0006-160 (AR)4
- !
m7000,1 of Divisi6n 3 of the Business and
' i��bm��oo�d�«oo�
. —_-- __-' ~
uvm�e# ~ u�o�o � Exp. Date
4.`r'�
. w95/58 09130/2(
.�
Date Signature mContractor
OWNER -BUILDER DECLARATION
|ho exem - pt from the
License Law f6(, , the following reason:
%A,- tis. owner ofithe property, or my employees with wages as their sole
coWpensaiion, will do the work, and the structure is not intended or offered for
sale� �Se*c.. 7044, Business & Professionals Code).
( ) 1, as 6wner of'the property, am exclusively contracting with licensed
contractors to construct the project (S4c. 7044, Business & Professionals
Code).-�.^
( ) / am ox?mp . unuo SvononoupC. for this reaoon_________
Date Signatureof'Owner
WORKER'S COMPENSATION DECLARATION
| xonuDy affirm under penalty of perjury one of the following declarations:
()| have and will maintain ocertificate o/consent mself-insure for workers'
oomponaoUon, as provided for by Section 3700 o/ the Labor Code, for the
performance o/the work for which this permit iuissued.
and will maintain workers' compensation insurance, marequired uy
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. my wn,mam' compensation insurance carrier u policy no. are:
Camo Policy No. - ClAJ�KNDC8NHAT[�� T%A081398
(This section noou not uocompleted ifthe permit valuation iofor $1oo.000,|000
( ) | certify that inthe performance o(the work for which this permit ioissued,
| shall not employ any person in any manner soaombecome subject mthe
workers' compensation laws o/California, and agree that i, | should become
subject tO.the workers' compensation provisions of Section 3700 of the Labor
Date: Applicant 1p�/
Warning: Failure to secure Workers' Compensation coverage is unlawful and
Shall subject an employer to criminal penalties and civ , III fines up to $100,000, in
addition mthe cost o,compensation, damages aaprovided for in Ga000? 3700
of the Labor Code, interest and attorney's fees.
IMPORTANT xnpnovuion is xoeuy made tothe Director of Building and Safety
,o, a permit subject to the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made m each person at
whose request and for whose benefit work ivperformed under o,pursuant m
any permit ioevou as result ofthis oppUnamnagrees to, a o»on. indemnify
&oo|d harmless the City ofLuOuinta. its officers, agents and employees.
c. Any permit ioovod as a result of this application becomes nun and void if
wn,x is not commenced within 180 days from uouo o, issuance of such
- po,mit, or cessation n,work for 180 days will subject permit oocancellation.
|oemfy that | have read this application and state that the above information is
correct. | agree tocomply with all City, and State laws relating tothe building
oonotruction, and hereby authorize representatives of this City to onua, upon
the above-mentioned property for inspectidn purl6oses,
Signature (Owner/Agent)oauo�-���-���
DATb L_U-ATION LOT TRACT
21381;3- V
JOB SITE APN
ADDRESS 55-687 PFT1MJR.Yr 77-5-241-060
OWNER CONTRACTOR DESIGNER EN61NEER
Wm
58~687gIJMIQIW
LAQ8WA CA 92253
IW.BAYD8N CO. .
7516 O0 T,C3BAJ0I%7 9 M A UT, 3TI8W I
IAL"DC0WC CA 92211
(760)341~8227 CBIO 4512 `|
USE OF PERMIT
CUSTOM CONSTRUCTION 1,582.00 up
PORCWPAXTO 199.60 SF
0ARAGEICARPORT (W)
.
�E0OOWW= COST OF CONYnWC-017014
.
129,929.40
10U~000~418~000
PULN CHECK FEE
181'000439-818
FEW DEPOSIT
101`000~439^318
440V.0*
l01'008~421 -W&}
101~000-420~008
1701
PLUMBINO FEE
101'008~419-080
O0
.
'
STRONG MOTION RE'MUD
101~000-241~000
812.09
{BRADQND F��
181'80&'423'008
*30.00
�B-TONAL AND PLAN CHkM%'
LEN PRE'PAMBU
'
1 VIAL FF-ROW1 1V FUS -DUE NOW
�nsusIPr |o^r
DATE FINALIED
wapsoron - '
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
rj
Exhaust Fans
O.K. to Wrap
,4%
F.A.U.
