0108-070 (AR)LICENSED CONTRACTOR DECLARATION
I 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 # _ Lic. Class Exp. Date
Date %! �r'ff Signature ofContractorr,.af (`
"`- 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 co6struct 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.
?"IFI 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.
B,3at9i� JAS iC:�, i4gC?�kt3'1'7'"1!!�
(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 should become
subject t?, the workers' compensa lion•provision's of Section 3700 of the Labor
Code; I� shall forthwith comply with,those'provislons..
„aDate:,%..'s i1C(. Applicant { .�k,.
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil�fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees. r�
IMPORTANT Application.is hereby made to the Director of Building and Safety
for a permit subject to the conditions and restrictions set forth on his
application. f
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result.of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby' authorize representatives of this City to'enter upon
the above-mentioned property•for,,inspection purposes. /
�7
- .Signature,,.(:Owner/Ag`ent) �''# "'y� Dateta`/�
BUILDING PERMIT PERMIT #
DATE / ,pt VALUATION LOT 0108„0'0 TRACT
i cd/ ifA;4i3 A 2RIA?
JOB SITE APN
ADDRESS
Zv 8CN d 6±e'!k'7'6` S'iE�1['l4YlT EPICS' T! FP `7^1Q.' 11 i)G1 S't�9 e
OWNER CONTRACTOR / DESIGNER / ENGINEER
. C3t t �'' �y�Cp�ry.�:�yf?�!(M7"a7�fiy� cBy(Q�3lk":+1�1�r,'��[3+i�,�:l�:�:a$p�y��'01��7SIUii�"'�;�ON
55314 iGJ U1J..U:�f3.S.`R. AJ.A.S,NZ 99- .iii✓ S' d,L'+!+��C'3.1!'.i.'�6NE,
LA QVTN':f'A CA 92 1�A, Q1JDTTA C.� �2�5
USE OF PERMIT
S.F. =10J*,,.t':7SK R.O0'M ADDITION ION TO M«+'PMI MASTER BEDROOM
OUSTOM CONSTRUCTION 270.90 8F
E 91=XDM MST OF COTTSMal7•�:'1f 014
21 ,3300
NMI 01109 PER
M-000-439-318
2160A
CONSTRUMION FUZ
101 -000-418-000
$3215.00
XLEC RICAU, FRE
'101-000-420-000
!424,0
"',PrwN^a£s9anm trexr..�I�,�.fD
'ioi-000-m.,i-aaA
RECEIPT I DA) / I BY I DATE FINALED INSPECTOR
12.43
17,A3
INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
i Underground Ducts
Forms & Footings
p
Ducts
Slab Grade
_
�! ��
Return Air
Steel
Roof Deck
O.K. to Wrap
Framing
Insulation
Fireplace P.L.
_
/ / /J _
(� _ / (�
�/
Combustion Air
Exhaust Fans
s F.A.U.
f Compressor
Vents
Grills
`
Fireplace T.O.
Fans & Controls
`
Party Wall Insulation
Condensate Lines
Party Wall Firewall _
Exterior Lath �2/y�/
Drywall - Int. Lath
��—/21, 1, /tOG 6
/p
Final
BLOCKWALL APPROVALS
Final
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final I
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
l fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
:Bin #
60��� City of La Quin
Building 8r Safety Division Y
P.O. Box 1504, 78-495 Calle Tampico
La Quinta, CA 92253 - (760) 777-7012
Building Permit Application and Tracking Sheet
Permit #
Project Address
Owner's Name:
A. P. Number: �, 5 – l – 2.�
Address: ' rj tj
Legal Description: Lar 7 �R *Hot Re V71/008
Contractor':����j r .'os.
City, ST, Zip:
Telephone:
Address:
Project Description:
City. ST, Zip:
Telephone:
hone:
—
State Lic. # } City Lic. #:
i
Arch.. 'Engr., Designer:
t �
�5.ADID t t D
Address:
City. ST, Zip: H �t o G� , �/ Z Z 0/
Telephone, 2 � 7
State ic.
Name of Contact Person: % %/ ��A!54A :f' /'G.
n
Co strut '
tion Type: Occu ant ••
YP P
Pro1ect type (circle cle on e . New�Add'
n Alter Repair Demo
emo
F
Sq..Ftn # Stories: _7# Units.'
Telephone # of Contact Person:. 2 — ?8
Estimated Value of Project:
APPLICANT: DO NOT WRITE BELOW THIS LINE
#
Submittal
Req'd
Recd
TRACKING
PERMIT FEES
Plan Sets
Plan Check submitted
Item
Amount
Structural Calcs.
Qi
Reviewed, ready for corrections
Plan Check Deposit
Truss Calcs.
Called Contact Person
Plan Check Balance
Title 24 Calcs.
'J/ _
Plans picked up
Construction
Flood plain plan
Plans resubmitted
Mechanical
Grading plan
2"" Review, readv for corrections/issue
Electrical
Subcontactor List
Called Contact Person
Plumbing
Grant Deed
Plans picked up
S,M1I 1
H.O.A. Approval
2
Plans resubmitted
Grading
I
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
Total Permit Fees
�.
