra Frowein
Owner Name Permit,#
No. 55-611 Street •Pinehurst Log #
City La Quinta Zip 92253 Study Area 106
Tract # Lot # Square Footage 98
Type of Development Residential- No. of Units
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:
Residential Addition 500 Sq. Feet or Less
EXEMPT
This certifies that school facilit Y =fees im p posed', ursuant to Government Code 53080
,. ._
in the amount of 0.00 X 9,8 4. or $6.00.
4
the property listed"above and;that building permifs and/or -Certificates of Occupancy for
this square footage inahis proposed project may now be issued.
Fees Paid By, ;4 Telephone 773=0019 .
Name on the check _
By Dr. Carol McGrew
Administrator in Charge
Fee collected /exempted by Ellen.Patino Exempt
Check No. N/A
Signature CXi
Collector: Attach a copy of county or`city plan check application; form to district•.copy for all waivers.
Embossed Original- Building Dept./Applicant Copy - Applicant/Receipt.. _ Copy - Accounting