Framing
Compressor
Insulation
d
Vents
Fireplace P.L.
Grills
:FireplaceT.O.
Fans & Controls
.'Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
Drywall - Int. Lath
Final
Final a/
BLOCKWALL APPROVALS
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
/
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APP R VALS
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
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 614 4.
Utility Notice (Perm) �qrlzla AK
COMMENTS:
P.O. BOX 1504 APPLICATION ONLY
Building _ 6� GQ / � 11 (V� �'I LA QUINTA8-495 CCCALIFORNIA 92253
Address
D R, J:"ll�'� '" r V �- /� I,�f \ BUILDING: TYPE'CONST. Vr�/ " ( OCC. GRP. P - v
MailinAddress 5 - 6 �,� P� � 4 �rt' ��� -7-7 5 C � l rD
A.P. Number
City Zi Tel. A, p
L�. Legal Description .O�i ~�� q�(p
Contract gr , ,� ! , � Project
Descriptions��'� B `��U� A-4- A 46 (Y N to
Address c�/�
City Jzip I Tel
State Lic.I City
& Classif. Lic. #
Arch., Engr., C.' p� -� fir} ' C�� �p
De�sti_gn/er /y(�/4Q�
7ddress `T)��jQ T Tel. ® �f�0 4
State
p toCiy 1. `i 1 o e—sm d Ip 2 2(g fl Lic. #��. 2ro j
LICENSED CONTRACTOR'S DECLARATION -.
I hereby affirm that I am licensed'under provisions of Chapter 9 (commencing with Section
7000) of Division 3 of the Business and Professions Code, and my license is in full force and
effect.
SIGNATURE DATE
OWNER -BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Business and Professions Code: Any city or county which requires a
permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile 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 five hundred dollars ($500).
as oner of the property, or my employees with wages as their sole compensation, will
do tI, he work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Piolessions 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 employees,
provided that such 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 did not build or improve for the purpose of sale.)
f 1 I, as owner of the properly, 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.)
1-1 1 am exempt under Sec.�B. & P.C. for this reason
Date Owner
WORKERS' COMPENSATION DECLARATION
Ihereby affirm that I have a certificate of consent to self -insure, or a certificate of
Worker's Compensation Insurance, or a certified copy thereof. (Sec. 3800, Labor Code.)
Policy No. Company
n Copy is filed with the city. ❑ Certified copy is hereby furnished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars ($100) valuation
or less.)
I certify that in the performance of lhp 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.
Date Owner
NOTICE TO APPLICANT: If, alter making this Certificate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
Ihereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, Civil Code.)
Lender's Name
Lender's Address
This is a building permit when properly filled out, signed and validated, and is subject to
expiration if work thereunder issuspendedfor 180 days.
I certify that I have read this application and state that the above information is correct.
1 agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives sof this city to enter the above.
mentioned property for inspection purposes.
Signature of aVPlicant Date
Mailing Address
City, State, Zip
Sq. Ft. J 0 2 No. l No. Dw. /
Size ( C` Stories Units 1
New ❑ Add)< Alter ❑ Repair ❑ Demolition ❑
Estimated Valuation
PERMIT AMOUNT
Plan Chk. Dep. ,
Plan Chk. Bal.
Const.
Mech.
Electrical
Plumbing
S.M.I.
Grading
Driveway Enc.