' Desert Sands Unified School District
47-950 Dune Palms Road
Notice: La Quinta, CA 92253
Document. Cannot Be Duplicated 760-771-8515:
CERTIFICATE OF COMPLIANCE `
Date 9/14/01 - APN# 774-190-021
No. 22501)'Jurisdiction, La Quinta
i
' Owner NameJohn & Carol Pollis ''' Permit # 0108-070
No. 55-514 Street Southern Hills 'Log #
City La Quinta zip 92253 Study Area
'Tract # 28149 Lot # 74' Square Footage ` 270
Type of Development Residential Addition No. of Units ' 1
Comments
At the present i time, the Desert Sands Unified School District does not collect fee's 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: -
" Y-.
Residential Addition 500• Sq Feet or Less
{ EXEMPT ,
-This certifies that school facility -fees imposed`pursuant to, Government Code 53080 in the,ainount of
0.00 'X 'X270 or $ 0.00 ' p the property listed,above and ilik building
permits and/or Certificates of Occupancy for this square footage.in this proposed. project may now be ssued-
Fees Paid By EXEMPT - Bob EdwardsTelephone '-760-7.75-7933'
Name on the check
By. Dr. Doris Wilson
Superintendent
Fee collected /exempted by Annette Barlow Exempt - $0.00
�,��� `Check No.
Si nature VVVLat.C� /- '
NOTICE: Pursuant of Assembly Bill 3081 (CHAP 549, STATS. 1998) 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 date 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
collect 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 r
r•
PGA WEST 11 RESIDENTIAL ASSOCIATION, INC.
P.O. BOX 1282, LA QUINTA, CA 92253
(760) 776-5100 FAX;(760) 776-511.1
John and Carol Pollis
55-514 Southern Hills
La Quinta, CA 92253 h
Reference: Architectural Request to Extend Master Bedroom,
Dear Mr. & Mrs. Pollis:
:..._.. _ pp_ . . plans y _. .p y - -
-`T1►e Architectural Committee has . reviewed our. plans to extend our master bedroom at its lune 120
meetingand unanimouslyapproved our as submitted.
Review by the Committee is only for general conformance with the architectural guidelines. It is the
responsibility of the owner, to fully understand and conform to the architectural guidelines criteria whether
or not all deficiencies are noted during review. It is also the owner's full responsibility to field verify all
existing conditions. The Comnuttee's decision with regard to project design will be final. Please refer to
the Architectural Rules for all required submittals.
Please contact Raphael Villareal, supervisor for Valley Gardening Service at 760/399-1844, and Carol
Fuller, the Association Manager, prior to any irrigation modifications associated with this change. Upon
completion of changes, please contact Carol.Fuller. Damage to the landscaping, i.e., shrubs, trees, flowers
and turf is the responsibility of the contractor. The landscaping must be brought back to its original
condition when the project- is completed.
Approvals given by the Architectural Committee are good for only six months'frorn the date on the
approval letter. After that time a new application must be submitted.
Upon completion of your project, please complete and return The Notice of Completion of Architectural
Change.
If you have any additional questions or concerns, please do not hesitate to contact Carol Fuller, Association
Manager, at 760/776-5100, Ext. 20.
Sincerely,'
PGA -WEST II RESIDENTIAL ASSOCIATION
For the Architectural Committee
Carol Fuller
Association Manager
cc: Board of Directors
Unit File
5
.COMPUTER METHOD SUMMARY
'project Title....:..... -- Page=3C-2R
------
SWARTZ_POLLIS_E+A Date..07/20/01 12:48:27
MICROPAS6 v6.01 File-2007ORE2 Wth-CTZ15S92 Program -FORM C -2R
I-----__User#_MPO207--User_Madlin's Ehterprises' Run -REMODEL
- - /-DUCTLESS I
---------------------------- ----------------
FENESTRATION -SURFACES
Y.
