9705-097 (AR)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Gbiapter 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
621156 13 W3G 7
ate / 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
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.
229-9640=60
(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 sh9uld become
iiisubject to the workers' compensation pro 'sions of Section 3700 of the,Labor
Code, I shall forthwith comply with those p •ovisions.
Applicant
r
Warning: Failure to secure Workers' Compen ation 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 Safetyt
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
t e above-mentioned propertysfor inspection purpose'.
signature (Owner/Age . t) �/' Dater"A'/ *' '
V
BUILDING PERMIT PERMIT t/ CONTROL#
970.9-097 5141
DATE- 7 LOT - TRACT
q1:74117
- 20 ����11 (.0L) JOB SITE
ADDRESS %�P�I
/ �
APN_16I — A ((Pt — O411
OWNER
CONTRACTOR/DESIGNER/ENGINEER
fZON NE,IISC.N
1.NIHORIITC 0NSTI U,rc:7If,)N
79.720 NOItl'RWOOD
54705 AVE. CARP.JVq&k
1'fA (JUIN I' CA 922.53 •
LA QUIN FA (-A 92253
(760)W-1274 Citi,# 2968
USE OF PERMIT
AI11A
tLvvNi AL011 iON
t3S"l', 1i i'OAt i't?:Ij4,".4'IO:N W3.00 SF
FW1'1MATED C,OS ' OF CONST RU 1110N
34„509.70
M+ AN 04E"X P%E 1,03-M0439-318 �2l i.11g
r0?q1t°f'I2I y7 fON T' I.Y., IM -000-41841100 Sz 170)
hH.4'11Ai41CAL 17M1 1 $13.00
t [,l;C•MICAL KE 101-000-420-000 VW.51
t'r,t iMi31tvc� [ 1•- ; 101-0010-419-0(T() S19"S0
°3'F'c)NG MOTION FI TS - RPSTO 1111 O[Ni-^41-(ITI�j $1.45
:dRi11:f',dQ RU 1A.t-0�•/123-rJf)0 S2t1.tf0
�p
2. •)('TAi1F +1T-hT. CONS'y 'td
.
$ I gf
& LESS PRE -PAID ITES
$0 00 ..
MAY 2 9 1997 PE Rn111•i' GE94
$61.1.51
TOTAL F)P , NOW
RECEIPT
DATE
BY.-
DATE FINAL ED
INSPECTOR
t
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 f /07
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 kX
Drywall - Int. Lath
Final
Final
POOLS - SPAS
BLOCKWALL APPROV LS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final 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)
Desert Sands Unified School District
Notice: .82-879 Highway 111
Document Cannot Be Duplicated Indio, CA 92201619-775-3500
CERTIFICATE OF COMPLIANCE
Date 5/21/97 APN # 761-461-049
No. 15560 Jurisdiction La Quinta
Owner Name Ron Nelson Permit #
No. 79720 Street Northwood Log #
City La Quinta zip 92253 Study Area 106
Tract # Lot # Square Footage 443
Type of Development Residential Addition No. of Units 1
Comments
;xtention to dining room
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 facility fees imposed pursuant to Government Code 53080 in the amount of
0.00 X 443 or $ 0.00 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 n/a- " X'
Telephone 564-127;4
Name on the check t q.
un
By Dr. Carol McGrew ra=,
Administrator in Charge it gar.
Fee collected /exempted by Pauline Pearson Exempt $0.00
Check No. n/a
Signature , 1 29 ALAA-CXK-
40TICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1996) this will serve to notify you that the 90 -day approval period in which you may protest the fees or other payment identified
above will begin to run from the dale on which the building or installation permit for this project is sssued or on which they are paid to the District(s) or to another public entity authorized to
.1lect them on the District('s)(s') behalf, whichever is earlier.
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
5
PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
PGA WEST. - (619) 776-5100 FAx (619) 776-5111
May 28, 1997
Ronald Nelson
4881 Del Monte Road
La Canada, CA 91011
RE: PGA WEST 11 Residential Association
Architectural Variance - Room. Addition / 79 720 Northwood
Dear Mr. Nelson:
Thank you for your submittal of plans on the above -referenced residence regarding a room
addition. After careful consideration we have decided to waive the requirement that you
provide a detailed landscape plan In relation to your room addition as the area of landscape
and scope of work required is minimal. Therefore your room addition is approved with the
following condition:
1. General contractor must coordinate any changes to the association irrigation with Miguel
Valenzuela, Valley Gardening Services (399-1844).
Thank you for your submittal; and should you have any questions, please do not hesitate to
contact me or my assistant, John Monahan, at 776-5100.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
...John H. Handel, Association Manager
cc: Don Troy, Chairman
Board of Directors
John Monahan, Assistant Manager
Unit File
�. PGA WEST II RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
PGA WEST _ (619) 776-5100 FAX(619)776-5111
April 29, 1997
Ronald Nelson _
4881 Del Monte Road -
tLa Canada, CA 91011 _
RE: PGA WEST II Residential Association
Architectural Variance - Room Addition / 79 720 Northwood
Dear Mr. Nelson:
Thank you for your submittal of plans on the above-referenced residence regarding a room
addition. Please be advised that the Architectural Committee of RGA WEST II Residential
Association, iry conjunction with the Board of Directors, has approved your plans with the
following conditions-.:",
1) Need a landscape 'plaii. "
2) General contractor must coordinate any changes to the association irrigation with
Miguel Valenzuela, Valley Gardening Services (399-1844).
Thank you for your submittal, and should you have any questions, please do not hesitate to
contact me or my assistant, John Monahan,-at 776-5-100.
Sincerely,
PGA WEST II RESIDENTIAL ASSOCIATION - =
For the Architectural Committee
By: ---
John H. Handei, Assoc inion. Manager
cc: Don Troy, Chairni3ri y-
Board of Directors -
]uhr, Monahan, Assistant Managerv
Unit Ftie