Infrastructure
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:
t
WHITE = FINANCE YELLOW = APPLICANT PINK = BUILDING DIVISION
pesert SandsUn'ified School District,
47-950.�Diti'ne Palms Road'
Notice: La- dhiti-,XA 92253
Document Cannot Be -D0pljqAt&d,
CER FHCOMPLI-ANCE
Date 6/15/00 APN# 775-241-060
No. 20554 Jurisdiction La Qujnt4
Owner NameMr. & Mr. Blumenthal Permit #0006 -160 -
No, 55-687 Street Pinehurst Log,#
City La Quinta -Zip 92253, Study Area
Tract# 21381-3 Lot # I Square Footage 1582
Type of Development Single Family Residence No. of Units
Comments
At the present time, the Desert;SandsUnified School. .District.*'does not collect fees'on - garage's/carports, covered
patios/walkways, residential additions und&2'5 00 square feet, -detached accessoryssostructi66s, ' or -mobilelidimes. It
has been determined the above-named owneils.exem`pk,7-6mi paying �' sichQ'Iees ai�.ihis time e due to the follow -mg reason
VM- Mff ION -,',,NOT, APPLICABLE
4,
This certifies that school facility.fees imposed pursuint to !Governnientcod 090 in the amount of
2.05 X 1,582 or $.3,243.10 the property listed above aiid . that I building
permits and/or Certificates of Occupancy for this. squarejoo;a9e m,this,orop66d project may now be issued
Fees Paid By CC/First Community; Bank/Mike Russo 760
TelOph6iie -250-9010
Ninielen,the check
By Dr. Doris Wilson
Superintendent -
Fee collected /exempted by .Mary Ann L. Borja Payment Received
243.1-0-
,
Check No.; :.095336
Signature
L U
collect
NO,nc,E.,. Pursuant of Assembly Bill 3081 (CHAP., W,PTAM'1996).this will serve to notify may protest the fees or other payment identified
above will begin to run frorri the. date on'which thb'building or Installation permit for this project 1sessuedlor on whi6h the, y are paid the Districts) or to another public entity authorized to
co" am on the Districq's)(s'-)'bet affi,whichover is 6artler. •i.A;
Collector: Attach -a -copy of county 6rclty,plan check application form".4o- district ciioy:ki-ill waivers.
Copi
Accounting
. '
Embossed Original-: Building Dept/Applicant copy - Apptican4ie►pt
Jun= -13-00 08:23 Andrzej Weber Architect 760 340 9502 P.02
's Y"
PGA WEST:
RESIOENTIAIaASSOCIAT ON; INC:
June 12, 2000
Jack Blumen aI
2550 Thelma
Tearhind, TX 7758.1
RE: 55-687 Pinehurst
Dear Mt. Rlu enthal:
Mr. Don Adol h, Arciutectural'Committee (;harrpecson, has approved the room addition at your 55=i,
,.
587 Pinehtus residence. Please note that ail extenor concreie:flat work; `a sand pad`and plastic
,.
rnembane m s -t be installed. iJpon e�mplettuu please'submiYthe enclosed Notice of Completion
to this office.
We reserve t e right to make a final inspeettbn of this change to make sure that it -matches the
original request. An apPnwal is bled. only un the "aesthetica of,your prpposed plan. and should not
be taken'as anj certification as to.the construction wortMh6tor str ictural.integrity of the proposed
change.
We ;appreciate your cooperation in subn fitting. this fequest for approval. If I may be of further
assistance, ple ase con act me at -the HOA ollke (760),77.1=1234, eztensiul 15.
Sincerely, ;
&c.Gall4ard
Operations Minager,
cc: Architectural Committee
Enclosure
P.O. Box 1060, La Quinta, California 92253,Te1ephone 760-T/1-1234 FAX 760-771-5125
CITY OF LA QUINTA
PLAN CHECK CORRECTION -LIST
June'13, 2000
Jack Blumenthal
55-687 Pinehurst, PGA West
La Quinta, CA 92253
PLAN CHECK NO.: 004-059 FINAL CHECK
JOB ADDRESS: 55-687 Pinehurst, PGA West OCCUPANCY: R-3
AREA-S.F.- : 1582(R)/184(U) . TYPE -OF -CONST.: V -N
The submitted plans and specifications have beenreviewed byVANDORPE CHOU ASSOCIATES . It is
our professional opinion that the'plans are in substantial, conformance with the building codes and
regulations adopted by the CITY OF LA QUINTAand°the State of California Amendment.
APPROVAL FOR A BUILDING PERMIT IS HEREBY RECOMMENDED SUBJECT TO OBTAINING
APPROVALS/CLEARANCES FROM ALL APPLICABLE CITY DEPARTMENTS, AGENCIES, AND
ASSOCIATIONS.
Plans checked by:
Peter Knowlton
VANDORPE CHOU:ASSOCIATES.
295 N Rampart Street, Suite A
Orange CA 92868
(714) 978-9780, VCA File No. LQ -11892
1
A
-t a ON TANDY
37630 Medjool k}Ave.
ye Palm;. Desert, CA '92211
-Office (760) 772-7192
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• Fax' (760) 772-7193
- - " Pager (760), 776-3338
REGISTERED INSPECTOR'S, WEEKLY REPORT .`�
TYPE Of•*�
..• .,
❑ REINFORCEOCONCRETE,� 1"❑,STRUCT STEELASSEMBLY ❑
'
INSPECTION,
.04POST TENSIONED CONCRETE . ' `❑,ASPHALT '
❑ OTHER I
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'❑ REI NFORCED'MASONRY } a{ ❑ FIRE PROOFING ..
