13-1016 (RPL)P.O. BOX 1504
78-495 CALLE TAMPICO
LA QUINTA, .CALIFORNIA 92.253
Application Number: -13-00001016
Property Address: 81100 SHINNECOCK HILLS
APN: 762-340-002-
- -
Application description: POOL - RESIDENTIAL
Property Zoning: LOW DENSITY
RESIDENTIAL
Application valuation: 40000
Ap icant:
Architect or Engineer:
4 "-
BUILDING & SAFETY DEPARTMENT
BUILDING PERMIT
VOICE (760) 777-7012
FAX (760) 777-7011
✓// INSPECTIONS (760) 777-7153
4
1 Owner:
KENNETH & KATHLEE
81100 SHINNECOCK S G
LA QUINTA, CA 92 Q
Contractor: / C/Ty
PREMIER OUTDOOR pIN�F�Q 1
77588 EL DUNA COURT, 4
PALM DESERT, CA 92211 T
(760)345-9791
Lia. No.: 963116
LICENSED CONTRACTOR'S DECLARATION
hereby affirm under penalty of per' ry_ at 1 am 1' ensed under provisions of Chapter 9 (commencing with
Section 7000) of Division 3 of th eusine s and ofessionals Code, and my License is in full force and effect.
Licensees Class: Ci53 License No.: 963116
tDate: tl �� �+ Contractor:
-BUILDER DECLARATION -
I hereby affirm under penalty of peVulh., I am exempt from the Contractor's State License Law for the
following reason (Sec. 7031.5, Buand Professions Code: Any city or county that requires a permit to
construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the
permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State
License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or
that he or she 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 (5500).:
(_) 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 and Professions Code: The.
Contractors' State License Law does not apply to an owner of property who builds or improves thereon,
and who does the work himself or herself through his or her own employees, provided that the
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 or she'did not build or
improve for the purpose of sale.).
(_ 1 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec.
7044, Business and Professions Code: The Contractors' State License Law'does not apply to an owner of
property who builds or improves thereon, and who contracts for the projects with a contractors) licensed
pursuant to the Contractors' State License Law.): ..
(._ 1 I am exempt under Sec. , B.&P.C. for this reason
Date: Owner:
CONSTRUCTION LENDING AGENCY '
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the
work for which this permit is issued (Sec. 3097, Civ. C.). '
Lender's Name:
Lender's Address:
LQPERMIT
Date
8/14/13
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 and policy number are:
Carrier CALIF INS Policy Number 4600301104
I certify that, in thepadQrmance o e work for which this permit is issued, I shall not employ any
person in any anner So
a subject to the workers' compensation laws of California,
and agree tha , if I shou be a bject to the workers' compensation provisions of Section
3700 of the L or Code I shall f hwith comply with those provisions.
Date 1� 1 ). Applicant:
WARNING: FAILURE TO SECURE KERS' MPENSATION COVERAGE IS UNLAWFUL, AND SHALL
SUBJECT AN EMPLOYER TO CRI I AL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND
DOLLARS ($100,000). IN ADDIT TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the
conditions and restrictions set forth on this 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 application,
the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City
of La Quinta, its officers, agents and employees for any act or omission related to the work being
performed under or following issuance of this permit.
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&,,d.
r cessation of work for 180 days will subject
permit to cancellation:
I certify that I have read this application and state thmation is correc agree to comply with all
city and county ordinances and state laws relating totion, and y authorize representatives
of this unty enter upon the above-mentioned prion p ses.
Date: Signature (Applicant or Agent):
Application Number . . . . . 13-00001016
Permit . . . ELECTRICAL 2013
Additional desc .
Permit Fee . . . . 23.83 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 2/09/14
Qty Unit Charge Per
Extension
1.00 23.8300 LS ELEC FIXTURES, FIRST 20
-----------------------------------------------------------------------------
23.83
Permit POOL 2013
Additional desc .
Permit Fee . . . . 178.75 Plan.Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date.. 2/09/14
Qty Unit Charge Per
Extension
1.00 178.7500 EA MISC POOL/SPA
--------------------------------------------------------- ------------------
178.75
Permit . . PLUMBING 2013
Additional desc .
Permit Fee . . . . 11.92 Plan Check Fee
.00
Issue Date . . . . Valuation . . .
. 0
Expiration Date 2/09/14
Qty Unit Charge Per
Extension
1.00 11.9200 LS PLBG GAS SYS, 1-4 OUTLETS
11.92
--------;--------------------------------------------------------------------
Special Notes and Comments
INSTALL POOL, SPA, BBQ WITH 150 L.F. OF
2 INCH GAS LINE. EQUIPMENT SHALL BE
INSTALLED•IN ACCORDANCE WITH
MANUFACTURER SPECIFICATIONS. ALARMS AND
BARRIERS REQUIRED TO BE INSTALLED AT
PRE -PLASTER INSPECTION. 2010 CALIFORNIA
BUILDING CODE.