Area U- Act Exterior
Orientation (sf) factor SHGC Azm Tilt Shade
------------------ ------ Location/Comments
1.ZONE - Existing ----- --- ---- -- ----------------=-----
1 Wind Back (N) 75.0 0.870 0.700
2 Wind Back (N') 0 90 Standard Metal Post 1978
80.0 0.8700.700 0 90 Standard Metal.Post 1978
3 Wind Left (W) 27.5 0.8.70 0.700 270 90 Standard Metal Post 1978
4 Wind Back 27.5 0.870 0.700p5 Wind Back �N�
N80.0 0.870 0.700 0 90 Standard Metal Post 1978
6 Wind Back (N) 27.5 0.870 90 Standard Metal POst,1978
0,700 0 90
7 Wind Right (E) 27.5 0.870 0,700 90 Standard Metal Post'1978
90 Standard Metal Post 1978
8 Wind Right (E) 40.0 0.870 0.700 90 90 Standard Metal Post 1978
9 Wind Right (E) 35.0 0.870 0.700 90 90 Standard Metal Post 1978
.0 Wind Front (S) 35.0 0.870 0.700 180 90 Standard Metal Post 1978
.1 Wind Right (E) 48.0 0.870 0.700 90 90., Standard Metal Post 1978
2 Wind Right (E) 20.0 0.870 0.700 90 90 Standard Metal Post 1978
3 Wind Left M. 8.0 0.870 0.700 270 90 Standard Metal Post 1978
4 Wind Left (W) 15.0.0.870 0.700 270 90 Standard Metal Post 1978
5 Wind Left (W) 15.0 0.870 0.700 270 90 Standard Metal Post 1978
6 Wind Left 5.3 0.870 0.700 270 90 Standard Metal: Post 1978
7 Wind Left WW 10.0 0.870 0.700 270 90 Standard
.ZONE - Existing Metal Post 1978
8 Wind Back (N) 96.0 0.870 0.700
.ZONE - New 0 90 Standard Metal Post 1978
9 Wind Right (E)/ 48,0 0.720 0-.730 90 90' Standard Metal Fixed
OVERHANGS AND SIDE FINS
---Window-- ------Overhan--------
-- Area LeftFin-,-, __7 ---Left ---Right Fin--
--face_- -(sf) Wdth ----- ---- ----Dpth Hght ExtExt
tg
Ext Dpth Hght Ext Dpth Hght
ZONE - New ---
'Window 48.0 6 8 20 .2 n - ---- ---- ---- ---- ---- ---- ,..
/a n/a n/a' n/a n/a n/a n/a n/a
SLAB SURFACES
----- --------
Slab Type Area
(sf)
------------ ___
1.ZONE
Standard Slab 2600
2 -ZONE
Standard.Slab 284-
f
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=METROSCAN PROPERTY PROFILE=
Riverside (CA)
ensus
ac
oc
OWNERSHIP INFORMATION
Parcel Number
_: 775 190 021. S: T: R :_ Q
Ref Parcel #
: 000,000 000 Pos Interest:
Owner Name
Pollis John G/Carol L
COOwneY
Site Address
: 55514 Southern His La Quinta 92253
Mail Address
; 55514` Southern His La Quinta Ca 92253
Telephone
: Owner : 760-564-1557 Tenant:
Book
:257
Page:8
SALES AND LOAN INFORMATION
Transferred
:12/05/1996 LoanAmount
Document #
:459547, Lender
Sale Price
Loan Type
Deed Type
: Grant Deed Interest Rate
% Owned
: 100 Vesting Type : Joint Tenant
AgPreserve
BathFull : 1
Units
Misclmpry
ASSESSMENT AND TAX INFORMATION
Land,
:$158,951- Exempt Type
Structure
: $304,476 ExemptAmount
Other
Tax Rate Area : 20-025
Total
: $463,427 00-01 Taxes :.$5,466.66
%Improved
:66"
PROPERTY DESCRIPTION
Map Grid
: "5530 C3
C
'r. t 456 01 Bl k 9
ensus
ac
oc
.
Land Use
: RO1 Res, Single
Family Residences
Legal
: LOT 74 NM 257/008 28149
Sub/Plat
: Tr 28149
Book
:257
Page:8
PROPERTY CHARACTERISTICS
Bedrooms :4
Stories
: 1 YearBuilt
: 1997
AgPreserve
BathFull : 1
Units
Misclmpry
: No
Bath3Qtr : 3
Bldg SgFt
:3,015, Street
: Paved
ADDITIONAL
BathHalf
Gar SgFt
:7-13 Waterf nt
"
Fireplce . : YesGar
Type
: Attached Elect Svc
: Undergrnd
RmAddtns : Yes .
Cntrl Ht : Yes
LotAcres
:.25 Gas Svc
: Developed
RmAddSF : 360
Cntr1AIC : Yes
Lot Sq'Ft
: 10,890 WaterSrce
: Developed
AddGarType :
Pool : Yes.
Roof -Type
: Tile SewerType
:.Developed
OthrPkng
Information compiled from various sources. Real Estate Solutions makes no representations
or warranties as to the accuracy or completeness ofinformation contained in
this report.
7 -800-345-7334
' SCAM IA 1M0 OF AN INCx
2
3
4
5
- —
-
- -- _- •
i ^7•,1 5 ,1. 9' -: - .
1NI5'YAP WAS PRFPA4E0 TOR ASSEY OFSSMENT PURPOSES 04lY NO LIA6ILITY
SHRI TE
- ALOCAL C101
-'
-
. PQR, SE 16 T, 6S. I R.7E• _
CITY OF LA QUINTA'
- T.R.A.
-
020-025
_-
>764-82. _
MAYNOTECONPLY'WITH -SPIV ORDATAENILOINC.SIOMINANCESL�
.
_
O
-
o
L-
- _
JUL 0 6 2000
'�-
- MB 214!53-57 TR NO 28176:
oil 01.0 WAM wn MUHN
li ! 1•II.i) 91 19.0
' ASSESSORS NAP. BK 175 PG 19
MB 275/8-15 TR NO 28149
MB 278/49-50 TR NO 29004
Jun 2000
s , il-u Is .
°° a 4",
I90 -0L9 -
Riverside County, Calif
of •19.110—b