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gEPORT.SEOUENCE N0.
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MATERIAL DESCRIPTION
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CERTIFICATION'OF;COMPLIANCE �" e, 1 i'•
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I HEREBY: CERTIFY_ THAT I HAVE INSPECTED TO THE,BEST OF MY, IG REiOF REGISTERED I PECTOR {
KNOWLEDGE'ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK•TO COMPLY WITH THE APPROVED43 07) � b %�C¢�,q
PLANS. SPECIFICATIONS. AND 'APPLICABLE SECTIONS OF THE + F
GOVERNING; BUILDING LAWS. ^ ".r' E� OFt REPORT REGISTER NUMBER
w
JON TANDY
37630,,Medjool Ave.
Palm Desert; CA 92211
• ti;; ,,,
Office, (760) '772-7192
SPECIAL • 'Fal '(760) .772-7193
{. r ,_.., - , . • .. ... Pager • (760) 776-3338
)P -REGISTERED INSPECTOR'S•WEEKLY'REPORT1 -a E,
TYPE OF, @
❑, REINFORCED CONCRETE,' .❑•STRUCT.'-STEEL ASSEMBLY; ❑
INSPECTION' ' s ., t
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PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT.I HAVE INSPECTED TO THE BEST OF MY IGNATU OF REGISTERED INSPECTOR
i KNOWLEDGE,ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE E ^
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS.' AND APPLICABLE SECTIONS OF 'THE,
GOVERNING BUILDING LAWS' 3 „' DA E OF'REPORT REGISTER NUMBER
REGISTERED INSPECTOR'S WEEKLY REPORT
JON TANDY
37630 Medjool Ave.
Palm Desert, CA 92211
Office (760) 772-7192
Fax (760) 772-7193
Pager (760) 776-3338
TYPE OF
INSPECTION
PERFORMED
O. REINFORCED CONCRETE ❑ STRUCT. STEEL ASSEMBLY --o— C/.l BX y
O POST TENSIONED CONCRETE O ASPHALT O OTHER
O REINFORCED MASONRY O FIRE PROOFING
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TYPE OF STRUCTURE
PERMIT NODATE
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DAY OF WEEK
MATERIAL DESCRIPTION
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PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS QTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE AIPPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
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\J DATE OF REPORT REGISTER NUMBER
' JON .ANDY.
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37630.. Medjool Ave.
` Y Palm Desert,'CA 92211
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TYPE OF _
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'
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PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY. CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY SIGN URE ' REGISTERED INSPECTOR
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THIS WORK TO COMPLY WITH THE APPROVED < �0370
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
OF'R PORT REGISTER NUMBER
GOVERNING BUILDING LAWS. DA •� •'« s �
REGISTERED INSPECTOR,'S WEEKLY REPORT
J,ON TANDY
37630 Medjool Ave.
Palmi 'Desert, CA 92211
I •
Office .(760) 772-7192
Fax (760) 772-7193
Pager - (760) 776-3338
i
TYPE OF760
INSPECTION
PERFORMED
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POST TENSIONED CONCRETE ❑ ASPHALT ❑ OTHER
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JOB LOCATION 55../�� / �
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REPORT SEQUENCE NO.
TYPE OF STRUCTURE ''
SF 61 -c-0 4-lNQ ?GA- WEST
PERMIT NO. - '.
DATE /�
DAY•OF WEEK
MATERIAL DESCRIPTION
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CONTINUED ON NEXT PAGE ❑
PAGE OF
CERTIFICATION OF COMPLIANCE
I HEREBY CERTIFY THAT I HAVE INSPECTED TO THE BEST OF MY
KNOWLEDGE ALL OF THE ABOVE REPORTED WORK UNLESS OTHERWISE
NOTED. I HAVE FOUND THISWORK TO COMPLY WITH THE APPROVED
PLANS. SPECIFICATIONS. AND APPLICABLE SECTIONS OF THE
GOVERNING BUILDING LAWS.
4
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