----------=------=---------------------------.-------------------------------
Other Fees . . . . . . . . . BLDG STDS ADMIN (SB1473)
1.00
PLAN CHECK, POOL
97.24
Fee summary Charged Paid Credited
---------------------------------------------------------
Due
Permit Fee Total 214.50 .00 .00
214.50
Plan Check Total .00 .00 .00
.00
Other Fee Total 98.24 .00 .00
98.24
Grand Total 312.74 .00 .00
312.74
LQPERMIT
Bin #
City of La Quinta
Building 8r Safety Division
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit#
Project Address: — Q S 9iAI /S ,-6t Ie I-}'j L4S
Owner's Name: V5/y Lh(
A. P. Number:
Address: 9j Q (, 51 fi /V/v4 Q C[( HTLtS
Legal Descri an:
City, ST, Zip:
Contractor:
Telephone:
Address: �����b Vl Y C S j �, (%
L Q
Project Description:
City,sT,Zip: �� ��542i GA-���I�
6QL SPS
Tele �
hone:
P76 3 L 7
"Lie. '
'Em
� State Lic. # : ' C
City #.
Arch., Engr., Designer:
AUG 1-0
Address:
C17Y
City., ST, zip:UNITY
Q INTq
Telephone:
:::?«;:;::::;<:;:;#<:#:':::::
Construction Type: occupancy: T
P Y�
tate Lic. #:tYP
Pro'ect a circle one): New Add'n Alter Repair Demo
J
Name of Contact Person: rj 4
Sq. Ft.:
# Stories:
#Units:
Telephone #,of Contact Person: G % �r j
Estimated Value of Project: L� 0 666.
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Rec'd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
god Review, ready for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S.M.I.
H.O.A. Approval
Plans resubmitted
Grading
IN HOUSE:
'^' Review, ready for corrections/issue
Developer Impact Fee
Planning Approval Called Contact Person A.I.P.P.
Pub. Wks. Appr Date of permit issue
School Fees CITY I IIKI J%
BUILDING
Tot:
FOR CONSTRUCTION
EXHIBIT C
COARLiANCE REVIEW -REQUEST
Owners are urged to ' provide appropriate notice to the Architectural Committee as to the progress of the
construction, reconstruction or the alteration of 4inprovements particularly in the case of major construction,
reconstruction or alterations. Requests for compliance reviews should be made upon completion of the
approved installations. It is the Owner's specific responsibility to insure that all Improvements are completed in
strict compliance with the approved plans and specifications, governmental requirements, and Regulations
including but not limited to setbacks, elevations, grading, colors, and landscaping. Architectural Committee
compliance reviews are independent of governmental inspections. Committee approval does not constitute or -
eliminate the need for governmental inspections'.
TO: PGA WEST Fairways Association
P.O. BOX 1690
La Quinta, CA 92247
Attn: ARCHITECTURAL COMMITTEE
FAX: (760) 776-5111 -
NAME OF OWNER: '
PROPERTY ADDRESS:
MAILING ADDRESS:
TELEPHONE #:
Indicate below the Improvements that have been completed for which a request for inspection is being made
pursuant .to this request. A description of type of work that should be compfleted at each of the following stages
of the construction follows.
OWNER'S SIGNATURE: _
DATE:
Compliance Review Fee Schedule:
First Review Second Review Additional Reviews
Minor Application Included $25.00 $25.00
Moderate/Major Application r
Deposit of $500-$5,000 Included' $50.00 $100.00
Deposit of $5,001415,000 Included $50.00 $100.00
Deposit of $15,001 and over Included $50.00 $100.00
Architect Review • Actual Cost $-100.00 + $200.00 +.
Actual Cost - t Actual Cost
Exhibit "C" Page 1 of°1
A
PGA WEST
FAIRWAYS ASSOCIATION
August 7, 2013
Kenneth and Kathleen Black
4 Ladbrook Grove
Coto De Caza, CA -92679
Re: Architectural Application — 81100 Shinnecock Hills
Dear Homeowner:
The Architectural Committee has reviewed your request to remodel the pool, spa, deck and landscaping in
the rear yard of your residence. I am pleased to inform you that the Architectural Committee has
approved the application_ as submitted subject to the submittal of an accurate cost estimate for the total
project, an additional performance deposit, photos and description of the plants not on the approved plant
palette and the updated copy of your contractors' license and insurance information.
Enclosed is Exhibit C — the Compliance Review Request form. Please complete this form after the work
is completed and return it by mail or fax to the address below so the completed project can be inspected.
If you have any questions, please contact Cassie Gertz, Operations Manager at 760-776-5100 Ext. 345 or -
email Cassie.Gertz@ anagementtrust.com.
-Sincerely;
For the Architectural Committee
PIVA WEST Fairways Association
3 CCAM, PCAM
Exhibit C — Compliance Review Request
cc: Lot File
Architectural Committee
RECEIVED
AUG 1''2 2013
coih�j� OFL4 QUINT
NITy pEVECOPMENT
Post Office Box 1.690 - La Quinta, California 92247 - Phone (760) 776-5100 - Fax (760) 776-5.111
CITY OF LA QUI.NTA.
BUILDING & SAFETY DEPT.
..APPROVED
FOR CONSTRUCTION
DATd 13 BY 4-
15� �` 614s cfty